Keynote Presentations: Physiotherapy Volume 93 Supplement 1

Physiotherapy Volume 93 Supplement 1 S1
Keynote Presentations
Keynote Presentation Keynote Presentation

3473 Sunday 3 June 09:00 3485 Tuesday 5 June 09:00
VCEC, Exhibit Hall A VCEC, Exhibit Hall A
FROM PATIENT TO CITIZEN: IMPLICATIONS OF THE UN CAPITALIZING IN TIMES OF DIFFICULTY
INTERNATIONAL CONVENTION ON THE RIGHTS OF PERSONS Delitto A; Department of Physical Therapy, School of Health and
WITH DISABILITIES Rehabilitation Sciences, University of Pittsburgh, USA
Heumann J; President, Heumann & Associates, Washington DC, The $1 trillion U.S. health-care system has been described as the
USA modern-day equivalent of a medieval patchwork of fiefdoms, with
On March 30, 2007 the UN Convention on the Rights of Persons doctors, hospitals, and insurance companies allied to form local
power structures. Disparities and inequities still exist, outcomes vary
with Disabilities was opened for governments to sign and ratify. This
and treatments are not received equally. It is an industry that has
is a historic period for disabled people and all those who believe that
become a high-volume, low-margin business that is riddled with
disabled people have been denied equal opportunities. Equality and
inefficiencies, outrageous costs, and outmoded technology. With
dignity are central to the theme of the Disability Rights Movement.
health care now accounting for a record 16% of the nation’s gross
Effective implementation of this UN Convention will, for the first time in
domestic product, the system is under crippling financial pressure
history, ensure human rights for the more than 650 million disabled
as medical spending continues to skyrocket. I will argue that as
people around the world. Human rights protections will only occur physical therapists, we are in a unique position to become a major
when governments, DPOs, donors, and concerned organizations part of the solution to some of these problems. For example,
such as the World Confederation for Physical Therapy, actively musculoskeletal disorders are fast becoming one of the leading
collaborate to ensure that the spirit and intent of the Convention categories of costs for payers. In some instances, costs for low back
becomes a reality. pain alone are staggering. How guilty is our field with regard to some
of the ills described above (e.g., not delivering care consistent with
The last few decades witnessed the rise of organizations run by and
evidence-based guidelines or inordinate treatment variability) and,
for disabled people. They saw that the broader society, including more importantly, how much could be saved if we were to change our
the helping professions, were not focusing on removing barriers behavior with regard to an evidence-based approach? I will attempt
that were limiting their ability to participate as equal members of to answer some of these questions using data from our own health
their community. From the poorest to the richest countries, disabled plan in a small-scale initiative. Our field’s contribution to the health
people have been organizing to create voices that enable them to care dilemma we face in every country can only be realized if we
be empowered, participating citizens. Like other movements before face the problems and perform to our highest capabilities. If we take
the absence of the voices of the effected group result in a belief that on this challenge, our place in health care will be very secure.
people are not capable.
Non-disabled people looked to the helping professions as the Keynote Presentation

disability experts. Yet, for all their professional strengths and skills, 3476 Wednesday 6 June 09:00
these experts had little direct experience fighting for the human rights VCEC, Exhibit Hall A
disabled people were really striving for, the same rights afforded CRANIOVERTEBRAL–CRANIOMANDIBULAR DISORDERS IN
to others, but denied to them. Exclusion resulted in the denial HEADACHE PATIENTS
of opportunities in education, employment, housing, health care, Rocabado M; Universidad Andres Bello Facultad de Ciencias de
rehabilitation, the right to free travel, to marry, to have and raise la Rehabilitación. Santiago, Chile
children, etc. People see disabled people as poor and have little
belief that the state of poverty is not because they have a disability “If I wished to show a student the difficulties of practice, I should give
but rather because of the denial of equal opportunity. him a headache to treat.” “Si yo quisiera demostrarle a un alumno
las dificultades de la práctica clı́nica le darı́a una cefalea para tratar.”
People in the helping professions, need to learn how to work with (Oliver Wendell Holmes).
DPOs. For some this will be easy for others not. This session will
For centuries headaches have troubled mankind. It is known that
discuss some of the following questions:
since 3000 B.C. drastic measures were adopted to alleviate a
1. What role can the World Confederation for Physical Therapy play
headache. They penetrated the bony skeleton to free the evil demons
in the effective implementation of the Convention?
who were responsible to cause the “untreatable headache symptom”.
2. What do WCPT members need to know in order to reform their
Later in 400 B.C. Hippocrates described the combination of visual
policies and practices to be more inclusive of the views of those
disturbances, headache and nausea. 200 years later Galenus named
they are to serve?
this combination of symptoms “Hemicrania” (1).
3. What changes need to be made in PT, classroom instruction,
field training, and continuing education? What role can the WCPT In 1934 Costen (2), ENT specialist, described a combination of signs
play to engage other professionals who must also contribute to and symptoms connected with the pathological Temporomandibular
reforms? Joints. Later, the Costen Syndrome became the most important
4. How can professionals learn to actively seek out and listen to the concept of dysfunction of the Masticatory system related to facial
voices of disabled people? Pain. At present the pathology only until approximately 10 years ago
5. Are you willing to become engaged in political activities and policy it was generally accepted as a TMJ or a Craniomandibular Disorder
reforms aimed at assisting in the implementation constructive or Alterations. At present most of the International Academies
reforms? have merged into the concept of Facial Pain or Orofacial Pain or
6. Will you add your voices to those of disabled people? Craniofacial Pain. The only Academy that has been able to open the
S2 WCPT 2007, Keynote Presentations
concept into a broad interprofessional approach to the pathology, has 9. Lous I, Oleson J. Evaluation of pericraneal tenderness and oral
been the Academia Iberolatino Americana de Fisiopatologı́a Craneo- function in patients with common migraine, muscle contraction
cervicomandibular y Dolor Facial (Iberian–Latinamerican Academy of headaches and combination headache. Pain 1982;12: 385-393.
Craniocervical–mandibular Physiopathology and Orofacial Pain). We 10. Forsell H. Mandibular Dysfunction and headache. Thesis.
are proud of our influence as OMT, to be part of this open minded University of Turku. Turkey.
and progressive academy. 11. Rocabado M, Tapia V. Radiographic Study of the Craniocervical
relation in patients under Orthodontic treatment and the
Although Costen (2), mentioned headaches as the most prevalent incidence of related symptoms. J Craniomandibular Practice
symptoms in his article. Many others such as Berlin et al (3) were 1987;5(1):36-42.
the first ones to mention the close relation between Craniomandibular 12. Rocabado M. The importance of soft tissue mechanics in
disorders and Headaches. Later many studies confirmed this Stability and Instability of the Cervical Spine: A functional
association (4-8). These studies demonstrated the incidence of diagnosis for treatment planning. J Craniomandibular Practice
Craniomandibular disorders in headache patients and showed an 1987:5(2):130-8.
alleviation of headaches after treatment of the musculoskeletal 13. Rocabado M. Análisis biomecánico cráneo cervical a través
system of the Temporomandibular joints, occlusion and related de una teleradiografı́a lateral. Revista Chilena de Ortodon-
structures. Later in 1982 Lous and Oleson (9) and Forssel in 1985 cia,19841:42-52.
(10), were the first ones to consider the neurological diagnosis of the 14. Nagasawa A, Sakakibara T, Takahashi A. Roentgenographic
headaches in studies on the prevalence of CMD, in general headache findings of the Cervical Spine in Tension type headache (TTH).
patients. Headache 1993;33(2):90-5.
Back in 1980s Rocabado (11-13) showed that 65.1% of the pediatric

population being treated for Orthodontics purpose, were headache
symptomatic conditions, and showed the most important finding a
loss of the physiological curvature of the spine with a straight or an
inverted spine. This might be the reason why such large percentage
of young pediatric population between the ages of 8 to 12 years
present loss of cervical lordosis and are symptomatic. The beginning
of a multi-factorial condition for common headache patients that is not
a problem of age. Later Rocabado showed that degeneration of the
spine in symptomatic patients was as high as 68% in patients that
had loss of the physiological curvature of the spine with abnormal
craniocervical relation.
At present it is well recognized the influence of abnormal mus-

culoskeletal relation of the head neck and the shoulder girdle
as common finding in Headache patients (14). 372 patients were
diagnosed as having Tension Type Headaches (TTH), and compared
with 225 control subjects. The largest percentage showed a loss of
the cervical lordosis with sustained flexor muscle contraction that
interfered with the loss of the physiological curvature. Mainly the
Longi Colli, Hyoid musculature, Anterior and medius scaleni and the
SCM muscle. Low set shoulder with hyperactivity of the neck flexors,
exert a posterior rotation of the craniocervical region with increased
activity of the suboccipital musculature, the passive occipital loading
is one of the mayor pathophysiologic causes of the suboccipital and
hemicranial type headaches.
References
1. Alvarez WC. Was there sick headaches in 3000 BC? Gastroen-
terology, 1945;5:524-526.
2. Costen JB. Syndrome of ear and sinus symptoms dependant
upon disturbed function of the Temporomandibular Joint. Ann
Otol Rhin & Laryngol 1934;3:1-4.
3. Berlin R, Dressner L. Bruxism and Chronic Headache. The
Lancet 1960;2:289-91.
4. Hansson TL, Nilner M. A study of the occurrence of symptoms
of diseases of the TMJ masticatory musculature and related
structures. J Oral Rehab 1975;2.
5. Rieder C. The incidence of some occlusal habits and headaches
and neckaches in an initial survey population. J Prosthetic Dent
1976;35:445-451.
6. Magnusson T. Mandibular Dysfunction and recurrent headache.
Thesis 1981; University of Goteborg.
7. Farrar B, McCarty W. Outline of TMJ diagnosis and Treatment:
The TMJ headache Patient. The Normandie Study Group.
Montgomery Alabama, USA.
8. Turner D, Stone A. Headache and its treatment: A random
sample Survey. Headache 1979;19: 74-77.
Focused Symposium Overviews
Focused Symposium Overview Focused Symposium Overview

3329 Sunday 3 June 10:45 193 Sunday 3 June 14:00
VCEC Ballroom B & C VCEC Ballroom B & C
THE FIRST PHYSICAL THERAPY SUMMIT ON GLOBAL HEALTH GAIT ANALYSIS AND TRAINING: STEPPING FROM
Dean E; University of British Columbia, School of Rehabilitation MECHANISTIC RESEARCH TO PRACTICE
Sciences, T325-2211 Westbrook Mall, Vancouver, Canada, R6T 2B5 Eng J; University of British Columbia, Vancouver, Canada
LEARNING OBJECTIVES: The principal outcome of this sym-
LEARNING OBJECTIVES: Following the symposium, the participant
posoium is the provision of a Summit designed for international
should be able to: 1. Discuss neural and biomechanical mechanisms
colleagues, to examine physical therapy’s role in global health issues
which influence gait function. 2. Be able to evaluate treatment ap-
in the 21st century. The discussion generated during this Summit will
proaches to improve gait with respect to mechanisms underlying im-
be used to prepare a position paper, and potentially a publication
paired gait. 3. Formulate treatment decisions for improving gait based
entitled “The First Physical Therapy Summit on Global Health: The
on an understanding of the mechanisms contributing to impaired gait.
Issues and the 2007-2011 Implementation Plan”. Participants will
SUMMARY: One of the key roles of physical therapists is to assess
contribute in this symposium in the format of a Summit. The learning
gait disorders and re-train gait function. Gait requires the integration
objectives include: 1. To review global health issues by WCPT region
of many systems (e.g., muscle, neural, cognitive, cardiovascular, pro-
with special attention to the diseases of civilization, ie, ischemic
prioceptive, visual) to generate a multi-degree, rhythmical human gait
heart disease, cancer, chronic lung disease, hypertension and stroke,
pattern which is robust, yet adaptable depending on the environment
diabetes, and osteoporosis. 2. To examine the evidence supporting
and task. This presentation, in addition to the other three, will evaluate
the degree to which physical therapy is addressing these issues
the role of different mechanisms underlying impaired gait and discuss
by WCPT region. 3. To discuss the facilitators and barriers to
the development of new and innovative, evidence-based treatments
physical therapy in addressing the global health issues identified, and
to improve gait function. Although different populations will be
how symposium participants believe these can be best addressed
through the international physical therapy community. SUMMARY: discussed, commonalities in the presentations include the use of gait
The leading global health care problems of this millennium are largely kinematics and kinetics, the knowledge of muscle and neural require-
related to lifestyle choices and therefore largely preventable (see ments during gait, and the appreciation of the complex coordination of
Dean et al, Phys Ther, 80:1275-8, 2000; World Health Organization multiple systems for effective gait. Stroke is one example of a chronic
Annual Reports over the last decade). These killers, the so-called condition which affects multiple body systems and the ability to walk.
“diseases of civilization or affluence”, include heart disease, smoking- Our interventions to improve gait in people with stroke are based on
related diseases, hypertension and stroke, diabetes, obesity, and a series of mechanistic studies. Kinematic and kinetic gait analyses
cancers. These deadly progressive conditions are prevalent in have demonstrated the critical importance of the ankle plantarflexors
developed countries and fast becoming epidemic in the Middle for an effective push-off and the hip flexors for an exaggerated late
East and Asia as well. AIDS/HIV is prevalent in African countries, stance “pull-off” which is not observed in healthy gait. We have also
and increasing globally. Physical therapy is an internationally- found that the ability to load the paretic limb during the stance phase
recognized, primary health care profession that exploits primarily is a strong predictor of gait performance. However, altered gait motor
non invasive practices to prevent, cure, and treat disease. Non patterns do not necessarily indicate a failure of the task, but may
invasive approaches including nutrition, physical activity and exercise, be adaptive in response to the impairments. In fact, some of our
smoking cessation, and stress management have proven efficacy observed compensations (e.g., abducting the paretic hip during the
in preventing, curing, and treating the “diseases of civilization”. The swing phase) deter from the “normal” gait pattern, but result in better
extent of this evidence will be critically reviewed. Not only are non in- function (faster gait). These findings challenge the notion that treat-
vasive prevention and management of these conditions insufficiently ment approaches should only be directed towards restoring “normal”
exploited globally in health care, but often underused in favor of patterns if the goal is to achieve optimal functional performance rather
risky, less indicated, and costly invasive interventions associated with than an aesthetic one. At a muscle level, we have found that that the
the traditional medical model of illness care. A position paper will paretic leg muscles of people with chronic stroke have a reduced rate
summarize the findings of this symposium, including a statement of force production, in addition to an inability to generate sufficient
of the prevalence of these conditions in the CPT regions, and magnitude of force, and these variables correlate with gait speed.
recommendations for physical therapy involvement and intervention, Such data suggests that improving muscle strength and speed across
education, and research. IMPLICATIONS/CONCLUSIONS: This joint range may enhance gait performance. We have also found that
symposium provides an opportunity for participants to reflect on the balance ability has a high correlation, while cardiovascular fitness,
leading health care priorities of their respective countries, familiarize has a low correlation with gait speed. Based on our mechanistic
themselves with the literature supporting physical therapy’s role in findings, we have undertaken a series of controlled clinical trials
the prevention and in some cases ‘cure’, as well as the management in people with stroke which focus on dynamic weight-bearing,
of the “diseases of civilization”, and consider ways in which, in their functional muscle strengthening (with emphasis on fast movements)
unique contexts, the role of physical therapy can be facilitated in and balance tasks. The results have demonstrated improvement
addressing these leading health priorities that are contributing to in gait speed, mobility, fear of falling, and a reduction in falls.
significant human suffering and economic burden worldwide. The role IMPLICATIONS/CONCLUSIONS: Gait impairments following stroke
of genetic predisposition in people of some ethniticies is discussed. result from multiple systems and understanding these mechanisms
The outcomes of the Summit will lead to a systematic action plan for may help to direct treatment programs to improve gait. KEYWORDS:
the next 4 years. KEYWORDS: health issues, Diseases of civilization, Gait, Walking, Treatment. FUNDING ACKNOWLEDGEMENTS:
Ischemic heart disease, Cancer, Hypetension and stroke, Diabetes, Funding for these studies was provided by the Canadian Institutes
Obesity, Osteoporosis, Physical therapy’s role, Prevention, Cure, of Health Research, Michael Smith Foundation for Health Research
Management. FUNDING ACKNOWLEDGEMENTS: None and Heart and Stroke Foundation of BC and Yukon.
S4 WCPT 2007, Focused Symposium Overviews
Focused Symposium Overview Focused Symposium Overview
255 Sunday 3 June 14:00 243 Monday 4 June 10:45
VCEC Meeting Rooms 1-3 VCEC Ballroom A
PHYSIOTHERAPY MANAGEMENT AND ORGANISATIONAL BREAST CANCER AND EXERCISE
ARRANGEMENTS, IS THERE A “BEST” MODEL? Harris S; University of British Columbia – School of Rehabilitation
Jones R; National Health Service, United Kingdom Sciences, Vancouver, BC, Canada
LEARNING OBJECTIVES: 1. To understand the effects and LEARNING OBJECTIVES: At the completion of this symposium,
importance of management structure and organisation on the attending participants will be able to: 1) cite current literature on
provision of “quality” physiotherapy and other health professions the role of physical activity for women living with breast cancer and
services. 2. To explore the different organisational and management provide implications for clinical practice; 2) cite recent research on
arrangements for physiotherapy services internationally. 3. To upper extremity rehabilitation for women living with breast cancer and
consider important factors required for the effective and efficient present guidelines for upper extremity rehabilitation and; 3) describe
management of physiotherapy and other health professions services. the mechanisms for musculo-skeletal dysfunction in women with
SUMMARY: Changes in health care are driven by several factors: breast cancer as well as the clinical implications of surgery, radiation
financial, political, economic and social. Consumer changes, with therapy, and lymphedema. 4) discuss how the material presented
increasing life expectancy, the increasing number of people with in this symposium will be used to guide their clinical or educational
long term illnesses, widespread access to health information and practice. SUMMARY: The goals of this focused symposium are to
increasing demand for both quality and quantity of health care update learners on the most recent research relating to the role and
has required health strategists to re-evaluate the organisation effects of physical activity for women living with breast cancer and to
and structure of health care services worldwide. In response to describe recent research and clinical implications of upper extremity
the increasingly competitive and demanding health environment, (UE) rehabilitation for women living with breast cancer. Research on
physiotherapy managers have frequently been required to consider the effects of physical activity for women undergoing breast cancer
what might be the “best” organisational structures for their services, treatments (surgery, radiation and chemotherapy) and following
in order to manage effective clinical service provision and improve completion of treatments has grown substantially in the past decade.
patient outcomes within resource constraints. Structural changes Dr. Campbell will summarize this body of research and define the
have caused concerns for physiotherapy services. These have role of physical therapists in incorporating physical activity into their
related to service fragmentation into small teams often managed by treatment plans for women with breast cancer. The two most frequent
directorates, divisions or general managers. The individual issues impairments resulting from breast cancer treatment are shoulder
included; fears that staff would not get the professional support dysfunction (ROM limitations) and UE swelling (lymphedema). Ms.
needed and professional standards would drop, difficulties with McNeely will present results of a systematic review that examined
recruiting and retaining staff, lack of career progression and the evidence from randomized controlled trials on the benefit of
Head of Service being accountable for professional standards without therapeutic exercise interventions in preventing or minimizing UE
authority. The introduction of relatively decentralised management morbidity due to breast cancer treatment. Clinical implications of
units based largely on medical speciality groupings has often the findings will be shared. In the third session of the symposium,
been perceived by physiotherapists as a need to “make them Ms. Binkley, a physical therapist who works clinically with women
fit” with a desire for neat organisational boxes on organisational with breast cancer, will describe the mechanisms of musculoskeletal
charts. Management arrangements for physiotherapists are not dysfunction in the shoulder that result from surgery and radiation.
uniform. In some places a single Head of Service manages each As well, she will describe the effects of UE lymphedema on
of the health professions as individual entities. In others they shoulder dysfunction and provide clinical implications for practition-
are managed in a variety of different groupings, for example ers. IMPLICATIONS/CONCLUSIONS: Breast cancer is the most
in directorate structures, combined health professions groups or common cancer affecting women. The life-prolonging treatments,
matrix management models. Despite the recognised contribution to including axillary and chest surgery, chemotherapy and radiation
patient care, research into physiotherapy management has been therapy, often result in significant morbidity to the women treated,
limited. Physiotherapy and other health professions have lacked e.g. loss of shoulder ROM, lymphedema, post-treatment fatigue, and
influence in comparison with medical and nursing colleagues in the depression. To function as evidence-based practitioners, physical
larger policy process of structural reforms at national, regional and therapists working in women’s health, oncology or general practice
local levels throughout the world. Thus, the potential for strategic must be aware of the latest research that should then be translated
influence has been fragmented and diluted. Organisational structures to guide their practice. This evidence-based, focused symposium will
for health professions services appear to have “swung” between enable practitioners, educators and other women’s health/oncology
full devolution to localities and centralisation to health professions researchers to become aware of the latest research advances in the
directorates, without full consideration for the impact of these care of women living with breast cancer. KEYWORDS: breast cancer,
decisions on patient care and the many factors affecting clinical upper extremity, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
governance. IMPLICATIONS/CONCLUSIONS: The importance of ML McNeely and KL Campbell were supported by studentships from
organisational structures cannot be ignored. They establish the the Alberta Heritage Foundation for Medical Research.
context for many aspects of healthcare; commissioning, patient flows,
cross-organisational boundary working, information management,
Focused Symposium Overview
communication processes, clinical governance and the management
of risk. Management structures should be defined after the functions 246 Monday 4 June 10:45
of a service are determined. Organisational structure directly influ- VCEC Ballroom B & C
ences the provision of patient care, affecting both staffing and service MOVING ELECTROPHYSICAL AGENTS FORWARD IN AN
issues. KEYWORDS: Physiotherapy; Management; Organisational EVIDENCE-BASED PRACTICE ENVIRONMENT
Structures. FUNDING ACKNOWLEDGEMENTS: None Goh A1,2 ; 1 Shinshu University, Matsumto, Nagano Prefecture, Japan;
2 Curtin
University of Technology, Perth, Western Australia, Australia
LEARNING OBJECTIVES: 1. To discuss the present status of
electrophysical agents (EPA) in clinical practice, education and
research. 2. To discuss how to move EPA forwards in an evidence-
based practice environment, in terms of changes to current clinical
Focused Symposium Overviews S5
practice, education and research. 3. To propose the formation of protein degradation. The first symposia lecture will present recent
an EPA sub-group within WCPT to co-ordinate these changes. investigations aimed at studying factors that triggers muscle atrophy
SUMMARY: Together with massage and exercise, the use of EPA and identify the proteolytic system responsible for contractile
has been one of our core skills since the profession started. However, protein degradation. Combined effects of multiple factors such as
the clinical usage of EPA has often been criticised as ineffective hyperinflation, malnutrition and increased work of breathing are
through recently published meta-analyses and critical appraisals, and potentially responsible for the development of inspiratory muscle
the continued teaching of EPA in many schools has been questioned dysfunction in CPOPD. Inspiratory muscle training is one strategy
in journal editorials and meetings. It is necessary to address used by clinician that may help to relieve patients from symptoms
these issues before appropriate changes can be proposed and such as dyspnea. The second lecture will review the literature to
implemented on a global scale through international collaboration. expose the audience to the known effect of inspiratory muscle
While we do not claim to have all the answers, research evidence training in adults with COPD. Pulmonary rehabilitation programs
do suggest that the practice of EPA in an evidence based practice consistently have improved exercise capacity, quality of life, and
environment is possible for most of the modalities we currently use, symptoms over the past decade. Although training has been shown
if not all. However, the transition from “evidence” to an “evidence- to be an essential component of the rehabilitation program, individual
based practice environment” requires a strategy which goes beyond patients do not always benefit to the same extent. The third allocution
producing more evidence through clinical research. In order to make will discuss the concept of responders and nonresponders in COPD
a successful transition, it is necessary to change the mindsets patients exposed to exercise training and how to distinguish both
and practice patterns of clinicians; with the way we educate our groups. IMPLICATIONS/CONCLUSIONS: Actually, worldwide COPD
future clinicians in undergraduate programs across the world; and population is increasing and multiple evidences prove that their
with the way we coordinate and prioritise our research efforts peripheral and respiratory muscles experience changes in terms
in this area. In 1999, at the WCPT congress in Yokohama, a of quantity and quality. These muscle alterations have detrimental
meeting was held to address some of these issues. The meeting effects on the clinical status of these patients. Fortunately, inspiratory
demonstrated that there was global interest and support for proposed and peripheral muscle trainings are powerful tools available for
changes in EPA, with the formation of an on-line discussion group. clinicians. Judicious application of these training modalities in
An inaugural International Electrophysical Agents Congress was selected patients can enhance their muscle strength and endurance,
planned for in 2001 / 2002, with the aim of promoting further exercise capacity, dyspnea and quality of life. KEYWORDS: COPD,
discussions on these issues, under the organisation of Professor muscle atrophy, proteolysis, respiratory muscle, exercise training,
Luther Kloth (Marquette University, USA), but this was cancelled due inspiratory muscle training, pulmonary rehabilitation, responder,
to the September 11, 2001 terrorist attack in New York. A follow- nonresponder. FUNDING ACKNOWLEDGEMENTS: None.
up meeting was also planned for in Barcelona at the 2003 WCPT
Congress, but this was cancelled due to poor attendance attributed
to the SARS epidemic. IMPLICATIONS/CONCLUSIONS: It is hoped Focused Symposium Overview
that discussions on issues related to EPA can be reinstated and
417 Tuesday 5 June 09:00
new interests generated with the focussed symposia at the WCPT
VCEC Ballroom B & C
congress in 2007. KEYWORDS: Electrophysical Agents, Evidence-
based practice environment, international collaboration. FUNDING FES THERAPY AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL,
ACKNOWLEDGEMENTS: None. PSYCHOSOCIAL, BIOENGINEERING OUTCOMES
Field-Fote E; The Miami Project to Cure Paralysis and the
Focused Symposium Overview Department of Physical Therapy, University of Miami School of
Medicine, Miami, USA
298 Monday 4 June 14:00
VCEC Ballroom B & C LEARNING OBJECTIVES: Following this symposium participants
ADVANCES IN PULMONARY REHABILITATION: PERIPHERAL will be able to: 1) Discuss how training with FES influences physiology
AND RESPIRATORY MUSCLE ADAPTATIONS and neurophysiology; 2) Describe the how FES is being used for
upright mobility; 3) Understand how FES may influence quality of
Brooks D; Toronto University, Toronto, Canada life and societal participation; 4) Appreciate the future directions
LEARNING OBJECTIVES: Essentially, this symposium should of FES technology. SUMMARY: The effects of spinal cord injury
help the audience to appreciate the clinical consequences of on mobility and function are the most obvious consequences of
peripheral and respiratory muscle dysfunction in chronic obstructive this disorder. However, the injury also affects the way the nervous
pulmonary disease (COPD) and realize the beneficial effects system processes sensory information and contributes to motor
of inspiratory muscle training and pulmonary rehabilitation this output. Fortunately, evidence suggests that the nervous system
population. SUMMARY: Actually, there is an estimation of 14 responds to training even in individuals with chronic SCI. The
million Americans and 750 000 Canadians having COPD. There disability associated with SCI profoundly influences the individual’s
continues to be an increase in the prevalence of and mortality life roles, affecting work, family and social participation. Enhanced
from COPD. By 2020, the World Health Organization predicts that function and mobility can have a meaningful influence on the
COPD will rise from the 12th most prevalent disease worldwide development of effective coping strategies, and therefore functional
to the 5th and from the 6th most common cause of death to electrical stimulation has the potential to significantly impact quality
the 3rd. Clinical consequences of COPD are dramatic. Besides of life by contributing to the achievement of patient-centered goals.
debilitating dyspnea, peripheral and inspiratory muscle dysfunction, Progress in biotechnology hold promise for future advancements that
fatigue, decrease endurance and reduced exercise capacity are all may make FES systems even more functional, practical and useful
contributing to impair functional capacity, reduce quality of life and for individuals with SCI. Changes in engineering processes and
increase mortality in this population. Concretely, COPD patients are miniaturization may also make these devices more readily accessible
loosing 30% of their peripheral muscle mass during the progression to individuals with SCI. IMPLICATIONS/CONCLUSIONS: Functional
of the lung disease. Intense research is ongoing to unravel factors electrical stimulation has the potential to influence all the domains of
responsible in the initiation and the development of muscle wasting disability. Improvements in physiology, neural control, body function
in COPD. Muscle wasting is not exclusive to COPD. Indeed, and movement abilities are associated with enhanced health and
in vitro and in vivo investigations have clearly demonstrated, in wellness as well as improved quality of life and societal participation.
numerous catabolic models, that the Ubiquitin-Proteasome system, KEYWORDS: Activity, plasticity, biotechnology, participation, quality
an ATP-dependant proteolytic pathway, is involved in contractile of life. FUNDING ACKNOWLEDGEMENTS: None.
S6 WCPT 2007, Focused Symposium Overviews
Focused Symposium Overview that quadriceps strengthening should be the main focus of the
287 Tuesday 5 June 14:00 conservative treatment of PFPS. Some randomized clinical trials have
VCEC Ballroom B & C shown consistent improvement of short-term pain and function after
PROMOTING EFFECTIVE INTERVENTIONS FOR UPPER quadriceps strengthening exercises. However, it remains enigmatic
EXTREMITY RECOVERY IN NEUROLOGICAL CONDITIONS as to why these exercises improves the patients’ symptoms, and
Levin M; Director, Physical Therapy Program, School of Physical why not all patients benefit from it. In contrast to the importance
and Occupational Therapy, McGill University, 3654 Prom. Sir of the strength of the quadriceps, some authors state that the neu-
William Osler, Montreal, Quebec. H3G 1Y5, CANADA romuscular timing of the hip muscles and vastus medialis obliquus
of the quadriceps plays a major role in the development of PFPS.
LEARNING OBJECTIVES: Participants in this Focused Sympo- Consequently, the neuromuscular training of these muscles should
sium will: 1) understand how findings of animal research inform be the most essential aspect in the rehabilitation of these patients.
rehabilitation of the upper limb in patients with stroke; 2) be able Again, conflicting research results are found concerning the effect
to differentiate between different training approaches based on and importance of neuromuscular training in PFPS. In addition, many
repetitive use of the more affected arm of patients with stroke authors have shown in biomechanical studies that PFPS patients
and determine their applicability; 3) understand the role of the suffer from important malalignment characteristics of the lower
therapist in promoting client involvement in decision making and extremity. As a result, PFPS patients should be evaluated and treated
treatment planning. SUMMARY: This symposium will examine the for existing malalignment patterns. IMPLICATIONS/CONCLUSIONS:
evidence for the effectiveness of treatment interventions for the It can be concluded that after reviewing the literature no clear
affected upper limb in patients with hemiparesis due to stroke. consensus exists concerning the predisposing factors of PFPS.
Discussion will be based on current high-level evidence resulting Consequently, today many different treatment approaches exist, with
from basic science research and randomized control trials. The first sometimes conflicting research results. The aim of this symposium
speaker (Wolf) will present the evidence for the effectiveness of is to identify these different approaches, to clarify the conflicting
such rehabilitation techniques as repetitive task practice, constraint- results, and to present up-to-date clinical guidelines which can be
induced therapy, forced use therapy and muscle strengthening used in the treatment of PFPS. In addition, this symposium will
techniques. The second speaker (Levin) will discuss basic motor elucidate the benefit of future studies on the conservative treatment
control studies that investigate the role of the trunk in reaching and of PFPS. KEYWORDS: patellofemoral pain syndrome – conservative
how the trunk may be used to compensate for distal motor control treatment – malalignment – neuromuscular control – quadriceps
deficits. Results of recent randomized controlled trials using trunk strengthening. FUNDING ACKNOWLEDGEMENTS: None.
restraint as an intervention will be presented. The third speaker
(Winstein) will discuss the role of the therapist in engaging the client
in decision making and treatment planning as a means to facilitate Focused Symposium Overview
mechanisms of neuronal plasticity. All speakers will emphasize how 291 Wednesday 6 June 10:45
results from basic research can be utilized to maximize therapeutic VCEC Ballroom B & C
effectiveness. The presentations will be followed by a 20 minute RANDOMIZED TRIALS IN COMMON MUSCULOSKELETAL
question and answer period in which questions from the audience PROBLEMS: CHALLENGES AND FUTURE DIRECTIONS
will be solicited and discussed among the Symposium participants.
Foster N; Clinical Trials Unit, Primary Care Sciences Research
The Symposium will conclude with a summary in which the main
Centre, Keele University, UK
points will be reiterated. IMPLICATIONS/CONCLUSIONS: Recent
animal research has provided evidence of a great potential for LEARNING OBJECTIVES: This symposium will provide a much
cortical reorganization after focal brain injuries such as stroke. needed opportunity for experienced clinical trialists, practitioners
This symposium will focus on the translation of basic findings and and others, interested in improving the quality of the evidence
principals of motor relearning based on neuronal plasticity into the from randomized controlled trials (RCTs), to: 1. Examine what
clinical setting. KEYWORDS: Knowledge translation, motor control, can be learned from available, high quality RCTs of physical
motor learning, upper limb rehabilitation, treatment effectiveness, therapy for common musculoskeletal problems, 2. Understand the
evidence-based practice, client-centered practice, constraint-induced challenges of designing and conducting high quality RCTs in physical
therapy. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of therapy musculoskeletal practice, and how to overcome them, 3.
Health Research (CIHR), National Science and Engineering Council Prioritise the key issues for inclusion in future RCTs of physical
of Canada (NSERC), National Institutes of Health (NIH) therapy for musculoskeletal problems, 4. Provide recommendations
to improve future RCTs in musculoskeletal physical therapy.
SUMMARY: Common musculoskeletal problems such as low back
Focused Symposium Overview pain, neck pain, knee pain and shoulder pain are commonly treated
209 Tuesday 5 June 16:15 by physical therapists. The randomised controlled trial (RCT) is
VCEC Ballroom B & C the most appropriate tool to test the effectiveness of physical
CONSERVATIVE TREATMENT OF PATELLOFEMORAL PAIN therapy interventions. Designing RCTs of complex physiotherapy
SYNDROME interventions, however, comes with considerable challenges. There
is a clear trend towards large, high quality RCTs showing either
Witvrouw E; Ghent University, Faculty of Medicine and Health
no differences or very small differences between physiotherapy
Sciences, Department of Rehabilitation Science and Physiotherapy,
approaches in the management of musculoskeletal problems. Where
Ghent, Belgium, Europe
differences are seen, these may be statistically significant but
LEARNING OBJECTIVES: The objective of this symposium is to give of questionable clinical importance. Such results seem strongly
the attendees up-to-date information concerning the conservative at odds with the experiences of physiotherapy practitioners who
treatment of the patellofemoral pain patient. The attendees should see individual patients improve, often dramatically with specific
be able to understand this information, and incorporate the given physiotherapy approaches and whose clinical experience leads
clinical guidelines in the future treatment of their PFPS patients. them to firmly believe in the effectiveness of specific interventions.
SUMMARY: Patellofemoral pain syndrome (PFPS) is a common IMPLICATIONS/CONCLUSIONS: There are a range of possible
condition for which patients are referred to rehabilitation. Despite explanations for the mismatch beween the results of high quality
its high incidence, PFPS remains a challenging musculoskeletal RCTs of physical therapy interventions and the strongly held
entity. Reviewing the literature, conflicting data and approaches seem beliefs of practitioners. For example, there may be overestimation
to exist regarding the conservative treatment. Some authors state of the specific effects of interventions and underestimation of
Focused Symposium Overviews S7
the non-specific effects, there may be inadequate identification of

important subgroups of patients and insufficient individualisation
of the interventions. If physical therapy interventions only offer, at
best, small to moderate benefits for patients with musculoskeletal
pain, then RCTs must be designed carefully so that these small
to moderate effects can be detected. Conversely, if interventions
can offer large benefits and recent RCTs have been unable to
identify these, then it is timely to review the way in which RCTs
are designed and conducted. The presentations and discussion
within this symposium will lead to recommendations for future RCTs.
KEYWORDS: Randomised controlled trials (RCTs), musculoskeletal
problems, physical therapy. FUNDING ACKNOWLEDGEMENTS:
Nadine Foster would like to acknowledge the National Coordinating
Centre for Research Capacity Development, Department of Health,
England, for funding her current Career Scientist post at Keele
University, and the Arthritis Research Campaign for project specific
funding.
Focused Symposium Contributions
Focused Symposium Contribution Region with respect to articles published related to these conditions
3330 Sunday 3 June 10:45 for an index of scientific research. IMPLICATIONS/CONCLUSIONS:
VCEC Ballroom B & C Preliminary analysis supports gaps between the need for a higher
This contribution is part of Focused Symposium “THE FIRST PHYS- level of visibiltiy of physical therapy in the prevention, ‘cure’, and
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329 management of the diseases of civilization in the SA Region, the
STATUS OF THE DISEASES OF CIVILIZATION IN THE NORTH proportion of professional curricula dedicated to these conditions,
AMERICA CARIBBEAN REGION AND RELATED PHYSICAL and physical therapy research. Physical therapy education is typically
THERAPY PRACTICE based on the biomedical model and impairment-focused interven-
Dean E; Professor, School of Rehabilitation Sciences, University tions, rather than a health model focused on interventions to promote
of British Columbia, Vancouver, Canada health, prevent and ‘cure’ disease, in addition to management.
Most physical therapy programs surveyed, report minimal to no
LEARNING OBJECTIVES: 1. To review health and mortality of content related to prevention (<2%), and if included, was usually
the North America Caribbean (NAC) Region of WCPT with special in the musculoskeletal area, e.g., ergonomics. Reframing of the
attention to the diseases of civilization, ie, ischemic heart disease, profession is indicated based on inconsistency between epidemiology
cancer, chronic lung disease, hypertension and stroke, diabetes, and and physical therapy practice in South America. KEYWORDS:
osteoporosis. 2. To examine the evidence supporting the degree to South America Region, diseases of civilization, AIDS/HIV, clinical
which physical therapy is addressing these issues in this WCPT practice, physical therapy education, and research. FUNDING
region clinically, professional education, and research. SUMMARY:
ACKNOWLEDGEMENTS: None
Data are being tabulated from: the WHO and Health Canada for
prevalence of the diseases of civilization and AIDS/HIV; proportion
of curriculum on the prevention, ‘cure’, and management, from the
schools of physical therapy in the countries of the NAC Region; and
the physical therapy journals in the NAC Region with respect to Focused Symposium Contribution
articles published related to these conditions for an index of related 3332 Sunday 3 June 10:45
scientific research. IMPLICATIONS/CONCLUSIONS: Ischemic heart VCEC Ballroom B & C
disease, cancer, smoking-related conditions, hypertension and
stroke, obesity and diabetes, and osteoporosis have high prevalence, This contribution is part of Focused Symposium “THE FIRST PHYS-
and are underrepresented in physical therapy practice, professional ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
education, and research.The indigenous people of Canada and STATUS OF THE DISEASES OF CIVILIZATION IN THE EUROPE
the United States are at particularly high risk. Preliminary analysis REGION AND RELATED PHYSICAL THERAPY PRACTICE
supports gaps between the need for a higher level of visibiltiy Gosselink R; Professor, Rehabilitation Sciences, Dean Faculty of
of physical therapy in the prevention, ‘cure’, and management Kinesiology and Rehabilitation Sciences, Respiratory Rehabilitation,
of the diseases of civilization in the NAC Region, proportion of Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven,
professional curricula dedicated to these conditions, and physical Belgium
therapy research. KEYWORDS: North America Caribbean Region,
diseases of civilization, AIDS/HIV, clinical practice, physical therapy LEARNING OBJECTIVES: 1. To review health and mortality in the
education, and research. FUNDING ACKNOWLEDGEMENTS: None Europe Region of WCPT with special attention to the diseases of
civilization, ie, ischemic heart disease, cancer, chronic lung disease,
Focused Symposium Contribution hypertension and stroke, diabetes, and osteoporosis. 2. To examine
3331 Sunday 3 June 10:45 the evidence supporting the degree to which physical therapy is
VCEC Ballroom B & C addressing these issues in this WCPT region clinically, professional
education and research. SUMMARY: Data are being tabulated from:
This contribution is part of Focused Symposium “THE FIRST PHYS-
the WHO and the ministries of health of the European Region
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329
countries for prevalence of the diseases of civilization and AIDS/HIV;
STATUS OF THE DISEASES OF CIVILIZATION IN THE SOUTH proportion of curriculum on the prevention, ‘cure’, and management
AMERICA REGION AND RELATED PHYSICAL THERAPY from the schools of physical therapy in the countries of the Europe
PRACTICE Region; and the physical therapy journals in the Europe Region
Dornelas de Andrade A; Professor, Physiotherapy Department, with respect to articles published related to these conditions for an
Federal University of Pernambuco, Recife, Brazil index of scientific research. IMPLICATIONS/CONCLUSIONS: There
LEARNING OBJECTIVES: 1. To review health and mortality and are marked differences in prevalence of the diseases of civilization
disabilty in the South America (SA) Region of WCPT with special across the countries of the Europe Region, e.g., eastern Europe
attention to the diseases of civilization, ie, ischemic heart disease, has among the highest rates of smoking globally; Scotland has the
cancer, chronic lung disease, hypertension and stroke, diabetes, and highest rate of heart disease in the world; and Mediterrean countries
osteoporosis. 2. To examine the evidence supporting the degree to having lower rates of heart disease. Preliminary analysis supports
which physical therapy is addressing these issues in this WCPT gaps between the need for a higher level of visibiltiy of physical
region clinically, professional education, and research. SUMMARY: therapy in the prevention, ‘cure’, and management of the diseases of
Data are being tabulated from: the WHO and Pan American Health civilization in the Europe Region, proportion of professional curricula
Organziation for prevalence of the diseases of civilization and dedicated to these conditions, and physical therapy research.
AIDS/HIV; proportion of curriculum on the prevention, ‘cure’, and Regional differences are highlighted. KEYWORDS: Europe Region,
management from the schools of physical therapy in the countries diseases of civilization, AIDS/HIV, clinical practice, physical therapy
of the SA Region; and the physical therapy journals in the SA education, and research. FUNDING ACKNOWLEDGEMENTS: None
S10 WCPT 2007, Focused Symposium Contributions
Focused Symposium Contribution of civilization in the Africa Region commensurate with its economic
3333 Sunday 3 June 10:45 development in the 21st century, proportion of professional curricula
VCEC Ballroom B & C dedicated to these conditions, and physical therapy research.
This contribution is part of Focused Symposium “THE FIRST PHYS- KEYWORDS: Africa Region, diseases of civilization, AIDS/HIV,
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329 clinical practice, physical therapy education, and research. FUNDING
ACKNOWLEDGEMENTS: None
STATUS OF THE DISEASES OF CIVILIZATION IN THE ASIA
WESTERN PACIFIC REGION AND RELATED PHYSICAL
THERAPY PRACTICE Focused Symposium Contribution
Al-Obaidi S; Associate Professor, Physical Therapy Department, 307 Sunday 3 June 14:00
Kuwait University, Kuwait VCEC Ballroom B & C
This contribution is part of Focused Symposium “GAIT ANALYSIS
LEARNING OBJECTIVES: 1. To review health and mortality the Asia
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO
Western Pacific (AWP) Region of WCPT with special attention to the
PRACTICE.” number 193
diseases of civilization, ie, ischemic heart disease, cancer, chronic
lung disease, hypertension and stroke, diabetes, and osteoporosis. 3-D ANALYSIS OF NOVEL STRATEGIES TO IMPROVE GAIT IN CP
2. To examine the evidence supporting the degree to which physical Damiano D; Washington University
therapy is addressing these issues in this WCPT region clinically,
professional education, and research. SUMMARY: Data are being LEARNING OBJECTIVES: 1.appreciate the history of gait analysis
tabulated from: the WHO for prevalence of the diseases of civilization with respect to physical therapy applications, with specific attention
and AIDS/HIV; proportion of curriculum on the prevention, ‘cure’, and here on cerebral palsy; 2.recognize the effects of strength training
management from the schools of physical therapy in the countries on gait performance and patterns; 3.discuss task-related intervention
of the AWP Region; and the physical therapy journals in the AWP approaches and mechanisms by which these enhance gait function.
Region with respect to articles published related to these conditions SUMMARY:: The proliferation of 3-D gait analysis laboratories lead
for an index of scientific research. IMPLICATIONS/CONCLUSIONS: to an exponential increase in outcomes studies on patients with
The AWP Region is perhaps the most culturally diverse of the WCPT cerebral palsy (CP). These laboratories were initially set up by
regions. Even its low-income countries are exhibiting increasing orthopaedic surgeons with the desire to better understand and treat
prevalence of the diseases of civilization with increasing affluence. gait deviations in CP, with the surgical decision making process
In wealthy oil-rich countries, a major health priority in adults and of paramount interest. In the past two decades, the use of gait
children is metabolic syndrome including obesity, hypertension, and analysis has expanded to other clinical populations and to multiple
abnormal blood lipids, particularly in the wealthy oil-rich countries. disciplines asking questions relative to their practices. This talk will
Preliminary analysis supports gaps between the need for a higher focus on the use of gait analysis to assess outcomes of physiotherapy
level of visibiltiy of physical therapy in the prevention, ‘cure’, and interventions for persons with CP, so as to design more effective
management of the diseases of civilization in the AWP Region, treatment strategies. Much rehabilitative effort in CP is expended
proportion of professional curricula dedicated to these conditions, and towards the goal of improving gait. The effectiveness of interventions
physical therapy research. KEYWORDS: Asia West Pacific Region, such as strength training has been evaluated using gait analysis
diseases of civilization, AIDS/HIV, clinical practice, physical therapy under the assumption that gait performance is adversely affected by
education, and research. FUNDING ACKNOWLEDGEMENTS: None muscle weakness. Several studies have demonstrated that strength
training may improve several aspects of gait performance such
as speed and symmetry, with perhaps more pronounced changes
Focused Symposium Contribution
seen when asking subjects to walk as fast as possible. Kinematic
3335 Sunday 3 June 10:45 changes as a result of strengthening alone have been less commonly
VCEC Ballroom B & C reported and responses seem to be quite variable across individuals.
This contribution is part of Focused Symposium “THE FIRST PHYS- This suggests that for those in whom walking is limited mostly by
ICAL THERAPY SUMMIT ON GLOBAL HEALTH” number 3329 weakness, strengthening may improve their ability to move against
STATUS OF THE DISEASES OF CIVILIZATION IN THE AFRICA gravity, depending on which muscle groups were trained. However,
REGION AND RELATED PHYSICAL THERAPY PRACTICE the influence of muscle contractures or spasticity on gait may
dominate in others, and strengthening alone in those individuals, even
Umerah G; Assistant Director, Physiotherapy Dept, University of
when considerable weakness is present, is likely to be ineffective.
Nigeria Teaching Hospital (UNTH), Enugu, Enugu State, Nigeria
Even more intriguingly, it has been predicted by muscle modelling
LEARNING OBJECTIVES: 1. To review health and mortality in that strength training in CP that focused on improving hip and
the Africa Region of wCPT with special attention to the diseases knee extension would also improve rotational abnormalities due
of civilization, ie, ischemic heart disease, cancer, chronic lung to positional alterations in the muscle lever arms, and we will
disease, hypertension and stroke, diabetes, and osteoporosis. 2. present experimental data testing that hypothesis in children with
To examine the evidence supporting the degree to which physical spastic diplegia. More recently, treadmill training and other intense
therapy is addressing these issues in this WCPT region clinically, repetitive leg exercise protocols have shown a positive effect on
professional education and research. SUMMARY: Data are being gait, which is hardly surprisingly since the training involves similar
tabulated from: the WHO for prevalence of the diseases of civilization or identical motions as the target task. While immensely useful
and AIDS/HIV (credibility of national data questionable); proportion for many rehabilitation applications, 3-D gait analysis is limited
of curriculum on the prevention, ‘cure’, and management from the due to its somewhat artificial environment that typically involves
schools of physical therapy in the countries of the Africa Region; walking over a short distance on a level surface with minimal
and the physical therapy journals in the Africa Region with respect environmental distractions, Therefore, it is recommended that these
to articles published related to these conditions for an index of measures be compared to or complemented by those with greater
scientific research. IMPLICATIONS/CONCLUSIONS: With economic ecological validly. IMPLICATIONS/CONCLUSIONS: Physical therapy
development in Africa, the diseases of civilization are becoming a treatment options in CP and other disorders for improving gait have
greater priority. Obesity is beginning to offset malnutrition in the expanded greatly in recent years, with efficacy demonstrated by 3-D
extreme economic groups. HIV/AIDS is a major health priority which gait analysis and other measures. Strategies include strengthening,
is often coupled with tuberculosis. Preliminary analysis supports endurance training, and repetitive practice under varying conditions
gaps between the need for a higher level of visibiltiy of physical to improve motor coordination. KEYWORDS: strength, cerebral
therapy in the prevention, ‘cure’, and management of the diseases palsy. cycling. FUNDING ACKNOWLEDGEMENTS: Work cited and
Focused Symposium Contributions S11
conducted by author has been funded by the National Institutes Focused Symposium Contribution
of Health, specifically NCMRR/NICHD and NINDS, and by United 333 Sunday 3 June 14:00
Cerebral Palsy Education and Research Foundation. VCEC Ballroom B & C
This contribution is part of Focused Symposium “GAIT ANALYSIS
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO
Focused Symposium Contribution PRACTICE.” number 193
319 Sunday 3 June 14:00 BIOMECHANICAL INSIGHT INTO QUESTIONS ABOUT GAIT IN
VCEC Ballroom B & C PERSONS WITH STROKE
This contribution is part of Focused Symposium “GAIT ANALYSIS Olney S; Motor Performance Group, School of Rehabilitation
AND TRAINING: STEPPING FROM MECHANISTIC RESEARCH TO Therapy, Queen’s University, Kingston, Ontario, Canada
PRACTICE.” number 193
LEARNING OBJECTIVES: The audience will: 1) understand the
USING GAIT ANALYSIS IN PARKINSON DISEASE TO ENHANCE
major biomechanical principles underlying the gait of persons with
THERAPY OUTCOMES
stroke, 2) know the gait compensations frequently used by persons
Morris M; The University of Melbourne with stroke that can be used to develop treatment objectives, and 3)
be able to use biomechanical principles to make clinical decisions
LEARNING OBJECTIVES: Following the symposium, the participant
in the treatment of persons with stroke. SUMMARY: The aim of this
should be able to: 1. Discuss the biomechanics and motor control
presentation is to develop an understanding of the biomechanical
of gait in people with idiopathic Parkinson’s disease. 2. Formulate
features in the gait of persons who have sustained a stroke by
treatment decisions for improving gait based on an understanding of considering five common clinical questions that can be addressed
the mechanisms contributing to impaired gait in PwPD. SUMMARY: from a biomechanical point of view. The first question is, “What
This presentation will explore the biomechanics, motor control and is good walking – what should we be aiming for?” Although there
objective measurement of gait in people with idiopathic Parkinson’s is agreement that safety is a prime concern, there is conflict
disease (PwPD) as the basis for clinical decision making in physical between speed and ‘gait pattern’ as an indicator of good walking.
therapy practice. Idiopathic Parkinson’s disease occurs frequently in Biomechanical arguments based on mechanical energy analyses and
older people and usually progresses relatively slowly over periods of joint power profiles can answer this important question. The second
15-25 years. Gait, balance and posture are compromised due to a question is, “Why does my patient walk slowly?” Slow speeds of
progressive loss of dopamine producing neurons in the substantia walking are caused by inadequate input of concentric muscle groups
nigra pars compacta of the basal ganglia. The resulting neurotrans- at specific times in the gait cycle, or eccentric muscle activity at the
mitter imbalance that occurs in the basal ganglia affects the person’s same time as the concentric activity. Examples and approaches to
ability to perform repetitive movement sequences and motor skills increasing speed will be presented. The third question is, “Do other
with speed and normal amplitude. In addition, because most PwPD muscle groups compensate for deficient muscle groups in gait and, if
are senior citizens and many have a sedentary lifestyle, impairments so, is there a predictable pattern to this?” The redundancy of muscles
of musculoskeletal and cardiopulmonary systems can contribute to acting across one or two joints means that compensations may occur
gait deviations. At Kingston Centre, within the Rehabilitation and in the affected limb (intra-limb) or in the unaffected limb (inter-limb).
Aged Care Program of Southern Health (Australia), we have a multi- It appears that the most common patterns are 1) an increase in
disciplinary team of clinicians and clinical researchers who work the power burst in early stance caused by hip extension (H1) on
together to ensure evidence-based clinical practice. Our international the affected side with an increase H1 on the unaffected side, or 2)
standard gait laboratory is situated within the hospital above the an increase in H1 on the unaffected side coupled with an increase
Parkinson’s disease ward and clinicians, researchers and patients in push-off of the affected side. The fourth question is, “Increased
communicate on a daily basis. Based on 3-D motion analysis and walking speed frequently results in a poorer gait pattern; how do
validated methods of clinical observation, we have shown that PwPD I decide what is most important?” One must first determine upon
hypokinesia have a fundamental deficit in footstep regulation as well what factors the pattern can be said to be poorer, then determine
as a marked reduction in gait speed. These are correlated with priorities with input from the client. At the same time, one must
reduced community ambulation and an increase risk of falls. Gait ascertain whether the poor pattern can be reduced or eliminated
disorders and falls are a particular risk during dual task performance by making footwear, orthotic or training modifications. Examples will
and when PwPD have to make a rapid adjustment to changes in be given. The fifth question is, “What are the biomechanical guiding
task goals, floor surface conditions or when there is the need to walk principles for choosing an ankle-foot orthosis for a person affected
as part of a long or complex motor skill. Gait impairments not only by stroke?” Orthoses are used for three reasons, 1) to facilitate
affect quality of life in the person with the disease, they can also foot clearance in swing, 2) to prevent excessive ankle dorsiflexion in
contribute to “caregiver burden” in family members such as partners stance, and/or 3) to hold the foot in a balanced position if it tends to
and adult children. Current research is focusing on the biomechanics invert or evert. Each requires different biomechanical considerations.
of turning, the effects of PD on ability to make transitions from one IMPLICATIONS/CONCLUSIONS: Clinical decision-making can be
support surface to another, the effects of dual motor and cognitive enhanced if physical therapists understand the biomechanics of
tasks on gait and the relationship between gait dysfunction and gait in persons with stroke, the typical biomechanical differences
falls. We have also recently completed a randomized controlled from normal gait and the biomechanical compensations that are
clinical trial comparing the outcomes of two methods of physical frequently used. KEYWORDS: gait, stroke, biomechanics. FUNDING
therapy for in-patients with PD. IMPLICATIONS/CONCLUSIONS: ACKNOWLEDGEMENTS: Main financial support provided by: Heart
People with parkinson’s disease have a short stepped, slow, shuffling and Stroke Foundation of Ontario (Grants T-4649 and ST-2714);
gait with reduced arm swing, reduced trunk rotation, a forward Medical Research Council of Canada or Canadian Institutes of Health
stooped posture and reduced ankle power generation. The relative Research (MA-8178, ME-8296, MOP-57664), Health and Welfare
contributing factors to gait dysfunction in PwPD vary widely according Canada, and Ministry of Health, Ontario, (#04121).
to disease duration, advanced age, sex, coexisting medical conditions
and individual factors. Based on accurate clinical observations and
measurements of gait deviations (supplemented by 3-D gait analysis
where possible) physical therapists can plan effective gait training
programs tailored to individual needs. KEYWORDS: gait, falls,
Parkinson’s disease. FUNDING ACKNOWLEDGEMENTS: NHMRC,
ARC, The University of Melbourne
Focused Symposium Contribution explains and evaluates the new organisational models within health
302 Sunday 3 June 14:00 service agencies that have been responsible for a renaissance in the
VCEC Meeting Rooms 1-3 influence of health professionals in Australian healthcare agencies.
This contribution is part of Focused Symposium “PHYSIOTHERAPY Subsequently, these models, and the new professional identities
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS and managerial competencies that emerged as a result of them,
THERE A “BEST” MODEL?” number 255 were leveraged to create further opportunities for influence at the
PHYSIOTHERAPY AND ORGANISATIONAL STRUCTURE: state and national health system levels. Today, Australian health
MASSAGING THE ORGANISATION TO FACILITATE OUTCOMES professionals routinely obtain seats on executive level management
teams in health care agencies, they are a vital part of the decision-
Mueller J; Auckland District Health Board, Auckland, New Zealand making apparatus that feeds into government policy and they are
recognised by politicians as equal partners with medicine and
LEARNING OBJECTIVES: 1 To describe organisational structures
nursing as key members of the health workforce. In 2005, the
as they impact on physiotherapists in a hospital-based setting. 2
culmination of this change agenda was the formation of a national
To develop an understanding of change management challenges
health alliance drawing together health interests from all sectors
and issues for health professionals associated with significant
(health, higher education, community services) (private and public
organisational change. 3 To describe a model of organisational
sectors) (urban and rural) into one organisation – Allied Health
structure for hospital-based physiotherapists designed to provide
Professions Australia (AHPA). IMPLICATIONS/CONCLUSIONS: The
consumer-focussed quality care with a large health-care organ-
isation in New Zealand SUMMARY: This presentation outlines research outcomes associated with this study concludes that the
the professional issue of changes to the organisational structure organisational models in which health professionals find themselves
of the allied health service at Auckland District Health Board are important determinates of their influences within local, state
(ADHB) in New Zealand as it has impacted upon hospital-based and national health services. Without contextually appropriate
physiotherapists. It traces the initial steps of a journey on which organisational models the health professional voice can not be
ADHB hospital-based health professionals embarked to support a heard, nor incorporated within higher level decision-making circles.
vision of interdisciplinary and client centred work practices for all Underpinning the success of the new organisational models was the
professional groups. While this project leveraged learnings from recognition by health professionals that significant influence could
existing experience and literature, ADHB’s scale, organisational only be achieved by reducing the tyranny of tribalism and joining
culture and the limited timeframe created unique problems and with others professions under the umbrella of “allied health” to
solutions. IMPLICATIONS/CONCLUSIONS: A significant change create a new identity. That identity has involved a shift from a self-
management process was undertaken for hospital-based allied concept of “allied to medicine” to one of “allied to each other and
health staff, to restructure the work environment from the traditional the communities we serve”. KEYWORDS: Professional organisation,
single discipline departments to a mixed model of a health division organisational structure, professional power and influence. FUNDING
supported by a clearly defined professional leadership structure. ACKNOWLEDGEMENTS: University of Queensland Research Fel-
This work is contextualised within the New Zealand health-care lowship Scheme; Australian Research Council.
environment and the organisation, providing a model of health
structure that supports the individual professional disciplines as well
as positioning health professionals to further develop interprofes-
sional skills to meet complex consumer health needs. KEYWORDS: 328 Sunday 3 June 14:00
Physiotherapy, Organisational Structure, Interdisciplinary Teams. VCEC Meeting Rooms 1-3
FUNDING ACKNOWLEDGEMENTS: Nil. This contribution is part of Focused Symposium “PHYSIOTHERAPY
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS
THERE A “BEST” MODEL?” number 255
MANAGEMENT ARRANGEMENTS FOR HEALTH PROFESSIONS
320 Sunday 3 June 14:00
VCEC Meeting Rooms 1-3 Jenkins F; South Devon Health Services, England
This contribution is part of Focused Symposium “PHYSIOTHERAPY LEARNING OBJECTIVES: 1. To describe roles, responsibilities and
MANAGEMENT AND ORGANISATIONAL ARRANGEMENTS, IS duties of health professions managers 2. To communicate health
THERE A “BEST” MODEL?” number 255 professions managers’ views about the benefits and disadvantages
STRATEGIC CHOICES FOR AUSTRALIAN PROFESSIONAL of their current management arrangements. 3. To recommend
ORGANIZATION: A DECADE OF CHANGE the management domains that need to be considered when
evaluating the management structure of health professions services.
Boyce R; University of Queensland, Brisbane, Australia
SUMMARY: This presentation reviews the tasks undertaken by
LEARNING OBJECTIVES: (1) to describe and explain the health professions managers, the majority of whom were physio-
historical trajectory, organisational models and strategic initiatives therapists. Their opinions regarding the strengths and weaknesses
via which Australian health professionals have attained significant of their management arrangements are considered, and compared
and sustained political and policy influence at the level of national, with views on those who were employed in professional advisory
state and local health agencies and decision-making bodies. non-managerial roles. An assessment tool was jointly developed by
SUMMARY: In the late 1980s there was one universal way of Robert Jones and Fiona Jenkins following the study, which has been
organizing health professionals such as physiotherapists in Australian designed to assist those evaluating different management models
healthcare agencies. That organisational model was based on for health professions services to enable objective assessment of
medical management with very limited leadership and influence possible management structures. IMPLICATIONS/CONCLUSIONS:
opportunities for health professionals. The 1990s saw a period of Health professions managers are frequently challenged to consider
multiple policy reforms such as casemix funding, purchaser-provider the “best” management structure for their services. There continues
split, internal market reforms, patient-focused care, decentralized to be management restructuring of health professions services
management structures, clinical directorates and evidence-based world wide, with many different models in place. Health professions
practice. During this period of change the question of “who should managers have experience of working in different structures and
manage the health professions?” was addressed for the first time have opinions about what works well and where management
in a structured way in which professionals were able to play a reorganisation has had a detrimental effect of their ability to
role in determining their own future. This presentation describes, provide quality patient care. The assessment tool developed draws
together research in this subject spanning thirty years, and provides will be presented and the clinical implications of findings discussed.
managers with a method of comparing the merits of different KEYWORDS: breast cancer; exercise; upper limb; physical therapy.
management structures enabling them to ensure that a secure FUNDING ACKNOWLEDGEMENTS: Margaret McNeely is funded
evidence base underpins service management. KEYWORDS: Health by a studentship from the Alberta Heritage Foundation for Medical
Professions, Management Arrangements, Management Domains. Research.
FUNDING ACKNOWLEDGEMENTS: Nil
Focused Symposium Contribution 464 Monday 4 June 10:45
399 Monday 4 June 10:45 VCEC Ballroom A
VCEC Ballroom A This contribution is part of Focused Symposium “BREAST CANCER
This contribution is part of Focused Symposium “BREAST CANCER AND EXERCISE” number 243
AND EXERCISE” number 243 EXERCISE INTERVENTIONS IN BREAST CANCER PATIENTS:
MUSCULOSKELETAL DYSFUNCTION IN WOMEN WITH BREAST A META-ANALYSIS
CANCER
Campbell K; University of Alberta
Binkley J; TurningPoint Women’s Healthcare
LEARNING OBJECTIVES: The primary purpose of this systematic
LEARNING OBJECTIVES: 1. Understand the mechanisms of review is: 1) to examine the available evidence concerning the effect
musuloskeletal dysfunction in women with breast cancer, including of exercise in women with breast cancer and 2) to understand the
implications of surgery, radiation and lymphedema. 2. Understand the implications for clinical practice. SUMMARY: Margaret L. McNeely,
clinical implications and role of exercise in women with breast cancer Kristin L. Campbell, Brian H. Rowe, Terry P. Klassen, John R.
through an evidence-based case study. SUMMARY: Treatment Mackey, Kerry S. Courneya. A systematic review of randomized
for breast cancer has a multitude of physical and psychosocial controlled trials of exercise interventions in women with breast
implications relevant to physical therapy. The mechanisms of cancer was completed. The literature search included: Cochrane
musculoskeletal dysfunction, including lymphedema, related to breast Registry of Clinical Trials, MEDLINE, EMBASE, CINAHL, PsychInfo
cancer will be addressed. The presentation will include an evidence- and Cancerlit in addition to conference proceedings, clinical practice
based case study that will highlight the role of physical therapy guidelines, and other grey literature resources. Studies were required
and exercise for women with breast cancer, including lymphedema to be randomized controlled trials that examined exercise in women
and musculoskeletal dysfunction. IMPLICATIONS/CONCLUSIONS: with breast cancer. A comprehensive search identified 140 papers,
The residual effects of breast cancer treatment and the subsequent of which 14 were considered potentially relevant. Despite significant
role of physical therapy is not are not well identified. There is heterogeneity and relatively small sample sizes, the point estimates
significant evidence to support a more well-defined role for physical in terms of exercise benefits for all outcomes were positive even when
therapists in supporting wellness and quality of life following breast statistical significance was not achieved. Exercise led to significant
cancer. KEYWORDS: breast cancer, exercise, radiation effects, improvements in quality of life as assessed by the Functional
lymphedema. FUNDING ACKNOWLEDGEMENTS: Not Applicable. Assessment of Cancer Therapy-General and Functional Assess-
ment of Cancer Therapy-Breast. Exercise also led to significant
improvements in physical functioning, peak oxygen consumption and
Focused Symposium Contribution fatigue. IMPLICATIONS/CONCLUSIONS: This preliminary evidence
400 Monday 4 June 10:45 suggests that exercise is an effective intervention to improve
VCEC Ballroom A quality of life, cardiorespiratory fitness, physical functioning, and
This contribution is part of Focused Symposium “BREAST CANCER fatigue. Physical therapists could be playing a major role in the
AND EXERCISE” number 243 rehabilitation of women living with breast cancer, not only in providing
treatment but also by contributing to the knowledge base underlying
EXERCISE INTERVENTIONS FOR UPPER LIMB DYSFUNCTION
those treatments through rigorous and carefully conducted clinical
DUE TO BREAST CANCER
research. KEYWORDS: cancer, physical activity, aerobic fitness,
McNeely M; University of Alberta exercise, quality of life. FUNDING ACKNOWLEDGEMENTS: KL
Campbell and ML McNeely are supported by Studentships from the
LEARNING OBJECTIVES: To review recent research on upper ex-
Alberta Heritage Foundation for Medical Research
tremity rehabilitation for women living with breast cancer; and provide
clinical guidelines for upper extremity rehabilitation. SUMMARY: Post
surgical impairments from breast cancer include decreased shoulder Focused Symposium Contribution
range of motion (ROM), pain and numbness in the surgical area, 266 Monday 4 June 10:45
nerve injury, loss of strength in the upper extremity, and swelling VCEC Ballroom B & C
of the upper extremity and chest wall. The two most frequent
impairments from breast cancer treatment are shoulder dysfunction This contribution is part of Focused Symposium “MOVING ELEC-
and arm swelling, complications related to axillary lymph node TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED
dissection and axillary radiation therapy. Although the prevalence PRACTICE ENVIRONMENT” number 246
of impairments varies from study to study, the literature is clear RESEARCH EVIDENCE FOR WOUND HEALING WITH LOW
that a significant number of women have limitations in shoulder FREQUENCY ULTRASOUND
ROM and strength, as well as difficulties with functional activities.
Kloth L; Marquette University, Milwaukee, USA
While rehabilitative interventions after breast cancer surgery have
been noted to improve recovery of shoulder ROM and function, LEARNING OBJECTIVES: 1. Base on research evidence, compare
some controversy remains over the intensity and timing of the and contrast similarities and differences between traditional high
post-operative intervention, mainly surrounding issues of wound frequency and low frequency ultrasound (US). 2. Discuss indications,
drainage and seroma formation. The purpose of this systematic advantages and mechanisms of 25 kHz and 40 kHz US in promoting
review is to examine the evidence from randomised controlled trials chronic wound healing and the need for additional research. 3.
on the benefit of therapeutic exercise interventions in preventing Illustrate wounds of patients for which low frequency US was used
and/or minimising upper limb morbidity due to breast cancer to facilitate tissue repair. SUMMARY: Traditional or high frequency (1
treatment. IMPLICATIONS/CONCLUSIONS: Results of the review and 3 MHz) US has a long history of use by physical therapists
for the treatment of a variety of musculo-skeletal afflictions. The mobilising or stretching requires little more than anecdotal evidence
evidence supporting the use of high frequency US to promote for support. It is a very minor component of a treatment, has
healing of recalcitrant wounds is inconclusive. It seems reasonable few opportunity costs, is cheap, requires minimal user skills and
to assume that through the properties of cavitation and acoustic introduces few risks. By contrast, requiring a child to wear a visible
streaming, low frequency US has been shown to promote healing electrical stimulator for hours per day may have a considerable impact
of intractable chronic wounds by speeding debridement of necrotic on their life. The evidence required to justify this has clearly to
tissue, enhance enzymatic fibrinolysis, remove bacteria, reduce be considerably more convincing. IMPLICATIONS/CONCLUSIONS:
bacterial viability in biofilms and improve perfusion. Using saline This abstract has outlined 2 of the dimensions of evidence:
coupling, US at kHz frequencies may be delivered in contact scientific/clinical and strength of evidence. Moving the use of EPAs
or non-contact with wound tissues. Indications, contraindications, forwards in an evidence-based practice environment requires more.
advantages and mechanisms for the use of low frequency US Clinicians must use science and clinical research critically and
to augment wound healing will be presented as an example of effectively. They need a sufficient depth of scientific knowledge and
an EPA intervention that has had a delayed impact on clinical of the contributions of different clinical research methods. They must
practice. IMPLICATIONS/CONCLUSIONS: The use of US at kHz also be able to balance different types of evidence when insufficient
frequencies has been shown in vitro to enhance cellular processes is available or it’s contradictory. For example, contraindications to
involved in soft tissue repair and to promote wound healing using therapeutic ultrasound over epiphyses or electrical current over
in a limited number of clinical trials. Additional basic science a pregnant uterus are typically based on historical evidence of a
research is needed to clearly identify mechanisms by which low questionnable clinical relevance. Above all moving forwards requires
frequency US promotes wound healing. More clinical research is also being able to change practice in response to new evidence. This
needed to determine how chronic wound healing is affected by US is possibly the greatest barrier most of us face in an evidence-
treatments with different low frequencies. Are clinical observation and based environment. KEYWORDS: Electrophysical agents, evidence,
positive treatment outcomes alone, adequate justification for treating research. FUNDING ACKNOWLEDGEMENTS: None.
patients with existing and new EPA technologies? KEYWORDS:
Low frequency ultrasound, wound debridement, wound healing. Focused Symposium Contribution
FUNDING ACKNOWLEDGEMENTS: Funding not available
VCEC Ballroom B & C
Focused Symposium Contribution This contribution is part of Focused Symposium “MOVING ELEC-
305 Monday 4 June 10:45 TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED
VCEC Ballroom B & C PRACTICE ENVIRONMENT” number 246
This contribution is part of Focused Symposium “MOVING ELEC- ELECTROPHYSICAL AGENTS: THE CHALLENGE FOR
TROPHYSICAL AGENTS FORWARD IN AN EVIDENCE-BASED EDUCATION
PRACTICE ENVIRONMENT” number 246
Baxter D; School of Physiotherapy, University of Otago, New Zealand
RESEARCH-BASED EVIDENCE AND ELECTROPHYSICAL
AGENTS LEARNING OBJECTIVES: 1.to explore the salient issues in teaching
Robertson V; University of Newcastle, Newcastle, New South electrophysical agents (EPA) 2.to investigate how evidence can be
Wales, Australia incorporated to support teaching of EPAs; 3.to propose models for
effective teaching of EPAs. SUMMARY: Teaching of electrophysical
LEARNING OBJECTIVES: 1. To explore the types of evidence agents presented specific challenges for educators, including the
relevant to justifying using EPAs. 2. To investigate how evidence need to integrate knowledge from diverse fields (biophysics), variable
can support using EPAs. 3. To investigate the requirements of levels of evidence to support applications, and changing clinical
users evaluating EPAs. SUMMARY: Evidence of the effectiveness practice. In providing students with the requisite skills to be competent
of clinical interventions is integral to ethical practice. Dismissals of as ‘research-enabled’ practitioner, it is important that evidence
some uses of electrophysical agents (EPAs) as not supported by is seen in the widest sense to underpin teaching in the EPAs:
evidence from randomized controlled trials indicates an overly narrow i.e. at every level appropriate evidence should be provided to
interpretation of ‘evidence’. This abstract will outline two dimensions inform the biophysical basis of specific modalities, principles of
of evidence and other requirements necessary for users of EPAs application, and contraindications, as well as the indications for
in an evidence-based environment. Energy forms commonly applied treatment based on evidence of effectiveness. In the latter case,
clinically have well described physical properties. For example, many learning should provide students with the basis to appreciate the
effects of electrical currents depend upon the pulse duration and difference between internal and external validity in published studies.
frequency. Similarly, if a type of energy cannot pass through the IMPLICATIONS/CONCLUSIONS: Students need to be research-
skin barrier in sufficient quantities and to a sufficient depth its enabled practitioners if they are to practise autonomously. For this,
bioeffects may be very limited. Scientific knowledge like this is the they need to develop a knowledge of the scientific basis of treatment
first type of evidence adduced when evaluating EPAs. Contributing with EPAs, and of the relative contributions of different types and
sciences include chemistry, biophysics, microbiology and physiology. levels of evidence. KEYWORDS: Electrophysical agents, Evidence,
Future contributions will come as newer sciences develop alternative Teaching. FUNDING ACKNOWLEDGEMENTS: New Zealand Centre
methods of investigation. Clinical evidence is the second type of for Physiotherapy Research
evidence needed. It is essential for confirming that extrapolations
from science are justified. In vitro research findings often apply
only to very small volumes of fluid or necessarily oversimplified
research conditions. Clinical research introduces the complexities
of a living body and the commitment of a range of homeostatic
mechanisms designed to limit change and of patients’ idiosyncrasies
and preferences. All types of clinical research methods are justified
and can potentially add some valid information about the effectivenss
of an EPA. Ideally adequate scientific and clinical evidence is
available for each type of clinically used energy. This is unusual.
however. Another issue concerns the quality or strength of the
evidence required. Using infrared for superficial heating prior to
Focused Symposium Contribution Focused Symposium Contribution
326 Monday 4 June 14:00 431 Monday 4 June 14:00
This contribution is part of Focused Symposium “ADVANCES IN PUL- This contribution is part of Focused Symposium “ADVANCES IN PUL-
MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY
MUSCLE ADAPTATIONS” number 298 MUSCLE ADAPTATIONS” number 298
FATIGUE, INJURY AND TRAINING OF THE INSPIRATORY REHABILITATION OF COPD PATIENTS: THE CHALLENGE OF
MUSCLES IN COPD ADJUSTING THE SAILS
Reid W; Associate Professor and Co-ordinator of Research Gosselink R; Respiratory Rehabilitation and Respiratory Division,
Graduate Programs, School of Rehabilitation Sciences, University University Hospitals, and Department of Rehabilitation Sciences,
of British Columbia Faculty of Kinesiology and Rehabilitation Sciences, Katholieke
Universiteit Leuven, Leuven, Belgium
LEARNING OBJECTIVES: Following this session, the participant
LEARNING OBJECTIVES: Give insights and tools in the assessment
will be able to: 1. describe evidence supporting the benefit of
of COPD patients. SUMMARY: Rehabilitation programs should be
inspiratory muscles training in COPD; 2. describe evidence of
part of a larger decision tree including optimal medical therapy,
fatigue and injury of the inspiratory muscles in COPD; 3. outline
and non-pharmacological treatment options. The current programs
training precautions and guidelines for inspiratory muscle training for improve health related quality of life and exercise tolerance to
people with COPD. SUMMARY: Because many generic and disease a greater extent than any other intervention currently available
specific factors contribute to skeletal muscle dysfunction in COPD, for COPD patients. Pulmonary rehabilitation reduces health care
physiotherapists need to consider these injury promoting factors in utilization in patients with excessive utilization of health care
order to prescribe exercise that has an effective training stimulus resources. It has become clearer that patients at both ends of the
but minimizes injury. Inspiratory muscle training can reduce dyspnea disease spectrum can be good candidates for properly designed
and improve exercise tolerance but the literature has provided rehabilitation programs. The presence of muscle weakness is an
conflicting results. The first part of the presentation will provide indicator of favourable outcome. Psychosocial factors and disease
evidence from recent systematic reviews that support the benefit severity seem less important factors in the prognosis of outcome
of inspiratory muscle training on inspiratory muscle strength and of (multidisciplinary) pulmonary rehabilitation. Future research in
endurance, exercise capacity, dyspnea and quality of life for adults rehabilitation should focus on further fine-tuning the rehabilitation
with chronic obstructive pulmonary disease (COPD). We performed programs for individual patients. However the overwhelming evidence
a systematic review of the literature according to the Cochrane currently available is clearly sufficient for regulatory authorities to
Collaboration protocol using Medline and CINAHL databases. We conclude that there is an evidence base for reimbursement for pul-
compared inspiratory muscle training versus sham or no intervention; monary rehabilitation. IMPLICATIONS/CONCLUSIONS: Pulmonary
low versus high intensity inspiratory muscle training; and two different rehabilitation programs improve health related quality of life and
types of training devices. Meta-analyses revealed that targeted exercise tolerance to a greater extent than any other intervention
resistive or threshold inspiratory muscle training improved inspiratory currently available for COPD patients. Patent selection and tailoring
muscle strength and endurance, exercise capacity, and dyspnea programs to make these benefits as large and as long-lasting
compared to sham training whereas inspiratory muscle training as possible remains a major challenge. KEYWORDS: Pulmonary
without a target or threshold trainer did not show improvement in rehabilitation, prognosis, muscle weakness, psychosocial factors,
these variables. There was no conclusive evidence supporting the COPD. FUNDING ACKNOWLEDGEMENTS: None.
benefit of inspiratory muscle training on quality of life measures. The
second part of the presentation will present evidence of diaphragm Focused Symposium Contribution
injury in people with airflow obstruction and those who died with a
diagnosis of COPD. Morphometric analysis of hematoxylin and eosin
VCEC Ballroom B & C
stained diaphragm cross-sections showed that the percent cross-
sectional area (CSA) of abnormal muscle was 17.6% in patients This contribution is part of Focused Symposium “ADVANCES IN PUL-
going for thoracotomy and this CSA was significantly correlated to MONARY REHABILITATION: PERIPHERAL AND RESPIRATORY
airflow limitation. Post-mortem analysis of diaphragm cross-sections MUSCLE ADAPTATIONS” number 298
revealed a CSA of connective tissue to be increased in people with PERIPHERAL MUSCLE ATROPHY DEVELOPMENT IN CHRONIC
a diagnosis of COPD (24.2% versus 18.6%, respectively, in those OBSTRUCTIVE PULMONARY DISEASE
with and without a diagnosis of COPD). The percentage of abnormal Debigare R; Université Laval, Faculté de Médecine, Département
or injured diaphragm fibres was 28.4% versus 12.0%, respectively, de Réadaptation, Québec, Canada
in those with and without a diagnosis of COPD. These structural
LEARNING OBJECTIVES: This presentation should demonstrate
changes have significant clinical implications because animal models
the significant clinical consequences of peripheral muscle atrophy in
have demonstrated that structural changes of a lesser magnitude
COPD patients and describe some biochemical mechanisms related
result in force losses that can be 5 to 7-fold greater than the
to its initiation and development. In addition, exercise will presented
CSA of abnormal muscle. The last part of the presentation will as a potential tool to stop or slow down muscle atrophy development.
outline an integrative approach to exercise prescription that outlines SUMMARY: Among the clinical consequences of chronic obstructive
guidelines and precautions to optimize outcomes of inspiratory pulmonary disease (COPD), peripheral muscle atrophy is definitely
muscle training while minimizing the potential for undue fatigue an important issue. As the pulmonary disease progresses, afflicted
and muscle injury. IMPLICATIONS/CONCLUSIONS: Inspiratory patients will loose as much as 30% of their muscle mass impairing
muscle training is effective but underutilized by physiotherapists their functional status as well as their quality of life. More importantly
who prescribe exercise to people with stable COPD. Utilizing the peripheral muscle atrophy is responsible for an increased risk of
appropriate training device, careful monitoring and progression of mortality independently of the lung disease. Muscle mass is a
training intensity will ensure effective training while minimizing tight balance between protein synthesis and degradation. Hints
untoward responses. KEYWORDS: Respiratory, Muscles, Exercise. regarding hypertrophying and atrophying signalling are accumulating
FUNDING ACKNOWLEDGEMENTS: British Columbia Lung Associ- in different catabolic models but are still obscure in COPD. In
ation, Ontario Respiratory Care Society general, protein catabolism is predominant and muscle atrophy will
develop progressively. The Ubiquitin-Proteasome system, an ATP- are important to understand to ensure that we are meeting the
dependant proteolytic system, is degrading contractile proteins in functional and psychosocial needs of the users of FES. KEYWORDS:
muscle tissue. Its proteolytic activity thoroughly increases during pediatrics, FES, psychosocial. FUNDING ACKNOWLEDGEMENTS:
catabolic conditions. There are evidences that it would be also These studies have been funded by Shriners Hospitals for Children,
the case in peripheral muscle of patients with COPD. Precise Grants 8530 and 8540.
factors initiating muscle wasting in COPD are still unknown. Using
different models such as cell culture, animal models and human Focused Symposium Contribution
muscle biopsies, we are currently exploring plausible causes in our 511 Tuesday 5 June 09:00
laboratories including hypoxia, inflammation and oxidative stress. VCEC Ballroom B & C
IMPLICATIONS/CONCLUSIONS: Because of its clinical implication
(morbidity and mortality) in several chronic diseases, peripheral This contribution is part of Focused Symposium “FES THERAPY
muscle wasting is an important problem to study. It is based on AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL,
accurate knowledge of the biochemical mechanisms underlying BIOENGINEERING OUTCOMES” number 417
peripheral muscle atrophy initiation and development that the medical FUNCTIONAL RESPONSE TO FES GAIT TRAINING AND
community will be in an advantageous position to design and NEUROPROSTHESIS AFTER SCI
implement efficient therapies aimed at stopping or slowing down the Daly J; Case Western Reserve Un and DVA Cleveland Medical
progression of muscle wasting in patients with COPD. KEYWORDS: Center
Muscle atrophy, COPD, proteolysis, proteasome, inflammation, hy-
poxia, oxidative stress. FUNDING ACKNOWLEDGEMENTS: None. LEARNING OBJECTIVES: Learning objectives: Following this
presentation, participants will be able to: 1) Describe the advantages
of various FES systems for standing and walking. 2) Discuss
Focused Symposium Contribution the limitations of these system. 3) Appreciate how differences in
459 Tuesday 5 June 09:00 patient characteristics help determine the most suitable form of FES
VCEC Ballroom B & C SUMMARY: Loss of mobility and walking after spinal cord injury (SCI)
is debilitating from a physical and emotional standpoint. Functional
This contribution is part of Focused Symposium “FES THERAPY
electrical stimulation (FES) has shown promise for restoration of
AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL,
mobility for both motor incomplete and complete SCI. Several
BIOENGINEERING OUTCOMES” number 417
research groups have studied the feasibility of using FES for gait
FES APPLICATIONS IN PEDIATRIC SCI AND PSYCHOSOCIAL training, finding that FES with surface stimulation can be a practical
ASPECTS OF FES approach for training sessions and when few channels of stimulation
are required. Response to surface FES gait training has shown
Johnston T; Shriners Hospitals for Children, Philadelphia, PA
promise for those with motor incomplete SCI. According to measures
LEARNING OBJECTIVES: 1) Describe the unique aspects of of spasticity (pendulum test), and walking speed, FES + treadmill
children in relation to FES use. 2) Discuss past and current research showed greater absolute gains versus other gait training methods.
with FES for children with SCI. 3) Discuss the psychosocial aspects of For those with complete SCI, one promising approach is the use
FES use for children and adults. SUMMARY: The majority of the work implanted FES technology as a prosthetic device. In the 1980’s,
with functional electrical stimulation (FES) for individuals with spinal one research team demonstrated that a multi-channel system (up to
cord injury (SCI) has focused on adults. However, children with SCI 12 channels per limb) could be coordinated in correct sequencing
can also benefit from these applications and perhaps have greater and timing to provide stance and swing phase gait components,
potential to succeed with FES due to their desire to move, explore, for those with complete SCI, that closely resembled normal gait.
and learn. In addition as children’s systems are still developing, there More recently, a more compact system of 8 or more channels per
is potentially greater neuroplasticity of the nervous system, providing limb showed the capability of providing mobility functions such as
unique opportunities for children. Research on FES for children with transfers; standing; one-handed reaching; forward, side, and back
SCI has examined percutaneous and implanted FES systems for stepping; and stair ascent and descent. The implanted components
standing and walking, hand function, and bladder and bowel function. of this system include the intramuscular electrodes and a multi-
Implanted systems require accommodation for growth as children as channel receiver-stimulator, a passive pacemaker-like device that
young as 7 years old have participated in these studies. Growth and receives power and command signals from a wearable external
electrode responses are continuing to be monitored until maturity control unit. In an effort to reduce the energy cost of FES-driven
is reached. More recently, surface stimulation has been applied gait, researchers have investigated the hybrid system of FES and
for FES cycling for children with SCI, as a cycle is now available bracing. At slow speeds, the hybrid system requires less energy
to accommodate the size of children. Research in this area is cost than does bracing alone or FES alone. For long-distance
ongoing to examine the potential for cardiovascular, musculoskeletal, walking this is a promising finding. IMPLICATIONS/CONCLUSIONS:
and neurological changes to determine if improvements occur in For long-term clinical applications in complete SCI, implanted
children. Literature reports success in these areas with adults, but systems provide advantages over surface FES systems, including
children have been excluded. An additional aspect of FES is its reliability, repeatability, convenience, cosmesis, and maintenance.
psychosocial benefits for children and adults with SCI. Studies have For individuals with incomplete SCI, surface systems my provide
reported improvements in the ability to interact with others and improved mobility without the invasiveness of the implanted systems.
the environment. Increased independence seen with FES can lead KEYWORDS: Spinal Cord Injury, Gait, Mobility, Functional Electrical
to increased self-esteem and an overall sense of feeling good. Stimulation. FUNDING ACKNOWLEDGEMENTS: Department of
Users of FES systems for standing have reported that they enjoy Veterans Affairs, Rehabilitation Research and Development Service;
looking eye to eye with people and those with FES systems for National Institutes of Health; Department of Defense
bladder function report greater freedom within the community due
to decreased fear of incontinence. IMPLICATIONS/CONCLUSIONS:
This presentation will first focus on the unique aspects of FES use
for children with SCI and will discuss issues due to growth and
development. Some of these considerations may also apply to adults
with pediatric-onset SCI, so are important to physical therapists
treating children and/or adults with SCI. The second part of the
presentation will discuss the psychosocial aspects of FES use, which
Focused Symposium Contribution Focused Symposium Contribution
521 Tuesday 5 June 09:00 451 Tuesday 5 June 14:00
This contribution is part of Focused Symposium “FES THERAPY This contribution is part of Focused Symposium “PROMOTING EF-
AFTER SCI: FUNCTIONAL, PHYSIOLOGICAL, PSYCHOSOCIAL, FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY
BIOENGINEERING OUTCOMES” number 417 IN NEUROLOGICAL CONDITIONS.” number 287
NEW DEVELOPMENTS IN FES TECHNOLOGY FOR SCI RETHINKING REHABILITATION AND RECOVERY – THE
REHABILITATION BRAIN-BEHAVIOR CONNECTION
Prochazka A; Centre for Neuroscience, University of Alberta, Winstein C; University of Southern California, Los Angeles, United
Edmonton, AB, Canada States
LEARNING OBJECTIVES: Following this presentation, participants LEARNING OBJECTIVES: 1. Critique current treatment protocols in
will be able to: 1) Discuss the applications of FES for upper extremity, neurologic rehabilitation for scientific rationale pertaining to intensity,
lower extremity, respiratory and bladder function. 2) Appreciate the duration, and contents. 2. Evaluate a new conceptualization of the
possible role of implanted spinal cord stimulators in the restoration problem of stroke-hemiparesis that incorporates the important con-
of movement after SCI 3) Discuss the role of BIONS and other structs of skill, capacity, and motivation. 3. Assess the Accelerated
neural prostheses in restoration of functional movement. 4) Discuss Skill Acquisition Protocol (ASAP) which incorporates principles of skill
the role of automated, FES-assisted exercise therapy. SUMMARY: development derived from the fields of psychological science, social-
While neural regeneration after spinal cord injury (SCI) will likely cognitive neuroscience, and exercise/movement science. 4. Review
be possible at some time in the future, it is also likely that real case examples that capture, patient-therapist collaboration, self-
some functions will not be fully restored. Neural prostheses may management and problem-solving, and the promotion of self-efficacy
be used to restore functions lost due to damage of the spinal for persistent and sustainable outcomes. SUMMARY: What critical
cord. In addition to providing or augmenting limb movement, neural ingredient binds together, brain plasticity, recovery, and function?
prostheses can be used to restore high priority functions such Significant growth and interest in the field of rehabilitation medicine
as bladder control and respiration. Epidural spinal cord stimulators has been fueled in part by advances in rehabilitation science within
have been shown to improve walking function in individuals with an interdisciplinary research model. More importantly, research in
SCI, and in animal models of SCI, stimulators implanted directly rehabilitation has witnessed the application of the scientific method to
into the spinal cord can control the activation of lower extremity specific functional problems such as recovery of upper extremity (UE)
muscles. Improvement in bladder and bowel function is a high use after stroke hemiparesis. Recently, this translational research
priority for many SCI people. In the last five years a number of has spawned various protocol based treatments, for example, to
biomedical engineering developments have occurred that will likely enable use of the hemiparetic UE in adults with sub-acute stroke.
lead to significant advances in the rehabilitation and evaluation of However, if rehabilitation medicine is to join the ranks of other
quadriplegia and hemiplegia. Three new surface stimulators have evidence-based medical and pharmaceutical practices, objective
recently entered the North American marketplace: the H200 hand treatment protocols will become a necessary component of valid
stimulator and the Odstock and WalkAide footdrop stimulators. efficacy and effectiveness research. The development of specific and
Several groups are studying the efficacy of FES-assisted intensive objective rehabilitation treatment protocols will be a clear signal of
exercise therapy for hand function. A variety of instrumented exercise progress in the field of rehabilitation medicine. At present, the majority
workstations and robotically-assisted devices are in clinical trials. At of published protocols in neurologic rehabilitation lack an explicit
least three new types of implantable neural prostheses are at various scientific rationale for the intensity, duration, and most importantly,
stages of testing: the Bion microstimulator, the Neurodan footdrop the contents (e.g., task-specific versus muscle-specific) of training
stimulator and a new passive neural prosthesis, the “Stimulus within the rehabilitation treatments. Without an explicit rationale (or
Router.” The applications include shoulder subluxation, hand function, even hypothesis), the precise parameters of training for a given
incontinence and footdrop. Biomechanical evaluation devices are rehabilitation treatment can take on a mythical quality with hidden
gradually replacing qualitative evaluation of spasticity and motor meaning at worst, and lead to “blind” following at best. This process
function in ADL. IMPLICATIONS/CONCLUSIONS: It seems that undermines scientific enquiry and in some cases tends to hinder the
the long-awaited emergence and availability of new technologies development of alternative and innovative approaches. For example,
in rehabilitation is now fully underway, most significantly in the why is the signature constraint-induced therapy (CIT) protocol of 6
commercial arena. New FES garments, and the emergence of h/day (60 h total) with one-on one supervised training for no less
automated exercise workstations and devices that quantify outcomes than a 2-week period “optimal” for reversing learned non-use? How
is changing the way motor rehabilitation is performed and assessed. important is the “constraint” within a CIT training protocol? These
More must be known about how implanted neural prostheses interact rhetorical questions provide the starting point for the development
with the nervous system over the long term. KEYWORDS: Functional of a new conceptualization of the problem of stroke-hemiparesis
electrical stimulation, neural prostheses, FES-assisted exercise ther- that incorporates the important constructs of skill, capacity, and
apy, bladder control. FUNDING ACKNOWLEDGEMENTS: Funded motivation. My presentation will describe this new conceptual model
by ISRT, NIH, CIHR and AHFMR and an emergent treatment protocol recently developed, named
the Accelerated Skill Acquisition Program (ASAP). The ASAP
protocol incorporates principles of skill development derived from
the fields of psychological science, social-cognitive neuroscience,
and exercise/movement science. Video clips will illustrate the
translation of these principles into practice with real case examples
that capture, patient-therapist collaboration, self-management and
problem-solving, and the promotion of self-efficacy for persistent
and sustainable outcomes. IMPLICATIONS/CONCLUSIONS: The
emerging interdisciplinary field of social cognitive neuroscience
provides an excellent foundation for addressing the complex
problems of neurorehabilitation that include motivation, behavior
change and persistance. KEYWORDS: skill, capacity, motivation,
recovery. FUNDING ACKNOWLEDGEMENTS: National Institutes of
Health (NIH)
Focused Symposium Contribution transport during arm swinging, reaching and for hand orientation
460 Tuesday 5 June 14:00 during grasping. Despite widespread use of motor compensations,
VCEC Ballroom B & C studies of therapeutic effectiveness focus on task accomplishments
This contribution is part of Focused Symposium “PROMOTING EF- as outcome measures with less consideration of how functional
FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY gains are achieved: by recovery of lost movement elements or by
IN NEUROLOGICAL CONDITIONS.” number 287 increased use of compensations. Since increased compensation may
EVIDENCE SUPPORTING FOCUSED UPPER LIMB TREATMENT potentially limit recovery of lost movement elements, it is essential
TECHNIQUES IN STROKE REHABILITATION to describe effective training paradigms that reduce compensations.
This presentation will review how the trunk is used to compensate for
Wolf S; Emory University School of Medicine, Atlanta, Georgia, distal motor control deficits. A model of disordered motor control for
United States reaching will be presented. Results will be also presented of a double-
LEARNING OBJECTIVES: 1. To understand how findings from blind randomized control trial of a therapist-supervised home program
animal studies contribute to the evidence for effective upper (3x/wk, 5 weeks) in 30 patients with chronic hemiparesis stratified
limb rehabilitation among patients with stroke. 2. To differentiate by arm impairment level (Fugl-Meyer). The intervention group
between training approaches based upon repetitive use of the more (TR) received progressive object-related reach-to-grasp training with
affected upper limb of patients with stroke and determine their prevention of trunk movements. The control group (C) practised
applicability. 3. To familiarize participants with use of contemporary tasks without trunk restraint. Main outcome measures were upper
technologies such as TMS and neuroimaging as vehicles that provide limb impairment (Fugl-Meyer Arm Section) and function (TEMPA)
evidence to expose mechanisms contributing to improvement in and movement kinematics (trunk displacement, elbow extension;
clinical outcomes from focused upper limb treatment in patients Optotrak, 10 trials) of a reach-to-grasp movement. Evaluations were
with stroke. SUMMARY: Investigations in animal models of stroke repeated before, immediately and 1 month post-intervention by blind
have demonstrated that repetitive use that challenges problem evaluators. TR training led to greater improvements in impairment
solving can lead to anatomical and physiological evidence of cortical and function compared to C. Improvements were accompanied
reorganization. Findings suggestng these types of improvement have by increased active joint range and were greater in initially more
been observed among patients with acute, sub-acute and chronic severe patients. In these patients, TR decreased trunk movement
stroke who have undergone constraint induced movement therapy, and increased elbow extension while C had opposite effects
functional training or strengthening programs. This presentation (increased compensatory movements). In TR, changes in arm
provides evidence from the EXCITE Trial and other studies to function were correlated with changes in arm and trunk kinematics.
demonstrate the clinical effectiveness of these forms of training IMPLICATIONS/CONCLUSIONS: Basic motor control research has
and to relate these improvements to measures of cortical plas- described mechanisms by which deficits in arm motor function
ticity obtained through transcranial magnetic stimulation and fMRI may be compensated by trunk movements. Evidence suggests that
studies. IMPLICATIONS/CONCLUSIONS: Efforts to define patient interventions aimed at arm motor recovery should be tailored to arm
criteria that predict persistent improvement in upper limb function impairment severity with particular attention to controlling excessive
following stroke is a critical issue in neurorehabilitation.Identifying trunk movements if the goal is to improve arm movement quality.
clinical approaches, such as constraint induced movement therapy, KEYWORDS: Knowledge translation, motor control, motor learning,
functional training and strengthening exercises, and defining the upper limb rehabilitation, treatment effectiveness, evidence-based
attributes of those patients who best benefit from these interventions practice. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of
afford physical therapists the opportunity to optimally target treatment Health Research (CIHR), National Science and Engineering Council
approaches. The interface between tools to assess elements of of Canada (NSERC)
neuroplasticity and interventions yielding clinical improvement forms
the cornerstone of linking the art and science underlying stroke
neurorehabilitation. KEYWORDS: cerebrovascular accident, hemi- Focused Symposium Contribution
plegia, upper limb, constraint induced movement therapy, forced use, 361 Tuesday 5 June 16:15
strengthening exercise, transcranial magnetic stimulation, functional VCEC Ballroom B & C
magnetic resonance imaging. FUNDING ACKNOWLEDGEMENTS: This contribution is part of Focused Symposium “CONSERVATIVE
Work described in this presentation was supported in part from NIH TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” num-
Grants R01 HD37606 and HD 40984, National Center for Medical ber 209
Rehabilitation Research of the National Institute of Child Health and
Human Development. ABNORMAL LOWER EXTREMITY MECHANICS AND
PATELLOFEMORAL DYSFUNCTION: IMPLICATIONS FOR
TREATMENT
485 Tuesday 5 June 14:00 Powers C; University of Southern California
VCEC Ballroom B & C LEARNING OBJECTIVES: 1) Describe the influence of abnormal
This contribution is part of Focused Symposium “PROMOTING EF- lower extremity mechanics on patellofemoral joint dysfunction. 2)
FECTIVE INTERVENTIONS FOR UPPER EXTREMITY RECOVERY Plan appropriate treatment interventions for the patellofemoral joint
IN NEUROLOGICAL CONDITIONS.” number 287 based on a dynamic assessment of the lower extremity. SUMMARY:
COMPENSATION AND RECOVERY OF REACHING IN PATIENTS Patellofemoral pain (PFP) is recognized as being one of the most
WITH STROKE common disorders of the lower extremity. Despite its high prevalence
however, the clinical diagnosis and treatment of this condition
Levin M; School of Physical and Occupational Therapy, McGill
remains vague and highly controversial. The premise behind most
University, Montreal, Canada
treatment approaches is that PFP is the result of abnormal patellar
LEARNING OBJECTIVES: 1) to understand how compensatory tracking and/or patella malalignment. Given as such, interventions
movements of the trunk are used to assist in the accomplishment typically focus on the joint itself and have traditionally included
of reaching and grasping in patients with stroke; 2) to evaluate vastus medialis oblique (VMO) strengthening, taping, bracing, soft
the effectiveness of a treatment intervention aimed at diminishing tissue mobilization, and patellar mobilization. More recently, it has
motor compensations of the trunk on reaching and grasping in been recognized that the patellofemoral joint and therefore PFP
patients with stroke. SUMMARY: Trunk anterior displacement is a can be influenced by the interaction of the segments of the lower
compensatory movement used by patients with hemiparesis for arm extremity. For example, abnormal motions of the tibia and femur
in the transverse and frontal planes can have a substantial effect play a considerable role in maintaining an optimal lower limb
on patellofemoral joint mechanics. In particular, internal rotation alignment during weight bearing activities. Reduced strength or
of the femur and valgus at the knee (achieved through thigh neuromotor control of these muscles may be associated with an
adduction and/or tibial adduction) can increase the lateral forces increase in hip internal rotation and adduction, with deleterious
acting on the patella. Although structural deformities can lead to consequences at the tibiofemoral and patellofemoral joints. Current
alignment abnormalities (i.e. femoral anteversion), in many cases, research has indicated that the activity of the hip muscles may
abnormal lower extremity kinematics can be observed through a be compromised in individuals with patellofemoral pain. Similar to
dynamic functional assessment. IMPLICATIONS/CONCLUSIONS: vasti muscle dysfunction, individuals with hip muscle dysfunction
There is growing research and clinical support for the concept form a subgroup on those with patellofemoral pain. Further research
that dynamic lower limb alignment can be achieved through has aimed at identifying individuals with hip muscle dysfunction.
strengthening and improving neuromuscular control. With this in Combined interventions that have incorporated hip muscle retraining
mind, interventions aimed at controlling hip and pelvis motion have been shown to be effective and efficacious for patellofemoral
(proximal stability) and ankle/foot motion (distal stability) may be pain. However, as this is an emerging area of research, further
warranted and should be considered in this population. However, scientific evidence is required to confirm the role of hip muscle
the necessity for such interventions should be determined by a dysfunction in the development and management of patellofemoral
thorough biomechanical/functional evaluation as not all patients with pain. IMPLICATIONS/CONCLUSIONS: Dysfunction of the vasti
PFP demonstrate lower limb abnormalities and/or lack of dynamic and/or the hip muscles may result from or contribute to PFPS and
control. By addressing all factors that may influence patellofemoral should be evaluated and addressed as part of a comprehensive
joint mechanics, better long term treatment success and prevention rehabilitation. KEYWORDS: quadriceps, vasti, hip, patellofemoral
of PFP can likely be achieved. KEYWORDS: Patellofemoral joint; pain. FUNDING ACKNOWLEDGEMENTS: National Health and
Biomechanics; Intervention; Lower extremity kinematics. FUNDING Medical Research Council (Australia)
ACKNOWLEDGEMENTS: None.
Focused Symposium Contribution 527 Tuesday 5 June 16:15
522 Tuesday 5 June 16:15 VCEC Ballroom B & C
VCEC Ballroom B & C
This contribution is part of Focused Symposium “CONSERVATIVE
This contribution is part of Focused Symposium “CONSERVATIVE TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” num-
TREATMENT OF PATELLOFEMORAL PAIN SYNDROME” number 209
ber 209
MUSCLE STRENGTH IN PATELLOFEMORAL PAIN SYNDROME:
HIP AND VASTI ACTIVATION IN THE MANAGEMENT OF PFPS TESTING AND TRAINING
Crossley K; University of Melbourne, Australia Werner S; Section of Sports Medicine, Karolinska Institute,
Stockholm, Sweden
LEARNING OBJECTIVES: After attending the presentation, the
participant will: (a) Be aware of the scientific and clinical rationale LEARNING OBJECTIVES: The objectives are: 1. To present
for hip and vasti activation in the development and treatment of the optimal way of measuring thigh muscle strength in patients
patellofemoral pain. (b) Understand the scientific evidence related to with patellofemoral pain syndrome (PFPS). 2. To explain how to
hip and vasti retraining in the management of patellofemoral pain. improve imbalance between vastus medialis and vastus lateralis in
SUMMARY: The vastus medialis obliquus (VMO) has long been patients with PFPS.3. To describe different ways of strengthening
considered to be implicated in patellofemoral joint dysfunction and the quadriceps muscle in patients with PFPS. SUMMARY: The
pain. This is mostly due to its anatomy and function as a medial quadriceps muscle is often weakened in patients with patellofemoral
stabilizer of the patellofemoral joint and the clinical observation pain syndrome (PFPS). In particular, hypotrophy of vastus medialis
of its wasting in individuals with anterior knee pain. Therefore, (VM) is common and it is the weakest and most vulnerable muscle
many physical therapy interventions have focused on training the of the extensor mechanism. Manual muscle testing comparing each
VMO as part of the rehabilitation. Current research has identified side gives a rough awareness of quadriceps strength. If possible,
a relationship between vasti dysfunction and patellofemoral pain, isokinetic measurement of quadriceps torque is recommended.
particularly the imbalance in the activation patterns of the VMO During isokinetic measurement it is preferable to evaluate whether
and the vastus lateralis (VL). However, conjecture remains over the pain inhibition might interfere with the “true” result of muscle torques.
relationship between vasti dysfunction and patellofemoral pain. The This could be done with twitch interpolation technique and also to
disparity in the evidence may be attributed to a number of factors, some extent with Borg’s pain scale or the visual analogue scale.
but the most likely explanation is that the aetiology of patellofemoral Several authors have emphasized the importance of quadriceps
pain is multifactorial. Individuals with vasti dysfunction comprise training in patients with PFPS to improve the extensor mechanism.
a subgroup in the entire cohort of individuals with patellofemoral Functional ability has been reported to be associated with increased
pain. While generalized quadriceps strengthening can be effective ability to generate quadriceps torque. The main objective is to
in reducing patellofemoral pain, the subset on individuals with strengthen VM, since appropriate timing and intensity of VM obliquus
vasti dysfunction may require specific training or retraining of the activation relative to vastus lateralis (VL) has been promoted as a key
vasti. This is especially the scenario for those with recalcitrant aspect in patients with PFPS. The balance between VM obliquus and
or recurrent symptoms. Vasti re-training has been shown to be VL should be restored before starting to train the entire quadriceps
efficacious in the management of patellofemoral joint dysfunction muscle group. The literature provides many suggestions to improve
when combined with other therapies (patellar taping, hip muscle VM by different exercises. However, transcutaneous electrical muscle
training and mobilisation). Furthermore, this combined intervention stimulation is the optimal way proven to selectively contract and
can improve the onset of VMO activity. While traditionally, the major improve the function of VM. Earlier authors have recommended
clinical and research interest has been targeted to the local knee isometric quadriceps training in order to decrease knee pain by
muscles of the tibiofemoral and patellofemoral joints, it has long reduced patellofemoral compression. However, isometric exercises
been recognized by clinicians that hip muscle function (strength or are time consuming, since strength is mostly gained at the fixed
co-ordination) may be impaired in individuals with patellofemoral position. Isometric training doesn’t improve functional performance
pain. This clinical observation has sparked more recent research and could therefore be questioned in patients with PFPS. Isokinetic
interest in pelvis and hip muscle contributions to patellofemoral quadriceps training has been suggested as a possible treatment
pain. Hip muscles (particularly the abductors and external rotators) for strengthening the quadriceps muscle, especially eccentrically, in
patients with PFPS. Quadriceps can be strengthened during closed patients. Subgroup analyses can be used to identify subgroups
as well as open kinetic chain exercises. In order to reduce the who respond better than others. Examples will be given based on
patellofemoral joint reaction forces closed kinetic chain exercises research in low back pain or shoulder pain. Subgroup analyses
have been reported to be trained during the last 30–40º of knee can generate interesting hypotheses to be tested in subsequent
extension and open kinetic chain exercises between 90º and 40º trials, but rarely provide conclusive results and may even lead to
of knee flexion. When the quadriceps muscle has improved and ‘data dredging’. The use and disuse of subgroup analyses will
a good balance exists within the extensor mechanism, functional be discussed. IMPLICATIONS/CONCLUSIONS: Although several
training with gradual increase of knee loading exercises could begin. obstacles need to be overcome when designing RCTs, high
There is a wide variation of functional knee loading exercises with quality studies can be successfully undertaken, and can provide
different heavy demands upon both the quadriceps muscle and the relevant evidence on the effectiveness of complex physiotherapy
knee joint. IMPLICATIONS/CONCLUSIONS: The isokinetic method interventions in patients with musculoskeletal pain. KEYWORDS:
is the most objective way of measuring thigh muscle torques. Cluster-randomization, patients preferences and expectations, sub-
Twitch interpolation technique used simultaneously with muscle group analyses. FUNDING ACKNOWLEDGEMENTS: The research
strength measurements is an objective way of evaluating whether presented was sponsored by The Netherlands Organization for
pain inhibition interferes with “true” muscle torques. Transcutaneous Health Research and Development and the Dutch Health Insurance
electrical muscle stimulation is the optimal way of improving the Council.
activity and function of VM. Isokinetic training is a good way of
quadriceps strengthening, in particular during eccentric actions in Focused Symposium Contribution
patients with PFPS. KEYWORDS: Anterior knee pain; Extensor
410 Wednesday 6 June 10:45
mechanism; Muscle activity. FUNDING ACKNOWLEDGEMENTS:
VCEC Ballroom B & C
The studies were supported by grants from the Swedish National
Center for Research in Sports, Stockholm, Sweden. This contribution is part of Focused Symposium “RANDOMIZED
TRIALS IN COMMON MUSCULOSKELETAL PROBLEMS: CHAL-
LENGES AND FUTURE DIRECTIONS” number 291
WHAT HAVE WE LEARNED FROM HIGH QUALITY RANDOMIZED
CONTROLLED TRIALS?
VCEC Ballroom B & C
Dziedzic K; Primary Care Sciences Research Centre, Keele
This contribution is part of Focused Symposium “RANDOMIZED
University, UK
LENGES AND FUTURE DIRECTIONS” number 291 LEARNING OBJECTIVES: This session will provide an opportunity
OVERCOMING THE CHALLENGES OF RANDOMIZED TRIALS for participants to Review the evidence from examples of high
OF MUSCULOSKELETAL PAIN quality, randomized controlled trials of physical therapy in the area
of low back and neck pain. Consider the studies in terms of patient
Van der Windt D; EMGO Institute and Department of General
selection, interventions delivered and outcomes measured. Reflect
Practice, VU Universiy medical center, Amsterdam, The Netherlands
on the implications of the findings of such studies SUMMARY: The
LEARNING OBJECTIVES: − Participants understand the advan- findings of large, well-conducted randomized controlled trials (RCTs)
tages and disadvantages of cluster-randomization. − Participants are widely considered the gold standard source of evidence for
are aware of the potential influence of patient expectations and the effectiveness of different treatment approaches. The RCT can
preferences on the outcome of intervention studies. − Participants address clinically important questions relevant to both patients and
understand the use and disuse of subgroup-analyses in randomised physical therapists by asking ‘is this treatment helpful on average for
controlled trials. SUMMARY: The randomised controlled trial (RCT) a wide range of patients?’. In line with findings of systematic reviews
is considered to be the tool providing the strongest evidence on in the area of musculoskeletal pain disorders, there is a clear trend
the effectiveness of physiotherapy interventions. However, designing towards large, high quality RCTs showing either no differences or
RCTs that evaluate the effectiveness of complex physiotherapy very small differences between different physical therapy approaches
interventions is not without challenges. In this presentation three to the management of a range of musculoskeletal pain disorders.
methodological problems encountered in RCTs will be discussed, Where differences are seen, although statistically significant their
along with the measures that can be taken to solve these clinical importance remains unclear. Key decisions are made when
issues. Specific examples will be given using published RCTs designing RCTs in physical therapy. Identifying the patient population,
evaluating primary care interventions for shoulder pain or back choosing interventions for the trial protocol and selecting outcome
pain. 1) Randomization of individual patients within a physiotherapy measures are all critical in designing a high quality study. A study
practice may not always be possible, especially when specific skills population needs defining according to eligibility criteria. The trial
are required to carry out a complex intervention. Newly learnt requirements are that large numbers of participants are recruited
skills may be (partly) transferred to patients in the control group as quickly as possible. In order to do this, eligibility criteria need
leading to contamination and a reduction of contrast between to be very broad. Patients in the study should reflect the people
interventions. Cluster-randomization (randomization of therapists who present with the condition in routine practice. The problem in
rather than individual patients) may solve this problem, but has musculoskeletal pain is that diagnostic classification is still somewhat
several disadvantages. Some of the pro’s and con’s of cluster- limited and its reliability in practice is not fully established. Therefore
randomization will be discussed. 2) In RCTs evaluating complex an approach adopted in primary care is to define cases quite broadly,
physiotherapy interventions it is often not possible to blind patients or excluding only people with red flags. With all these issues in mind
therapists to the allocated treatment. Patients may have preferences one approach is to be pragmatic e.g. a trial of physical therapy for
or expectations regarding the interventions under study, which may neck pain in primary care (1). The implications of this approach will
influence their response to therapy. Similarly, therapists may prefer be examined. 1. Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay
certain treatments or expect a better outcome of specific interventions EM. Effectiveness of manual therapy or pulsed shortwave diathermy
in individual patients. We assessed the influence of patient and in addition to advice and exercise for neck disorders: A prag-
therapist preferences on treatment outcomes in RCTs evaluating matic randomized controlled trial in physiotherapy clinics. Arthritis
primary care interventions for shoulder pain and knee pain. 3) Some Rheum. 2005;53(2):214-22. IMPLICATIONS/CONCLUSIONS: The
patients may respond better to specific physiotherapy interventions session will enable experienced clinical trialists, experienced clinical
than others. RCTs usually present an ‘average’ treatment effect, practitioners and others, interested in improving the quality of
which may obscure this variation in treatment response across the evidence from randomized controlled trials (RCTs) in physical
therapy, to examine what influences the findings of RCTs of not only advances that will impact clinical care, but also represent
musculoskeletal pain problems. An example of a pragmatic RCT important advances in research methodology that can enhance
of physical therapy approaches for common neck disorders will be the power of future research. Considering the economic as well
used to highlight issues of case definition, treatment selection and as clinical outcomes of physical therapy interventions will also
outcome measurement. KEYWORDS: Randomized controlled trial be an important consideration in future research. KEYWORDS:
design, musculoskeletal pain, evidence based practice. FUNDING patient sub-groups, clinical classification, clinical prediction rules,
ACKNOWLEDGEMENTS: The Arthritis Research Campaign, UK; economic analysis. FUNDING ACKNOWLEDGEMENTS: Foundation
The National Lottery Charities Board, UK; The North Staffordshire for Physical Therapy
Medical Institute, UK; The Physiotherapy Research Foundation,
UK; The Welsh Office, UK; The National Coordinating Centre for
Research Capacity Development, Department of Health, England.

VCEC Ballroom B & C
This contribution is part of Focused Symposium “RANDOMIZED
LENGES AND FUTURE DIRECTIONS” number 291
FUTURE DIRECTIONS FOR TRIALS OF INTERVENTIONS FOR
MUSCULOSKELETAL PAIN
Fritz J; Assistant Professor, Division of Physical Therapy, University
of Utah
LEARNING OBJECTIVES: 1. Participants will understand the
advantages of patient sub-grouping in future clinical trials of physical
therapy interventions. 2. Participants will understand the role that
clinical prediction rules can play in enhancing the power of future
clinical trials. 3. Participants will understand the importance of
economic evaluation along with clinical outcomes for future clinical
trials of physical therapy interventions. SUMMARY: There are
many challenges inherent in performing scientifically sound research
studies that accurately reflect the complexities of clinical care. Many
previous clinical studies investigating physical therapy interventions
have resulted in negative results or small effect sizes that have led
to questions regarding the efficacy of various treatment procedures.
Methodological issues may be partly responsible for these findings,
as previous studies have often involved heterogeneous patient
samples and non-standardized clinical decision-making. More recent
studies have begun to incorporate methodology that holds the
promise of improving the power of clinical research. Two primary
methodological advances will be discussed. 1) The development
of methods for sub-grouping patients will permit researchers to
identify more homogenous patient samples. Several sub-grouping,
or classification, systems have been developed to assist physical
therapists in identifying smaller sub-groups of patients from within a
larger clinical entity. The hallmark of a sub-group is that its members
are more likely to respond to a particular intervention approach. For
example, within the larger entity of patients with low back pain, a
smaller sub-group can be identified who are highly likely to respond
favourably to a manipulation intervention. Including only patients
with a likelihood of responding to an intervention greatly enhances
the power of a clinical trial examining that particular intervention.
2) Clinical prediction rules quantify the individual contributions that
history, physical examination and test results make toward the
diagnosis, prognosis, or likely response to treatment in an individual
patient. Prediction rules help to standardize clinical decision-making
by focusing the examination on the most important factors from
the examination. For example, clinical prediction rules have been
developed to identify patients with neck pain who have cervical
radiculopathy without the need for imaging, and to identify patients
with low back pain likely to benefit from a standardized program of
stabilization exercises. An additional consideration that is necessary
for future clinical trials of physical therapy interventions are economic
outcomes. Health care resources are limited, and policy-makers
need to know no only the amount of clinical improvement a certain
intervention can be expected to make, but also the cost of the
intervention. IMPLICATIONS/CONCLUSIONS: The development of
patient sub-grouping algorithms and clinical prediction rules are
Workshops
Workshop Funding ear-marked for invited and international educators can

356 Sunday 3 June 08:30 be invested into an institution’s e-learning programs. With its
VCEC Meeting Rooms 1-3 world-wide reach, our profession is in a unique position to take
CROSS CULTURAL E-LEARNING IN ENTRY-LEVEL PHYSICAL advantage of emerging e-technologies to foster universal access
THERAPY EDUCATION: MAXIMIZING EXPERTISE AND to quality education of physiotherapists and contribute to cost-
RESOURCES GLOBALLY effective improvement in global health. KEYWORDS: Physical
Redenbach D1 , Dean E1 , Jones A2 , McIntrye L3 , Bainbridge L4 ; therapy entry-level education; Web based e-learning; Video-linked e-
1 School of Rehabilitation Sciences, University of British Columbia, technology. FUNDING ACKNOWLEDGEMENTS: East-Meets-West
Vancouver, BC, Canada; 2 Department of Rehabilitation Sciences, Strategic Initiative Grant, Hong Kong Polytechnic University; Teaching
Hong Kong Polytechnic University, Hong Kong; 3 Telestudios, and Learning Enhancement Fund Grants, University of British
University of British Columbia, Vancouver, BC, Canada; 4 College Columbia
of Health Disciplines, University of British Columbia, Vancouver,
BC, Canada
LEARNING OBJECTIVES: During this workshop, the participants
will: 1.Evaluate the strengths and limitations of emerging e- Workshop
technologies, including interactive Web and video-linked technolo- 120 Sunday 3 June 10:45
gies, and discuss their potential for diverse physical therapy VCEC Meeting Rooms 1-3
programs. 2.Observe and experience new e-technology tools for
clinical education, in the capacity of learners. 3.Discuss and CLINICAL DATABASES IN PHYSICAL THERAPY: CREATING AN
consider the resources required and barriers to implementing INTERNATIONAL NETWORK
these technologies in relation to the needs of physical therapy Van der Wees P1 , Swinkels I2 , Hart D3 , Deutscher D4 ; 1 KNGF,
education programs in middle- and low-income, as well as high- Royal Dutch Society for Physical Therapy, Netherlands, Center for
income countries. SUMMARY: Changing global health indicators Evidence Based Physiotherapy, Maastricht University, Netherlands;
such as increased life expectancy, and the growing prevalence of 2 NIVEL, Netherlands Institute for Health Services Research, Utrecht,
chronic degenerative conditions that contribute to prolonged end-of- The Netherlands; 3 Focus On Therapeutic Outcomes, Inc, Knoxville,
life morbidity and health care cost, support the need for an increasing Tennessee, USA; 4 Maccabi Healthcare Services, Tel Aviv, Israel
number of physical therapists worldwide. Commensurate with the
demand for the expansion of physical therapy programs however, LEARNING OBJECTIVES: 1. To discuss relevance and char-
is a critical shortage of qualified educators. New technologies acteristics of clinical databases for transparency of outcome of
harnessing interactive e-learning opportunities are one means of care. 2. To exchange experiences and knowledge in setting-up
addressing this critical shortage. Workshop participants from across and running clinical databases. 3. To investigate the feasibility
the international community will have an opportunity to identify of creating an international network of investigators in clinical
barriers to their unique e-learning needs. They will experience two databases. SUMMARY: Clinical databases on physical therapy
e-learning technologies, namely, interactive web-based instruction, related information include useful data for health services research.
and an international video-linked learning experience. International An international investigation (Swinkels et al, submitted) resulted
educators and education researchers will provide insights into in seven identified clinical databases around the world. We speak
these two technologies and discuss the strengths and limitations of clinical databases when information from (electronic) medical
of these learning modes for physical therapy programs. They will records of multiple providers is stored in a database for research
discuss the implications for educational institutions and programs purposes. These databases are a valuable source of information for
globally, specifically, those in low- and middle-, as well as high- research and quality assurance. To a growing extent, information
income countries. Experts in the development of e-learning tools technology is an important tool for improving clinical management
will demonstrate emerging tools designed to enhance interactive and assessing clinical outcomes. Therefore, and due to advancement
distributed learning. The practicalities of setting up Web-based
in electronic data management capabilities, it is likely that the number
learning opportunities through linkages with international programs,
of clinical databases will grow in the near future. Content and
and video-linked learning opportunities will be presented. Physical
purposes of the existing databases, and possibilities of promoting
Therapy educators will learn how they can share learning resources
an international database will be discussed in the workshop.
and implement e-learning methodologies. The session will end with
By discussing procedures, opportunities and pitfalls of existing
a review of the unique barriers identified by participants at the
outset of the workshop and input from experts for solutions or databases, investigators can learn from each other. Experiences of
resources to address these needs. Participants will be invited to others can be applied in their own (future) databases. Consequently,
submit questions prior to the session to ensure their questions this will result in improved quality, validity and comparability of
are included. IMPLICATIONS/CONCLUSIONS: Exploiting e-learning databases, promoting an international use of data from clinical
technologies has several major implications for entry-level physical databases in physical therapy. IMPLICATIONS/CONCLUSIONS: The
therapy education globally. First, these technologies can help to workshop will contribute in creating a common body of knowledge
address the critical shortage of physical therapy educators worldwide. concerning clinical databases. The desired result of the workshop is
Second, these technologies promote the sharing of expertise across the start of an international network of investigators. This network
geopolitical borders and boundaries, and facilitate worldwide access will contribute to mutual learning and a body of knowledge. Future
to quality physiotherapy education. Third, sharing expertise in this goals are to compare physical therapy processes and patient
manner can be cost-effective in that internationally recognized outcomes internationally. KEYWORDS: Clinical databases; Outcome
experts in the field do not have to travel, be accommodated, or measures; Record keeping. FUNDING ACKNOWLEDGEMENTS:
take significant time away from their primary education affiliation. None.
S24 WCPT 2007, Workshops
Workshop Workshop
VCEC Meeting Rooms 8&15 VCEC Meeting Rooms 1-3
EDUCATING FOR MORAL ACTION: CREATING A GLOBAL CARDIORESPIRATORY PHYSIOTHERAPY EDUCATION: IS IT
DIALOGUE COMMENSURATE WITH THE HEALTH CARE NEEDS OF THE
Purtilo R1 , Jensen G2 , Swisher L3 , Mostrom E4 , Edwards I5 , WORLD?
Delany C6 ; 1 Ethics Initiative, MGH Institute of Health Professions, Cahalin L1 , Cruz Velandia I2 , Matsuo Y3 , Roskell C4 ; 1 Northeastern
Boston, MA, USA; 2 Dept Physical Therapy and Center for Health University, Department of Physical Therapy, Boston, Massachusetts,
Policy/Ethics, Creighton University, Omaha, NE, USA; 3 School USA; 2 Universidad del Rosario, Facultad de Rehabilitación y
of Physical Therapy, University of South Florida, Tampa, FL, USA; Desarrollo Humano, Bogota, Colombia; 3 Kobegakuin University,
4 School of Rehabilitation and Medical Sciences, Central Michigan Faculty of Rehabilitation, Kobe, Japan; 4 University of Birmingham,
University, Mount Pleasant, Michigan, USA; 5 School of Health School of Health Sciences, Birmingham, United Kingdom
Sciences, University of South Australia, Adelaide, Australia; 6 School
LEARNING OBJECTIVES: 1. Discover the results of an internet sur-
of Physiotherapy, University of Melbourne, Melbourne, Australia
vey examining cardiorespiratory physical therapy (PT) education and
LEARNING OBJECTIVES: Through active participation and dia- practice in a number of countries around the globe. 2. Understand the
logue, participants will engage in a process to: 1) Synthesize relevant cardiorespiratory PT education and practice opportunities provided to
insights regarding the state of ethics education for physiotherapy students in several specific countries (South America, Japan, United
in academic and practice settings. 2) Propose a framework for States, and the United Kingdom). 3. Dialogue with others in the
analysis and discussion of ethics education for physiotherapists audience about cardiorespiratory PT education and practice around
as moral agents. 3) Generate practical educational strategies for the globe. SUMMARY: Cardiovascular and pulmonary diseases
educators and practitioners that will support moral action and are common among many PT patients as primary, secondary, or
moral leadership in clinical and education settings. SUMMARY: This even combined diagnoses. Despite the fact, that the incidence of
workshop is designed to create an international dialogue about cardiovascular disease has decreased slightly, the incidence and
current and future needs for ethics education in both classroom prevalence of pulmonary disease and chronic cardiovascular disease
and clinic. There is renewed interest in enhancing and expanding is increasing. Both disorders are responsible for a substantial degree
ethics education for physiotherapists around the world fueled by of morbidity, mortality, and disability. Physical therapists are in
rapidly changing health care environments. Health care practitioners a pivotal position to favorably affect the morbidity, disability, and
experience ethical distress as health care delivery is seen more often possibly mortality of patients suffering with these disorders via
as a commodity driven by economic forces than a human service. secondary and primary prevention. However, few North American
Still, ethics education in physiotherapy often is more focused on physical therapists specialize in this area and few routinely assess
the selection of topics to be covered in courses or on the Code of the cardiorespiratory systems during PT. This is concerning since
ethics, than on dialogue about the models, concepts and leadership cardiovascular and pulmonary diseases are the leading causes of
initiatives necessary to meet current challenges locally and globally. morbidity, mortality, and disability worldwide and often co-exist with
Although details of ethical situations may vary in different national many other conditions routinely seen by physical therapists. The
contexts, educators and clinicians can benefit greatly by learning results of a questionnaire survey of cardiorespiratory PT education
from each other through dialogue about educational strategies and in the USA, Canada, United Kingdom, Australia, and New Zealand
authentic learning tools designed to promote moral reasoning, moral revealed that cardiorespiratory education in the USA appears to lag
leadership and moral action. This workshop includes examination of behind that in other countries. It appears that PT education in the
evidence for educational effectiveness, facilitated group discussion, USA is not commensurate with the health care needs of the USA or
lecture, and case examples to address ethics curriculum, moral the world. We are currently examining cardiorespiratory PT education
reasoning, and moral development in clinical education. The goal and practice in over 25 countries around the globe using an internet
of the session is to generate practical strategies for promoting survey. The results of this survey will be presented which will enable
moral reasoning, moral action and moral leadership in physiotherapy a comparison among countries to be made and discussion among
practice and educational settings. IMPLICATIONS/CONCLUSIONS: workshop participants. IMPLICATIONS/CONCLUSIONS: The World
Although physiotherapy ethics to date has primarily focused on Health Organization has identified cardiovascular and pulmonary
situations facing discrete national environments, the professional disease as two of the major preventable causes of death and disability
preparation of physiotherapists for successful participation in fu- throughout the world. Therefore, greater focus on the health care
ture local and global challenges facing our profession requires needs of each country and the world is needed in the PT educational
education based on dialogue that transcends national boundaries. programs throughout the world. Providing optimal academic and
Ethics education for physiotherapists needs to prepare physio- clinical experiences in cardiovascular and pulmonary areas are likely
therapists worldwide for effective reflection, moral reasoning and to ensure that PT is commensurate with the health care needs of the
moral action. KEYWORDS: Ethics education, Ethical reasoning, world. Not providing optimal PT academic and clinical experience in
Moral action/leadership. FUNDING ACKNOWLEDGEMENTS: We cardiovascular and pulmonary areas may allow others less qualified
acknowledge the Center for Health Policy and Ethics at Creighton to fulfill the need to care for the increasing numbers of individuals
University and federal grant support of HRSA Grant #D37 HP 00824 throughout the world diagnosed with cardiovascular and pulmonary
(Dreamcatchers and the Common Good:Allied Health Leadership disorders resulting in lower standards of care. KEYWORDS: 1.
in Generational Health and Ethics) for the Leadership in Ethics Physiotherapy education. 2. Cardiorespiratory physiotherapy. 3.
Education For Physical Therapy and Occupational Therapy working Global health. FUNDING ACKNOWLEDGEMENTS: Japanese Pfizer
institute. The institute project was published by FA Davis, 2005: Health Research Foundation.
Purtilo R, Jensen G, Royeen C(Eds): Educating For Moral Action:
A Sourcebook in Health and Rehabilitation Ethics.
Workshops S25
Workshop Workshop
“WALKING” – AN EVIDENCE-BASED APPROACH TO WEANING SYNERGY BETWEEN NEUROSCIENCE RESEARCH
PATIENTS FROM MECHANICAL VENTILATION IN ICU AND NEUROREHABILITATION: PUTTING KNOWLEDGE
Perme C1 , Dean E2 ; 1 The Methodist Hospital, Houston, Texas, TRANSLATION INTO PRACTICE
United States of America; 2 University of British Columbia, School MacKay-Lyons M1 , Corbett D2 , Ploughman M3 , Nudo R4 ; 1 School
of Rehabilitation Sciences, Vancouver, Canada of Physiotherapy, Dalhousie University, Halifax, Nova Scotia,
Canada; 2 Memorial University, St. John’s, Newfoundland, Canada;
LEARNING OBJECTIVES: During the workshop, with respect to 3 Physiotherapy, Rehabilitation Program, L.A. Miller Centre, St.
the patient who is mechanically ventilated, and through a series
John’s, Newfoundland, Canada; 4 Landon Center on Aging, Kansas
of case studies, participants will learn to: 1. Apply state of the art
University Medical Center, Kansas City, KS 66160
evidence for integrating exercises physiology, specifically walking as
an intervention in patients in the ICU. 2. Identify key elements of LEARNING OBJECTIVES: By the end of this interactive work-
the assessment including a “mobilization test” and its intrepretation. shop, participants will: 1. Demonstrate enhanced understanding of
3. Progress the mobilization stimulus consistent with long term the importance for researcher-clinician collaboration in advancing
patient goals. SUMMARY: Physical therapists, who practice in high knowledge translation in neurorehabilitation. 2. Identify mechanisms
dependency, critical care or ICU settings, face a complex challenge. of neuroplasticity that contribute to functional recovery following
ICU patients are surviving in greater numbers contributing to the damage to the nervous system. 3. Describe how certain intervention
physical therapist’s challenge both respect to the severity of the protocols have evolved from animal research and how future research
patients treated these days, and the duration of their ICU stay. initiatives could be informed by these protocols. SUMMARY: Knowl-
These patients have limited mobility due to life support, monitoring edge translation goes beyond the mere diffusion and dissemination
equipment, multiple medical problems, aerobic deconditioning, and of knowledge. It is about not only ensuring that clinicians are aware
muscle weakness. Early mobilization can facilitate weaning from of and use research evidence to inform their clinical decision-
mechanical ventilation as well as enhance functional outcomes by making but also ensuring that researchers are informed by the
optimizing cardiopulmonary and neuromuscular status. This work- experiences and information needs of clinicians. In other words,
shop describes the evidence-base and decision making strategies knowledge translation is a two-way street between clinicians and
to guide clinicians through the process of managing ICU patients, researchers. In the area of neuroscience, basic researchers, clinical
particularly with respect to walking patients on mechanical ventilation, researchers, and neurorehabilitation clinicians often function as
therapeutically and safely. Case reports are used to illustrate how three distinct communities. The traditional unidirectional nature of
early mobilization and ambulation positively impact the recovery and knowledge transfer has not been effective in encouraging clinicians
discharge of these patients. Practical clinical guidelines regarding to adopt new research findings. Rather, early engagement and
clinical decision making and judgment are highlighted with respect to: interactive exchange among these ‘communities’ are key to building
1. the assessment to determine the indications and contraindications researcher-user relationships that remove barriers to research
for mobilizing critically ill patients, 2. the mobilization prescription, utilization and tailor information so that effective interventions can
i.e., the type of mobilization, its intensity, and duration, and 3. be more widely applied. This workshop will emphasize researcher-
the progression of the mobilization stimulus including walking. The clinician exchanges in the analysis of animal and human case
role of monitoring is emphasized as a basis for clinical decision studies that are linked by the neurorehabilitation interventions and
making and includes vital signs, hemodynamic monitoring, ECG, mechanisms of neuroplasticity under investigation. The approach
muscle strength and endurance in addition to routine blood work, is novel – the presenters have the breadth of experience in basic
arterial blood gases, and signs of infection. Finally, the role of and applied research and clinical neurorehabilitation needed to
team work is discussed, in that mobilizing patients requires a high reinforce the notion of synergy in this exciting field. Stroke, spinal
degree of clinical judgment and cooperation among team members. cord injury and cerebral palsy comprise the main diagnostic groups
Audience participation through questions and answers, and small discussed. Animal research has precipitated or supported a number
group interaction, will be used to foster an interactive learning of neurorehabilitation interventions (e.g., environmental enrichment,
experience. IMPLICATIONS/CONCLUSIONS: Early mobilization of endurance exercise, skilled movement training, repetition of alternat-
ventilator dependent patients in the ICU may facilitate outcomes such ing, repetitive movements). Studies using animal models have shown
as weaning, functional return, discharge from the hospital, as well as that such interventions result in alterations in neuronal structure and
reduced ICU complications, which collectively, have implications for brain chemistry that enhance plasticity processes in the damaged
improving quality of life and reducing health care costs. In addition, nervous system that, in turn, promote functional recovery. The case
ICU physical therapy particularly related to mobilizing critically ill studies will underline the importance of effective researcher-clinician
patients, requires collaborative team work and respect for each team collaborations in developing intervention protocols that can be applied
member’s role. KEYWORDS: Oxygen transport; Intensive care; Early clinically. Emphasis on the practical implications of findings and the
mobilization; Weaning. FUNDING ACKNOWLEDGEMENTS: None needs of the user will create an “appetite for research” that will
accelerate its translation into practice. Special attention will be paid
to issues of concern to neurophysiotherapists, e.g., the intensity,
duration and timing to optimize outcomes. By way of example, recent
findings using animal models have shown that more intense forms
of rehabilitation produce greater recovery provided that the timing of
therapy is appropriate. There is evidence that delayed intervention
can markedly reduce brain remodeling and attenuate functional
gains. IMPLICATIONS/CONCLUSIONS: Knowledge translation is an
ongoing and iterative process requiring active participation of both
research generators and users. Synergistic alignment of researchers
and clinicians in neuroscience can result in mutually beneficial
outcomes – understanding the user context allows the researcher
to design relevant studies; understanding basic neurophysiological
mechanisms such as neuroplasticity motivates the clinician to uptake
research evidence. In the long term, this 2-way exchange leads
to accelerated translation of meaningful research findings into musculoskeletal and internal urogenital/gynecological systems. This
clinical practice. KEYWORDS: Neurorehabilitation; Neuroplasticity; workshop will facilitate information sharing for further development of
Recovery. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes multi-modal programs and stimulate research to validate and improve
for Health Research, Heart and Stroke Foundation of Canada, treatment for people with impairments of the musculoskeletal and
Canadian Stroke Network, Canada Research Chairs Program. urogynecological systems. KEYWORDS: Low back pain, pelvic girdle
pain, incontinence. FUNDING ACKNOWLEDGEMENTS: This work
is funded privately by Diane G. Lee Physiotherapist Corporation and
Workshop
LJPT Consulting
VCEC Ballroom A
BRIDGING THE GAP: THE ROLE OF THE PELVIC FLOOR IN Workshop
MUSCULOSKELETAL AND UROGYNECOLOGICAL FUNCTION 188 Monday 4 June 10:45
VCEC Meeting Rooms 1-3
Lee D1 ,
Lee L2,3 ; 1 Diane
Lee & Associates – Consultants in
Physiotherapy, White Rock, BC, Canada; 2 Synergy Physiotherapy WCPT: INTERNATIONAL COLLABORATION IN CLINICAL
& LJPT Consulting, North Vancouver, BC, Canada; 3 University GUIDELINE DEVELOPMENT AND IMPLEMENTATION
of Queensland, Brisbane, Queensland, Australia Van der Wees P1 , Hendriks E2 , Mead J3 , Rebbeck T4 ; 1 KNGF,
Royal Dutch Society for Physical Therapy, Amersfoort, Center for
LEARNING OBJECTIVES: 1) Review the evidence for clinical
Evidence Based Physiotherapy, Maastricht University, Netherlands;
tests for pelvic girdle musculoskeletal function and relationships 2 Center for Evidence Based Physiotherapy, Maastricht University,
between the pelvic floor and other muscles linking low back/pelvic
Netherlands, Dutch Institute of Allied Health Care (NPi), Amersfoort,
girdle pain and urogynecological dysfunction. 2) Combine evidence
Netherlands; 3 Chartered Society for Physiotherapy (CSP), London,
with clinical reasoning to assess and treat lumbopelvic and pelvic
United Kingdom; 4 University of Sydney, Australia
organ impairments with multi-modal programs, including using real-
time ultrasound imaging; highlight areas needing further research LEARNING OBJECTIVES: 1. To strengthen the existing network
to create clinical trials. 3) Integrate knowledge from different of clinical guideline developers in Physical Therapy. 2. To promote
physical therapy specialization subgroups to facilitate optimal care adaptation of existing (international) clinical guidelines for national
for patients by exposing therapists to new techniques and treatment and local use. 3. To facilitate involvement of member organisations
approaches and emphasizing the importance of communication and of WCPT in multi-disciplinary guideline development. SUMMARY:
efficient cross-referral between therapists of different subgroups. Clinical guidelines provide recommendations for practice, drawn
SUMMARY: In recent years, there has been an explosion of scientific from the available evidence. To create an international standard for
and clinical knowledge pertaining to musculoskeletal and urogy- Physical Therapy treatment and to enhance efficiency in development
necological function relevant to physical therapists. Consequently, of clinical guidelines, further international collaboration in guideline
specialization within physical therapy has evolved to meet the development is required. For example, existing (international)
challenge of evidence-based clinical practice. While focusing on one guidelines can be adapted for specific national or local use. We also
area of evidence facilitates expertise in an area (back/pelvic girdle observe a lack of involvement of Physical Therapy in multi-disciplinary
pain, incontinence/pelvic floor dysfunction), it can limit the holistic guideline development. In this workshop we we will present and dis-
view of the patient and the presenting problem. Recent studies cuss possibilities for (a) further collaboration in developing guidelines,
highlight epidemiological links between low back/pelvic girdle pain, (b) adaptation of existing guidelines for national or local use and
incontinence and respiratory disorders. Neurophysiological studies (c) involvement of Physical Therapy in multi-disciplinary guideline
identify biomechanical and neurological connections between the development. IMPLICATIONS/CONCLUSIONS: This workshop will
musculoskeletal system and the internal organs. It is increasingly help to enhance international collaboration in guideline development
apparent that patients with low back and pelvic ‘girdle’ pain share within physical therapy and will provide tools for adaptation of existing
common neuromuscular impairments with patients presenting with guidelines and involvement in multi-disciplinary guideline develop-
stress urinary incontinence and pelvic ‘floor’ pain syndromes. It is ment. KEYWORDS: Clinical Guidelines; Collaboration; Evidence
time to bridge the gap that has evolved with specialization and Based Practice. FUNDING ACKNOWLEDGEMENTS: None.
revisit an integrated approach to these two common problems
for men and women. To effectively treat people with the above
impairments, a multi-modal evidence-based rehabilitation program is Workshop
required. This workshop will discuss scientific and clinical evidence 210 Monday 4 June 02:00
that led to an integrated approach for assessment and treatment VCEC Meeting Rooms 11-12
of the lumbopelvic-hip region for low back/pelvic girdle pain and EXERCISE BASED CARDIAC REHABILITATION FOR HEART
urinary incontinence/pelvic floor syndromes. Case studies will be FAILURE
presented to reflect variances in clinical presentation and illustrate
Thow M1 , Taylor A2 , Lough F3 , Cowie A4 ; 1 Division of
how education, manual therapy, real-time ultrasound imaging, and
Physiotherapy, Glasgow Caledonian University, Glasgow G4 0BA,
exercise are integrated. Validated tests for load transfer through
Scotland, UK; 2 Department of Physiotherapy,University of Limerick,
the joints and organs of the pelvis as well as for deciding which
Limerick, Ireland; 3 Hatter Cardiovascular Health Institute, University
muscles to target for rehabilitation will be demonstrated through
College Hospital London; 4 Glasgow Caledonian University (School
video clips. The goal of this workshop is to demonstrate that
of Health and Social Care) Glasgow, Scotland
optimal musculoskeletal function and urogynecological function share
common components; therapists in previously separate fields need LEARNING OBJECTIVES: The key learning objectives for this
to bridge a gap in order to build an integrated and effective approach session will be: 1. Understand and appraise the evidence base
to rehabilitation. The mergence of this information will facilitate for exercise in people with heart failure; 2. Comprehend and apply
networking within the profession with the ultimate goal of providing contemporary principles of prescription and monitoring of exercise for
optimal rehabilitative care. IMPLICATIONS/CONCLUSIONS: The people with heart failure. 3. Critique the outcome measures for the
multi-modal, evidence-based rehabilitation program presented draws training effect of exercise in people with heart failure. SUMMARY:
on clinical experience of the presenters to bridge the narrowing, yet Chronic heart failure is fast becomming one of the most common
still present, gap between what we know (the evidence) and what cardiac conditions. As a result of improved medical management
we still need to know (clinical tools to be validated) to effectively and the ageing population, there are many more people living with
restore optimal function for the lumbopelvic region, both in the the limiting symptoms of heart failure. People with chronic heart
Workshops S27
failure are characterised by severe exercise intolerance, including will discuss the principles of exercise prescription for promoting
fatigue and dyspnoea. Furthermore, people with heart failure often bone health and review the scientific evidence on the effects of
have poorer quality of life and psychosocial outcomes. Historically, exercise therapy on bone health in selected chronic conditions.
people with heart failure were advised to restrict their physical activity. Physiotherapists can play an important role in the prevention and
Not only was this deleterious to their physiological function, also treatment of secondary osteoporosis in people with chronic condi-
contributed to poorer mental health. There has been a growing tions, including the assessment of risk factors for falls (e.g. balance,
body of evidence over the 1990’s and 2000’s of the positive muscle strength, vision) and secondary osteoporosis (e.g. muscle
effects of exercise on physiological and pshchosocial outcomes for atrophy, corticosteroid therapy), prescription of appropriate exercise
these patients, and they are now more often refered to exercise interventions to reduce falls and improve bone health, and patient
based cardiac rehabilitation. IMPLICATIONS/CONCLUSIONS: The education. IMPLICATIONS/CONCLUSIONS: Increasing emphasis
potential for exercise both to improve symptoms and functional has been placed on health promotion and prevention of secondary
capacity and to enhance quality of life is now recognised within conditions for people with disability. With the aging population and
the literature. Supervised, individualised, structured exercise can the increasing number of chronic disease survivors, osteoporosis
therefore be of great benefit to people with chronic heart failure. and bone fractures will be major health concerns. The prevention
For the cardiac rehabilitation specialist physiotherapist this group of of secondary osteoporosis and resulting fractures in people with
patients are now routinely refered for exercise based rehabilitation. chronic conditions is an important area where physiotherapists can
For the cardiac rehabilitation specialist physiotherapist, people with play a key role. KEYWORDS: osteoporosis, bone health, chronic
heart failure, compared with other cardiac groups, present a greater conditions. FUNDING ACKNOWLEDGEMENTS: Natural Sciences
challenge, due to their lower functional status and limiting symptoms. and Engineering Research Council of Canada (Marco Pang).
It is therefore important for the evidence for for this group of
patients to be integrated into physiotherapy practice. Furthermore,
valid and reliable outcome measures for exercise must be used.
KEYWORDS: Exercise, heart failure, outcome measurements,
Workshop
cardiac rehabilitation. FUNDING ACKNOWLEDGEMENTS: Ayrshire
and Arran Health Board managed clinical network for cardiology 145 Tuesday 5 June 10:45
is funding Aynsley Cowie’s research project on exercise outcome VCEC Ballroom B & C
measures for heart failure. STRUCTURAL DIFFERENTIATION DIAGNOSIS OF THE UPPER
AND LOWER QUARTER
Workshop Cook C1 , Cleland J2 ; 1 Assistant Professor, Duke University Medical
163 Tuesday 5 June 08:30 Center, Department of Community and Family Medicine, Division
VCEC Meeting Rooms 1-3 of Physical Therapy, Duke University, Durham, North Carolina,
United States of America; 2 Assistant Professor Franklin Pierce
BONE HEALTH IN CHRONIC CONDITIONS: IMPLICATIONS FOR
College, and Research Coordinator, Rehabilitation Services of
PHYSIOTHERAPISTS
Concord Hospital, Concord, NH, United States of America
Pang M1 , Eng J2 , Jones A1 ; 1 Hong Kong Polytechnic University,
Hong Kong, China; 2 University of British Columbia, Vancouver, LEARNING OBJECTIVES: 1) Categorize and synthesize the chief
British Columbia, Canada identifying features of the upper (cervical-spine, thoracic spine
and shoulder)and lower (lumbar-spine, hip and pelvis) quarter
LEARNING OBJECTIVES: After completion of the workshop, the
pain generating structures; specifically the overlap in symptom
participants will be able to: 1. describe the common imaging
manifestation, and identify red flags that masquerade of muscu-
techniques used to measure bone mineral density. 2. explain how
loskeletal disorders. 2) Evaluate the use of highly sensitive tests and
chronic conditions, such as spinal cord injury, stroke or COPD
measures versus highly specific tests and measures during structural
may negatively impact on bone health. 3. describe the current
differential diagnosis. 3) Apply the newly outlined tests and measures
scientific evidence concerning exercise intervention on bone health
toward the presented case studies of multidimensional pain patients
in people with chronic conditions and explain how physiotherapists
and organize an effective examination based on the structural
can play a key role in prevention and treatment of secondary
differentiation findings. SUMMARY: The purpose of a clinical
osteoporosis in people with chronic conditions. SUMMARY: In
examination is to outline the movements, positions, or activities
Canada, approximately 1.4 million people are suffering from osteo-
porosis. The Canadian health care cost associated with osteoporosis that produce, reduce, or selectively modify the patient’s ‘familiar
currently stands at 1.3 billion per year and is predicted to reach sign and symptoms’ and to isolate the causal structure behind the
32.5 billion by 2018 due to the aging population. Individuals living impairment. Additionally, an effective clinical evaluation reduces the
with a chronic condition (e.g. spinal cord injury, stroke, COPD) risk of missing “red flags” that may undermine the progression of
are particularly at risk for osteoporosis. These individuals often a patient’s condition. To accomplish this task, physiotherapists must
have a number of physical impairments (e.g. muscle weakness, focus their examination tests and measures toward the appropriate
low cardiopulmonary fitness, poor balance, sensory deficits), which structural region. Musculoskeletal regions such as the upper quarter
contribute to various functional limitations, resulting in a sedentary (cervical, thoracic and shoulder) and lower quarter (lumbar spine, hip
lifestyle. The lack of mechanical loading to the skeleton due to and pelvis) often display overlapping symptoms that require structural
physical inactivity may increase the rate of bone loss. The same differentiation. The appropriate use of structural differentiation tests
physcial impairments are also contributing factors to an increased that are highly sensitive and yield beneficial diagnostic value can
risk of falls. Compormised bone mineral density coupled with assist the clinician in ruling out inappropriate non-causal structures.
falls is the primary cause of fragility fractures and becomes a IMPLICATIONS/CONCLUSIONS: Physiotherapists function as entry
major health concern in people with chronic conditions. Knowing point providers for many musculoskeletal disorders. Proper structural
that skeletal loading is an important factor for promoting bone differentiation is necessary for effective treatment. Many upper
formation, exercise may be an effective method for the prevention and lower quarter impairments yield similar findings and require
and treatment of osteoporosis. Exercise interventions have been structural differentiation. The correct use and understanding of
shown to be effective in promoting bone health in older adults. appropriate diagnostic tests can improve the physiotherapists’
Concerning individuals with chronic conditions, literature review capability as a diagnostic clinician. KEYWORDS: Sensitivity, Speci-
suggests that there is some evidence that exercise is beneficial in ficity, Diagnosis, Differentiation, Tests and Measures. FUNDING
promoting bone health but further study is required. This workshop ACKNOWLEDGEMENTS: None
Workshop patients with CFS. When graded exercise therapy is implemented by
3334 Tuesday 5 June 02:00 means of the cognitive behavioural principles, it does not comply
VCEC Meeting Rooms 1-3 with our current understanding of CFS exercise physiology and
WRITING FOR PUBLICATION pathophysiology. Indeed, recent experimental research shows further
deregulation of the immune system in response to submaximal
Herbert R1 , Moore A2 , Baxter D3 , Hasson S4 , Simoneau G5 ,
exercise and subsequent increased fatigue and musculoskeletal
Hudson Z6 , Kolt G6 , Abbott H7 , Ada L1 , Harms M8 , Sundelin G9 ,
pain (postexertional malaise). Therefore, patients are encouraged to
Deutsch J10 ; 1 Australian Journal of Physiotherapy; 2 Manual
achieve an appropriate balance between activity and rest in order
Therapy; 3 Physical Therapy Reviews; 4 Physiotherapy Theory
to avoid exacerbation of symptoms and to set realistic goals for
& Practice; 5 Journal of Orthopedic and Sports Physical
increasing activity (pacing self-management techniques). Contrary
Therapy; 6 Physical Therapy in Sport; 7 New Zealand Journal
to the cognitive behavioural approach, pacing takes into account the
of Physiotherapy; 8 Physiotherapy; 9 Advances in Physiotherapy;
10 Journal of Neurologic Physical Therapy considerable fluctuations in symptom severity and delayed recovery
from exercise that typically occurs in patients with CFS. When a
LEARNING OBJECTIVES: By the end of the workshop participants person with CFS is able to manage their daily activity (i.e. when
should understand editorial processes and be better able to prepare they no longer experience fluctuations in symptoms) (stabilisation
manuscripts for submission to a scientific journal. SUMMARY: Editors phase), then the physical therapist can start to grade activity and
from seven leading physical therapy journals will offer advice and exercise levels (grading phase). During the grading phase, the
guidance on preparing and submitting manuscripts for publication. same pacing techniques are applied to grade both activity level
The workshop will include presentations about editorial processes and exercise level. This type of graded exercise has been found
and tips for aspiring authors, as well as critique of manuscripts in to be superior over relaxation and flexibility training in patients with
small groups. Elsevier publishers are working in partnership with CFS. Various validated methods of monitoring and assessing the
WCPT to publish Congress proceedings and will provide delegates effectiveness of this approach are available. The workshop aims at
in the workshop with handouts on manuscript preparation. There will incorporating the available research evidence into physical therapy
also be guidelines for submittign to a range of journals availabel practice, addressing both the fundamental (exercise physiology,
to take away. IMPLICATIONS/CONCLUSIONS: A large volume of pathophysiology, and psychopathology) and the clinical sciences
research and service developments presented at both national (clinical trials, assessment tools). IMPLICATIONS/CONCLUSIONS:
and international congresses is never written up or published in The workshop will allow participants to apply the research evidence
peer-reviewed journals. Many factors may affect this including the to support/guide the assessment, clinical reasoning process, and
authors’ abilities to prepare full manuscripts that withstand the rigours treatment employed by physical therapists to persons with CFS.
of the editorial process and a lack of understanding of journal The overall aim of the session is to improve the effectiveness of
editorial processes. By understanding more about scientific writing physical therapy management of those with CFS and consequently
and editorial processes it is hoped that workshop participants will reduce the impact of the condition on the lives of those who suffer
aspire to have their work published and feel inspired and able to from CFS. KEYWORDS: chronic fatigue syndrome, exercise therapy,
prepare manuscripts for publication. KEYWORDS: Journals, writing, activity management. FUNDING ACKNOWLEDGEMENTS: Jo Nijs
publications. FUNDING ACKNOWLEDGEMENTS: Elsevier would like to thank the research council of the Higher Institute of
Physiotherapy, Hogeschool Antwerpen, Belgium, and the research
council of the Vrije Universiteit Brussel, Belgium, for the financial
Workshop
support of the research.
GUIDED ACTIVITY AND EXERCISE THERAPY FOR CHRONIC Workshop
FATIGUE SYNDROME AND OTHER CHRONIC PAIN/FATIGUED 377 Wednesday 6 June 01:45
STATES VCEC Meeting Rooms 1-3
Nijs J1 , Paul L2 , Wallman K3 ; 1 Department of Human Physiology, CONSERVATIVE MANAGEMENT OF NECK DISORDERS: THE
Faculty of Physical Education and Physiotherapy, Vrije Universiteit CURRENT EVIDENCE, BIOLOGICAL FOUNDATIONS AND
Brussel, Belgium and Division of Musculoskeletal Physiotherapy, IMPLICATIONS FOR FUTURE RESEARCH
Higher Institute of Physiotherapy, Hogeschool Antwerpen, Belgium; Gross A, Mac Dermid J, Galea V, Goldsmith C, McLaughlin L;
2 Glasgow Caledonian University, Glasgow, Scotland, UK; 3 Human McMaster University, Hamilton, Canada
Movement & Exercise Science, University of Western Australia
LEARNING OBJECTIVES: 1. Learn about, apply, and identify
LEARNING OBJECTIVES: By the end of the workshop dele- gaps in the best current evidence on conservative management
gates will be able to: a. Demonstrate an understanding of the of mechanical neck disorders (MND)to resolve a patient case. 2.
pathophysiology, exercise physiology, and psychopathology of CFS; Describe new innovative technology utilizing neuro-sensory, motor
b. apply an evidence based approach to the management of control, serum, capnography and biomechanical methods that will
people with CFS; c. formulate possible referral criteria for people address knowledge deficits in MND disability. 3. Describe key
with CFS embarking on a physical therapy program; d. design research design issues for future RCTs. 4. Provide input into
and implement a graded/guided exercise programme in patients HaNSA’s future clinical and applied research. SUMMARY: Neck
with CFS; e. critically evaluate possible assessment strategies for pain is still a major contributor to disability worldwide with about
patients with CFS; f. apply the clinical reasoning process to the 70% of the people experiencing an episode of neck pain at some
holistic management of patients with CFS; g. appraise methods of point in their lives and 15% experiencing chronic pain. Chronic pain
engaging patients with CFS into an exercise/activity programme. accounts for about $150 to $215 billion USD each year in economic
SUMMARY: Controversy regarding the aetiology and treatment of loss (ie. lost work days, therapy, disability), and yet very little is
patients with Chronic Fatigue Syndrome (CFS) continues to affect known about the effectiveness of many of the available treatments.
the physical therapy profession. From the clinical research physical Since first publishing our overview in 1996 (Aker et al 1996), our
therapists and researchers in the field of CFS are now able to cervical overview group (COG) has completed and updated 11
use both general and disease specific measures for a reliable and systematic reviews on conservative management of mechanical neck
valid assessment of a variety of constructs in patients with CFS. disorders. In the course of the last ten years, we have come to
Research data from both the fundamental and clinical sciences can learn many things – not only about the effectiveness of certain
be incorporated in the clinical reasoning process and treatment of therapies, but also about the methodology of the trials themselves.
Workshops S29
Within this workshop, our case discussion will serve to summarize

our group’s findings. A major gap in this literature is our ability to
subgroup nonspecific neck pain, especially neck disorders with arm
disability. Three forms of testing will be explored. First, quantitative
sensory testing [grip force, key grip force, functional dexterity (manual
dexterity board test), current perception testing (small diameter
fibers), vibration threshold (vibrometer, large diameter fibers), touch
threshold, series of self report questionnaires to electro-physiological
testing (median nerve motor conduction, neuromax machine)] for
MDN will be evaluated. We will investigate its reliability and validity
of quantitative sensory tests in patients with MND and compare
two self report indices developed to measure symptoms /disability
in patients with cervical problems to determine if either instrument
preferentially discriminates subgroups of MND. Second, testing for
motor control of upper limb for MND 1-3 including quantitative
motion, electromyographic activity (EMG), dexterity testing may help
us identify upper extremity nerve root. The concurrent validity of
kinematics (a measure of shoulder/elbow coordination) and EMG
study for reach and grasp (ant/post deltoid, biceps, upper/lower trap,
serratus anterior, infraspinatus) in subgroups of MND will be explored.
Finally, the reliability and validity of the Neck Walk Index (NWI –
long range power law correlation) will be reviewed. Our progress
toward the development of a home unit will be discussed. Interactive
discussion will be used throughout this session. A further gap in
the literature is the design features of the randomized controlled
trial that will optimize the estimation of benefit for a multimodal
treatment approach. An expert methodologist and statistician will
review trials designs to optimize this dilemma. A trial design
exploring subgroup identification for nonspecific neck disorders
will be discussed. IMPLICATIONS/CONCLUSIONS: Clinicians and
researchers will have a better understanding of challenges faced
in identifying subgroups responsive to specific beneficial treatment
approaches. KEYWORDS: mechanical-neck-disorders, systematic
review, biological mechansims. FUNDING ACKNOWLEDGEMENTS:
1. Problem-based Research Fund, Sunnybrook and Women’s
College Foundation, Toronto, Canada. 2. Hamilton Hospitals As-
sessment Centre, Hamilton, Canada. 3. Physiotherapy Foundation of
Canada, Ottawa, Canada. 4. Hamilton Health Sciences Corporation,
Hamilton, Canada
Research Reports
reflex. FUNDING ACKNOWLEDGEMENTS: This research study was

Platform Presentations, Sunday 3 June not funded. CONTACT: [email protected], [email protected],
[email protected]
Research Report Platform Presentation ETHICS COMMITTEE: Egyptian physical therapy syndicate
PP Crystal Pavilion B & C
Research Report Platform Presentation
EFFECT OF TRUNK ROTATION ON SOLEUS H-REFLEX AND 2978 Sunday 3 June 08:30
RADICULAR SYMPTOMS IN SUBJECTS WITH SCIATICA VCEC Ballroom A
Ali M1 , Elhafez S1 , Balbaa A2 , Elhafez H3 ; 1 Department of CRYOTHERAPY FOR ACUTE ANKLE SPRAINS: A RANDOMIZED
Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt; CONTROLLED STUDY OF TWO DIFFERENT ICING PROTOCOLS
2 Department of Physical Therapy for Musculoskeletal Disorders,
Bleakley C1 , McDonough S1 , MacAuley D2 ; 1 Health and
Faculty of Physical Therapy, Cairo University, Egypt; 3 Department of
Rehabilitation Sciences Research Institute, University of Ulster,
Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
Northern Ireland; 2 Hillhead Family Practice, Belfast, Northern Ireland
PURPOSE: The first aim of this study was to test the effect of
PURPOSE: This study aimed to compare the efficacy of an inter-
trunk rotation from side lying (on the pain free side) on soleus H-
mittent cryotherapy treatment protocol with a standard cryotherapy
reflex and radicular symptoms in case of discogenic sciatica. The
treatment protocol in the management of acute ankle sprains.
second aim was to test whether a prolonged use of this position as
RELEVANCE: The application of ice after ankle sprain is a time-
a home program can reduce the radicular symptoms. RELEVANCE:
honored treatment. However no study has rigorously compared the
Controlling or reducing radicular pain without drug intake is the main
effectiveness of two different icing protocols; and there is no evidence
purpose of effective treatment. This study identifies how this pain to suggest an optimal mode, duration or frequency of ice application.
could be reduced using positional technique of the trunk in subjects PARTICIPANTS: Sportsmen (n=44) and members of the general
with discogenic sciatica. PARTICIPANTS: Thirty subjects with L5-S1 public (n=45) with mild / moderate acute ankle sprains METHODS:
sciatica were randomly selected and examined. Their age ranged Subjects were randomly allocated, under strictly controlled double
from 25-45 years. They were all suffering from unilateral sciatica with blind conditions, to one of two treatment groups: standard ice
radicular symptoms (pain, numbness, and/or weakness) matching application (n=46), or intermittent ice application (n=43). The mode
the dermatomal distribution of S1 nerve root. METHODS: H-reflex of cryotherapy was standardised across groups and consisted of
of the soleus muscle was recorded by stimulating the posterior melting iced water (0 degrees C) in a standardised pack. Function,
tibial nerve using 1 ms pulse at 0.2 pps and recording the reflex pain and swelling were recorded at baseline, one, two, three, four and
using surface electrodes. For each subject, H reflex was tested in six weeks post injury. ANALYSIS: Data was analysed using SPSS 9.0
two positions (the unloading prone lying and the loading standing for Windows. For all outcome measures, a within subjects repeated
positions). The H-reflex was tested for three times. The first time measures of analysis of variance (ANOVA) was performed to
was before any treatment. The second time was immediately after determine the significant change over time between groups. The raw
the subject had assumed the position (trunk rotation from side scores recorded at baseline, week 1, 2, 3, 4 and 6 were the six levels
lying) for 15 minutes. Then each subject was instructed to assume on the within subjects factor. The two treatment groups (intermittent
this position three times per day for 2 weeks as a home program and standard) were the two levels on the between subject factor. In
and after that the H reflex was recorded for the third time. The addition a within subjects repeated measures analysis of covariance
pain intensity was tested using Visual Analogue Scale (VAS) in (ANCOVA) was undertaken to control for the subjects baseline
the three tested conditions and Stanford score was measured in levels before looking at their change in subsequent time points.
the first session and after the 2 weeks of home program to test RESULTS: Subjects treated with an intermittent treatment protocol
how effective the treatment has been. ANALYSIS: The Stanford had significantly less ankle pain on activity, than those using a
score was tested using t-test. Two ways ANOVA was carried out standard twenty-minute treatment protocol; one week (p < 0.05) after
by using StatGraphics software with multiple range test to examine ankle injury, however there were no significant differences between
the significant difference between the three studied conditions. groups in terms of function, swelling, or pain at rest. CONCLUSIONS:
RESULTS: The results of the study indicated that trunk rotation It appears that intermittent applications may enhance the therapeutic
from side lying position on the pain free side significantly increases effect of ice after acute soft tissue injury, however the benefits
(p < 0.05) the amplitude of the soleus H reflex whether tested of intermittent treatment are currently restricted to pain relief, and
in loading or unloading position. Similarly the statistical analysis many more high quality studies are required. IMPLICATIONS:
revealed that the level of pain reduced significantly (p < 0.05) after Cryotherapy is largely accepted as the treatment of choice for
positioning. On the other hand the results indicated that the prolonged acute soft tissue injury, but current recommendations have many
use of this position as a home program (for 2 weeks) maintained the shortcomings and selection of parameters in a clinical environment
improvement of the H reflex of the soleus muscle. The functional continues to be made pragmatically. This is the first randomised
performance of the subjects improved significantly (p < 0.05) after controlled study to stringently compare two different cryotherapy
two weeks of positioning. CONCLUSIONS: Trunk rotation from side protocols using subjects with closed soft tissue injury and in
lying position (on the pain free side) improves the H reflex of the accordance with basic science research, the results highlight that
soleus muscle and significantly reduces the pain of the affected shorter, intermittent applications may enhance the analgesic effect
lower limb. IMPLICATIONS: Using trunk rotation as a treatment of ice after acute ankle injury. KEYWORDS: cryotherapy, ankle
program for subjects with sciatica was reported to be effective in sprain, soft tissue injury. FUNDING ACKNOWLEDGEMENTS: None.
reducing the radicular pain in the affected extremity. In addition CONTACT: [email protected]
this position improves the functional performance of the subjects ETHICS COMMITTEE: University of Ulster Research Ethics
when used as a home program. KEYWORDS: Sciatica, Rotation, H- Committee
S32 WCPT 2007, Research Reports
Research Report Platform Presentation Research Report Platform Presentation
VCEC Meeting Rooms 11-12 VCEC Meeting Rooms 8&15
VARIABILITY IN MOVEMENT: THE EXAMPLE OF GROUND LONGITUDINAL AND CONSTRUCT VALIDITY OF A
REACTION FORCES ON STAIR COMPUTERIZED ADAPTIVE TESTING FUNCTIONAL STATUS
Luder G, Rocourt M, Deschner G, Radlinger L; Physiotherapy OUTCOME MEASURE
Research, University Hospital Berne, Switzerland
Deutscher D1 , Hart D2 ; 1 Maccabi Healthcare Services – HMO,
PURPOSE: Variability is common in all movements. The important Tel-Aviv, Israel; 2 Focus On Therapeutic Outcomes, Inc., White
question is how much variability is advantageous or not. We propose Stone, VA, USA
as a hypothesis that there is an optimal variability for every movement
measurement. Lower or higher variability will lead to problems and PURPOSE: The purpose of this study was to assess performance
could be related to difficulties in movement control or conditional of a Hebrew translation of a computerized adaptive testing (CAT)
deficits. This hypothesis has been investigated by the example of functional status (FS) measure. Objectives were to assess longitu-
ground reaction forces (GRF) on stairs in people that underwent dinal and known groups construct validity in an Israeli population of
specific hip surgery and thus had to walk with reduced weight-
patients receiving physical therapy in community based outpatient
bearing for 8 weeks. RELEVANCE: Stair climbing is a demanding
clinics due to neuro-musculoskeletal conditions. RELEVANCE: An
task of daily-life and leads to a higher risk of falls than level gait.
FS measure estimated using a CAT application was developed in the
A higher variability of stride time and length in level gait is known
as an indicator for the risk of falling in elderly people. So the United States. The FS items were translated into Hebrew, and the
variability of GRF on stairs may also serve as a predictor for the outcomes system was implemented in Israel. Validity of the translated
risk of falling and could be an indicator for movement control and FS measure was unknown. PARTICIPANTS: Data were examined
quality. PARTICIPANTS: A cross-sectional survey with three groups from 4,423 consecutive Hebrew speaking adult patients (mean
was performed: persons three months after surgical hip dislocation age=49, SD=16, range=18-95, 56% women) referred to physical
(G3, n=29, 28.1±5.8 years, 76.7±17.1 kg), persons 12 months therapy for treatment of functional deficits secondary to a variety of
after surgery (G12, n=28, 30.1±5.1 years, 80.4±15.7 kg) and a neuro-musculoskeletal disorders. METHODS: Outcomes data were
healthy control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg). collected in 11 outpatient clinics. Measures of FS generated using
METHODS: GRF in stair ascent and descent were measured on a item response theory mathematics and applied using CAT methods
6-step staircase with two embedded force plates on the 3rd and 4th were transformed to a range from 0-100 (low to high functioning)
step. The inclination of the stair was 30.4º with a riser height of 17.9
on a linear metric. Outcomes data were integrated into an electronic
cm and a tread of 29 cm. All persons walked barefoot and without
health record system to produce a comprehensive database. Ability
using the handrail. ANALYSIS: Several force and time parameters of
of the translated FS measure to detect FS change (longitudinal
the GRF-curves were detected and the coefficient of variation (CV)
was calculated over 5 trials per subject. Descriptive statistics and construct validity) was assessed by measuring the effect sizes and
group differences (nonparametric: Kruskal-Wallis-H, post-hoc: Mann- standardized response means. Known-groups construct validity was
Whitney-U) were computed using SPSS. RESULTS: The CV of the assessed by determining if FS measures discriminated between
force parameters were all below 7%, with a slight decrease for both patients known to vary in clinically logical ways. We examined the
experimental groups, which was only significant for G12 in ascent. overall sample as well as the 4 largest groups of patients by body part
Loading rates showed CV up to 12% and mostly increased for G3 treated (lumbar, cervical, knee, shoulder). ANALYSIS: Descriptive
and G12 compared to G0. The highest changes between groups were statistics were used to calculate the effect sizes and standardized
found for time parameters CV’s, which reached 14%. The differences response means. Known groups construct validity was assessed
between groups were not systematic and only several differences using one-way ANCOVAs. FS change was the dependent variable.
were significant. CONCLUSIONS: Optimal variability seems to differ Intake FS measure was the covariate. Independent variables were
for different types of parameters and the changes between the groups symptom acuity, age, gender and surgical history related to the
were not consistent. The different variability of the time parameters
treated disorder. RESULTS: Effect sizes were 0.90 overall, and 1.07,
may partly be explained by differences in leg strength, which was also
0.91, 0.86, and 0.79 for patients with shoulder, lumbar, knee or
measured in the participants. Maybe the differences were small since
persons in our study did not have any falls or even severe difficulties cervical impairments, respectively. Standardized response means
in climbing stairs. IMPLICATIONS: Variability is an important and were similar, but magnitudes were less (range 0.77 to 0.91). For
interesting topic related to movement control. Further investigations the overall sample, FS measures discriminated patients in clinically
have to be done to show the CV of GRF for other groups, such logical ways by symptom acuity, age group and gender (P < 0.01), but
as elderly people, people with history of falls or with pain or not for surgical history (P = 0.09). For the body part specific samples,
difficulties while stair climbing. KEYWORDS: Variability, Stair, Ground FS measures discriminated patients consistently by symptom acuity,
reaction force. FUNDING ACKNOWLEDGEMENTS: Swiss Asso- but there were mixed results for age group, gender and surgical
ciation of Physiotherapy, Switzerland. CONTACT: gere.luder@fisio- history, especially for patients treated due to cervical impairments.
burgernziel.ch CONCLUSIONS: FS change measures were responsive to change
ETHICS COMMITTEE: The study was approved by the Ethics supporting longitudinal construct validity and discriminated most
committee of Canton Berne, Switzerland. patients in clinically logical ways, which tended to support known
group construct validity. IMPLICATIONS: Validation of outcomes
measures is necessary so they can be used to enhance clinical
reasoning processes. Although the overall findings of this study are
promising, further research is needed to assess the validity of the
FS measure for monitoring specific groups of patients and individual
patients. KEYWORDS: Functional status, outcomes measures,
computerized adaptive testing. FUNDING ACKNOWLEDGEMENTS:
This project was not funded. CONTACT: [email protected]
ETHICS COMMITTEE: IRB, Maccabi Health Care Services – HMO,
Tel-Aviv, Israel
Platform Presentations, Sunday 3 June S33
VCEC Meeting Room 16 VCEC Meeting Room 17
RECOVERY AND HEALTH-RELATED QUALITY OF LIFE (HRQL) IMPAIRMENT, ACTIVITY, PARTICIPATION: EFFECTIVE GOAL
OVER THE FIRST POST-STROKE YEAR: DOES AGE MATTER? SETTING – CHILDREN WITH CEREBRAL PALSY AND
LOWER LIMB BOTULINUM TOXIN (TYPE A) INJECTIONS
Wood Dauphinee S1−3 , Mayo N1−3 , Scott S3 ; 1 School of Physical &
Occupational Therapy, McGill University, Montreal, Canada; Kealey L1 , Megens A1 , McCormick A1 , Sveistrup H2 ; 1 Ottawa
2 Department of Medicine, McGill University, Montreal, Canada;
Children’s Treatment Centre, Ottawa, Ont,Canada; 2 University
3 Clinical Epidemiology, McGill University Health Centre, Montreal,
of Ottawa,Ottawa,Ont.,Canada
Canada
PURPOSE: Understanding the difference between clinicians’ and
PURPOSE: The goals of this study were to examine the impact parental observations is crucial for a multidisciplinary spasticity
of age and its common health and social problems on recovery management team. The purpose of the retrospective study was to
and HRQL during the first year after stroke. RELEVANCE: People collect information about pre-injection goal setting, post injection
with stroke, many of whom are elderly with comorbid conditions, are observations and parent reports of children with cerebral palsy who
commonly treated by physical therapists. Treatment generally focuses had injections with botulinum toxin(type A) in lower limb muscles.
on facilitating neurological recovery and resuming usual activities. RELEVANCE: Based on the use of the Gross Motor Function Clas-
sification System (GMFCS), children with cerebral palsy in different
Treatable complications, such as depression, and less than optimal
age bands demonstrate varying functional movement abilities. The
social resources may impact the outcome. PARTICIPANTS: In
types of goals and patterns of outcomes may differ between the
Montreal, 267 people with a confirmed ischemic or hemorrhagic first
GMFCS levels. The International Classification of Functioning and
stroke, who spoke English or French, were admitted to five involved
Disability (ICF) allows the clinician to conceptualize and categorize
acute care hospitals, and consented to participate were enrolled.
observations. PARTICIPANTS: The health records of 57 children,with
METHODS: Members of this inception cohort were interviewed by cerebral palsy, who had lower limb injections with botulinum toxin
trained interviewers over the telephone at 1, 3, 6, and 12 months post- (type a) between the years of 2003 and 2005 were included.
stroke using multiple measures including the Stroke Impact Scale METHODS: Ethics approval was granted from the University of
(SIS) and the Short Form (SF)-36. Clinical data were abstracted Ottawa Research Ethics Board. A retrospective chart review was
from the patients’ charts. ANALYSIS: Cross-sectional descriptive performed collecting the pertinent information relating to pre-injection
statistics (radar plots) and longitudinal growth curve analyses were goals, post-injection outcomes and family observations. ANALYSIS:
used to portray the results. Outcomes include the physical and mental The data forms were sorted according to the child’s GMFCS level
composite summaries (PCS & MCS) of the SF-36 and a ‘recovery’ from 1 to 5. The pre-injection goal areas, post injection outcomes
visual analogue scale (VAS) from the SIS. RESULTS: Mean and post-injection family observation were listed. The items were
trajectories of PCS and MCS remained 5-7 points below population counted and categorized into impairment, activity and participation
norms 1 year post-stroke. Most improvement in PCS occurred groupings. The frequency of items was calculated and compared in
during the first 6 months. On average, women scored 3 points each group and GMFCS level, to delineate the different patterns of
lower than men, and trajectories lowered with increased comorbidity; goal setting and outcome observation according to age band and
these differences remained over time. Stroke severity had a strong functional level. Means were calculated across the five GMFCS levels
impact at 1 month, though it was somewhat reduced over time, to compare impairment, activity and participation trends. RESULTS:
as those with more severe strokes demonstrated a higher rate of Pre-injection, the mean percentage of goals based on impairment
recovery. Their level of recovery, however, remained substantially items was 48.48%, activity items was 48.56%, and participation
below those with milder strokes. Age, beyond comorbidity, impacted items was 2.96%. Post-injection, the mean percentage of impairment
both the initial score and rate of recovery of PCS. While initial scores observations was 38.8%, activity was 57.66%, and participation was
varied by 2 points for a 15-year age change from the average (70 3.54%. Post-injection, parents reported on impairment observations
years), by 1 year that 2-point difference had increased to 3 12 points 17% of the time, activity 69.54% of the time, and participation
due to continued (though reduced) recovery in younger patients 13.42% of the time. Pre-injection, participation based goals were only
6 to 12 months post stroke. Both PCS and MCS varied by level reported in the GMFCS 1 group at 6%. There were no participation
of social resources. MCS trajectories of persons with the fewest based goals documented for children in GMFCS levels 2-5. Post-
resources (8%) were 8 points lower than those at the highest injection participation observations were reported in GMFCS 1 at
8.3%, GMFCS 2 at 4.2%, and GMFCS 3 at 4.2%. The families
level (27%). An inverse association was found between MCS and
of children in GMFCS 1 did not report on impairment. Families
stroke severity, with slightly lower trajectories found for those with
of children in GMFCS 4 and 5 did not report on participation but
milder strokes. MCS also varied by cognitive status and physical
families in the GMFCS 4 reported on activity post injection at 85.7%.
ability. No association with sex remained once other factors were
CONCLUSIONS: Trends are observed within the individual GMFCS
considered. Perceived stroke recovery, measured by the SIS VAS,
levels for pre-injection goal setting, post injection observations
was associated with physical ability, depression, social resources
and parent reporting. Collectively, impairment goal items decrease
and cognitive status. CONCLUSIONS: Age, severity, comorbidity, post injection. Families did not report on impairment to the same
social resources, and mental and physical abilities influence both degree as activity and participation. The evidence demonstrates
perceived recovery and HRQL the year after stroke. IMPLICATIONS: that potential functional change needs to be evaluated in the
When the person with stroke is elderly, attention to modifiable factors, child’s routine, environment and family lifestyle. IMPLICATIONS:
physical ability, co-morbidity and social situation, should be a focus The physical therapist is challenged to partner with the family to
of therapeutic management to achieve best results. Therapists and set realistic goals building on activity and participation outcomes.
other providers need to identify and deal with such problems during Future research is required to investigate the impact of spasticity
rehabilitation. KEYWORDS: Stroke, Co-morbidity, Social support. management on activity and participation, particularly in relation to
FUNDING ACKNOWLEDGEMENTS: The Canadian Stroke Network. family/child quality of life. KEYWORDS: Botulinum Toxin Type-A,
CONTACT: [email protected] cerebral palsy, goal setting. FUNDING ACKNOWLEDGEMENTS:
ETHICS COMMITTEE: Institutional Review Board of McGill Univer- Unfunded but supported by global budget of Ottawa Children’s
sity and the Ethics Review Boards of the participating hospitals: RVH, Treatment Centre. CONTACT: [email protected]
MGH, JGH, HSL, HMR ETHICS COMMITTEE: University of Ottawa Research Ethics Board
VCEC Meeting Room 18 VCEC Meeting Rooms 19-20
IS LEG LENGTH INEQUALITY IMPORTANT AFTER TOTAL HIP MORAL JUDGMENT OF PHYSICAL THERAPY STUDENTS: A
REPLACEMENT? COMPARATIVE STUDY
Beard D1 , Gill R1 , Andrew G2 , Nolan J3 , Barker K4 , Murray D1 ; Larin H1−3 , Geddes E2 , Eva K2 ; 1 University of Sharjah, Sharjah,
1 Nuffield Dept Orthopaedic Surgery, University of Oxford, UK;
United Arab Emirates; 2 McMaster University, Hamilton, Ontario,
2 Bangor Hospital, North Wales, UK; 3 Norfolk & Norwich Hospitals
Canada; 3 Ithaca College, Ithaca, NY, USA
Trust, Norwich, UK; 4 Nuffield Orthopaedic Centre NHS Trust,
Oxford, UK PURPOSE: This collaborative study investigated and compared the
PURPOSE: To document the incidence and influence on outcome of moral judgment of two cohorts of physical therapy students – one
length leg discrepancy (LLD) after cemented total hip replacement in Canada and one in the United Arab Emirates. RELEVANCE: Age
(THR). In addition, contributory factors to the aetiology of this com- and formal education are important variables for promoting change in
mon post operative complication were investigated. RELEVANCE: moral judgment, i.e., the ability to judge what is morally right or wrong.
Leg length discrepancy is a well known complication following THR. During their professional program, physical therapy students need to
The true magnitude, and the cause, of LLD remains unknown as there become reflective practitioners and develop their moral judgment.
are few studies documenting the incidence and potential mechanisms Since curricular improvements are based on student outcomes, it
of undesirable limb shortening after THR. To what extent this problem is imperative to measure students’ characteristics and change over
influences functional outcome is also unknown. Physiotherapists are time. However, the instruments chosen to measure outcomes must
often required to treat the sequelae of this condition because of be suitable. PARTICIPANTS: Two cohorts of students volunteered
the effect on gait and functional activity. Increased understanding of to participate: (1) Ten females from the 3-year BScPT program,
the problem will help therapists in the management of this common
University of Sharjah (UOS), who were Arabic and English speaking
complication. PARTICIPANTS: 1583 patients undergoing elective
(mean age 18.5 years); and, (2) 35 females from the 2-year BHScPT
cemented THR were recruited to the Exeter Primary Outcomes
Study (EPOS). All patients had all undergone cemented primary program, McMaster University (MAC) who were English speaking
THR using the Exeter stem in seven different UK centres. Either an (mean age 24.9 years). Written consents were obtained. METHODS:
anterolateral (n=1143) or posterior (n=426) was used. METHODS: The study design was longitudinal and comparative. The Defining
Data were collected prospectively by a research assistant in each Issues Test (DIT,) designed in English to measure moral judgment,
centre. Various demographic data were assimilated including age, was administered on entry into and exit from the students’ respective
gender, BMI, grade of surgeon, type of anaesthetic. Standard professional programs. The DIT was translated into Arabic for the
validated outcome instruments were used including the Oxford Hip UOS students. The primary investigators were blind to the study
Questionnaire and Activity scores at one and two years. True leg results until after the students’ graduation. ANALYSIS: Within each
length discrepancy was measured using the standard linear tape cohort and between the two cohorts, the entry and exit DIT mean
method from anterior superior iliac spine (ASIS) to medial malleolus. scores were compared using an ANCOVA. Change over time was
ANALYSIS: Descriptive methods were used for the frequency data. determined using matched entry and exit tests from both cohorts
Outcome data were examined in two ways; 1) by comparing those with age and grade point average (GPA) controlled as covariates.
with and without LLD (Mann Whitney) and 2) assessing the influence RESULTS: DIT mean scores at entry were: MAC 48.8 (SD 11.1) and
of LLD on specific activities (ANOVA with post hoc Tukey). A Chi UOS 30.8 (SD 5.7), p < 0.05. At exit, the scores were: MAC 53.9
square was used to examine the influence of anaesthetic type.
(SD10.6) and UOS 29.0 (SD12.6), p < 0.05. Because of attrition and
RESULTS: 318 patients (20%) had a LLD 1cm whilst 74 of
incomplete score sheets, DIT change scores could be matched for
these (5%) had LLD of 2cm. There was a significant difference
24/35 MAC and 8/10 UOS students. The mean change was: 47.5 to
in Oxford Hip Score between patients with and without LLD. In terms
of specific activities, patients with LLD found it more difficult to put 54.9 for MAC students (p < 0.05) and 29.1 to 27.4 for UOS students
on socks, ascend stairs and had more pain than those without. It (n.s.). Adjusting for differences in age and GPA had no effect.
was found that patients who underwent an epidural anaesthetic were The large differences in scores between cohorts enable statistical
more likely to have resultant and significant LLD after the operation significance despite the small sample size. CONCLUSIONS: There
than those who had a general anaesthetic. CONCLUSIONS: The was a significant difference in the moral judgement scores between
incidence of LLD after cemented THR is higher than expected. This physical therapy students at MAC and those at UOS regardless
complication has a major influence on outcome and specific function of age and GPA. DIT scores of MAC students were higher than
of THR patients. Excessive muscle relaxation during an epidural UOS students at both entry and exit from their programs. Only MAC
anaesthetic may contribute to the generation of LLD. IMPLICATIONS: students demonstrated significant change in their DIT scores over
These results, from a large multi-centre cohort, indicate the need time. IMPLICATIONS: In all cultures, professional programs have a
for increased vigilance by the rehabilitation team regarding leg role in furthering the development of moral judgment in students.
length discrepancy after THR. Physiotherapy management after THR However, these preliminary results have not been able to detect
should include careful screening and the initiation of appropriate change in the UOS students. These results should be interpreted
treatment for LLD. Intervention should include prosthetic referral and cautiously. This first Arabic version of the DIT requires further analysis
gait assessment/education as necessary. KEYWORDS: Hip, Leg,
with regard to its cultural sensitivity and logistical administration.
Length. FUNDING ACKNOWLEDGEMENTS: Stryker Howmedica
Ethics educators need to be aware of the process related to the
Osteonics have provided funding for the EPOS study. The Oxford
development of moral judgment from within the particular perspective
database group are thanked for their assistance. CONTACT:
[email protected] of the students’ culture in order to effectively develop and adapt their
ETHICS COMMITTEE: COREC (Oxford) UK curricula. KEYWORDS: Ethics, cultural diversity, education research.
FUNDING ACKNOWLEDGEMENTS: This study was supported by
a research grant from the University of Sharjah, Research and
Studies Center, Sharjah, United Arab Emirates (UAE). CONTACT:
[email protected]
ETHICS COMMITTEE: University of Sharjah, College of Health
Sciences, Research Committee
PP Crystal Pavilion B & C VCEC Ballroom A
CERVICAL PROPRIOCEPTION – HEAD REPOSITIONING EFFECT OF LOCAL COOLING ON THE CORTICO-MOTOR
ACCURACY IN NORMAL SUBJECTS MEASURED WITH THE EXCITABILITY OF ANKLE MUSCLES
VICON MOTION ANALYSIS EQUIPMENT Tremblay F1 , Dubé J, Adam P, Poirier M, Marcoux J; 1 Physiotherapy
Ross L, Green A, Blundell M; Coventry University, Coventry, England Program, School of Rehabilitation Sciences, University of Ottawa
PURPOSE: To investigate, using the 6-camera Vicon 512 video PURPOSE: To determine the effect of local cooling on the corticomo-
motion analysis system to measure in degrees, joint position error tor excitability of ankle muscles by means of transcranial magnetic
(JPE) via the error of head repositioning accuracy (HRA) in a stimulation (TMS). RELEVANCE: Local cooling is commonly used by
population of healthy subjects, in the three cardinal planes – physiotherapists as a hands-on modality to treat acute tissue injuries
sagittal, coronal and horizontal, following three different movements in the context of competitive sports or recreational activities. While the
performed: flexion/extension, lateral flexion and rotation in the local effects of cooling are relatively well known, its influence at the
cervical spine. RELEVANCE: The evidence for inclusion of the central level are less known. PARTICIPANTS: Twelve young healthy
proprioception aspect of a body region into assessment and adults (20-30 years, 6 males) participated in this study. METHODS:
rehabilitation programmes is compelling. Clinically only strength and Cortico-motor excitability was assessed by monitoring the amplitude
mobility are currently evaluated in the cervical spine and it has been and latency of motor evoked potentials (MEPs) elicited in the right
suggested that it is time to move away from these gross and non- Tibialis Anterior (TA) and Soleous (SOL) muscles in response to
specific measures of musculoskeletal function as the underpinning TMS of the left motor cortex. TMS pulses were produced using a
for diagnosis and towards more specific measurements such as double cone coil connected to a Magstim 200 stimulator (MagStim
cervicocephalic kinaesthetic awareness. However, there are very Co. Dyfed, UK). Variations in the amplitude and latency of MEPs
few studies, to date, into the proprioceptive ability of the normal, were measured before (i.e., baseline), during (5-min interval) and
healthy cervical spine PARTICIPANTS: A convenience sample of after local cooling (5 & 10-min post) of the ankle. The cooling
twenty four healthy adults (age 19-55) were chosen. Twelve males was produced by covering the anterior and lateral aspects of the
and twelve females. An ICC to give “good reliability” with 80% right ankle with a cold wrap (ice pack) for 20-min. Variations in
power at a 5% significance level required at least thirteen subjects the skin surface temperature were also monitored by means of an
if each was measured three times. The number needed to be a infra-red temperature gun. ANALYSIS: Paired t-tests were used to
multiple of six to allow for counterbalancing of the sequence of assess differences between baseline MEP values (pre-cooling) and
three movements to be performed. METHODS: All subjects were variations measured during and after cooling. RESULTS: During
measured on three separate occasions; performing flexion/extension, cooling, the amplitude of MEPs in TA gradually decreased in parallel
lateral flexion and rotation of their cervical spine in a counterbalanced with the drop in skin temperature, reaching its maximum at 15 min
order of performance. Measurements were taken with the Vicon (20% diminution on average, p < 0.05). MEP latency values in TA were
512 video motion analysis system which gave degrees of error of correspondingly increased during cooling with significant differences
HRA to subjective neutral in the three cardinal planes following being detected at 10 (p < 0.01) and 15-min (p < 0.05) cooling. After
each movement performed. ANALYSIS: The raw data was entered removal of the cold wrap, both MEP values and skin temperature
into SPSS version 11.5 and an intraclass correlation coefficient returned to baseline by the 10th min post-application. In the SOL,
(ICC) was calculated in a two way random effects model looking similar changes were observed though the overall effect was far less
for absolute agreement, against a test value of 0.7, for the important than in the TA, with large variations being noticed between
reliability of the three repeats. RESULTS: There was statistically no individuals. No statistical differences could be detected in the SOL.
significant difference between the three repeats in any movement CONCLUSIONS: Local cooling at the ankle selectively depresses
plane following any movement direction. Sagittal plane following the corticomotor excitability of the TA in parallel with the decrease
flexion/extension mean error HRA −4.81 degrees (undershoot), ICC in skin temperature. This depression is transitory, however, and
0.44, 95% CI 0.17-0.69; coronal plane following lateral flexion mean gradually vanishes as the cooling agent is removed from the treated
error HRA −0.39 degrees (undershoot), ICC 0.61, 95% CI 0.38- area. IMPLICATIONS: A period of 10-15-min should be allowed
0.80; horizontal plane following rotation mean error HRA −0.33 after a cold application for excitability to recover before a return to
degrees (undershoot), ICC 0.76, 95% CI 0.57-0.88. CONCLUSIONS: activity or engaging in exercises. KEYWORDS: motor cortex, ankle,
The normal healthy population can accurately and reliably relocate neurophysiology. FUNDING ACKNOWLEDGEMENTS: F. Tremblay
their head to a subjective neutral position following displacement is supported by NSERC. CONTACT: [email protected]
in all directions. However, the greatest error in this relocation ETHICS COMMITTEE: Research Ethics Committee, University of
was recorded in the sagittal plane following the movement of Ottawa
flexion/extension. IMPLICATIONS: The results give useful normative
data for future comparison with patient populations and as a
platform for further studies with specific subject populations e.g. Research Report Platform Presentation
patients suffering from whiplash associated disorder, sports specific 1117 Sunday 3 June 08:50
population where injury/stresses to cervical spine are common. VCEC Ballroom B & C
Further studies should be performed to evaluate the effectiveness THE ROLE OF EXPERIENCES IN FOSTERING DEVELOPMENT
of proprioceptive rehabilitation programmes. KEYWORDS: Cervical OF CULTURAL COMPETENCE IN EARLY-CAREER PHYSICAL
spine, Proprioception, VICON. FUNDING ACKNOWLEDGEMENTS: THERAPISTS
Not funded. CONTACT: [email protected] Salzman A, Canty T, Eaton K, Mosaddeghi P, Terada P, Sander A,
ETHICS COMMITTEE: Coventry University Ethics Committee Hilliard M; Physical Therapy and Human Movement Sciences,
Northwestern University, Chicago, IL, USA
PURPOSE: Rapidly changing population demographics within and
between countries are altering the character of communities
around the world. In the current age of globalization, physical
therapy education programs in all countries must strive to prepare
culturally competent professionals who can work effectively with a
diverse population. Unfortunately, little is known about how physical
therapists (PTs) develop cultural competence. This research, part Research Report Platform Presentation
of a larger study exploring the development of cultural competence 924 Sunday 3 June 08:50
in early-career PTs, primarily examined the role of experiences in VCEC Meeting Rooms 8&15
developing cultural competence. A secondary focus was to explore A SYSTEMATIC REVIEW OF MEASUREMENT TOOLS TO
how learning from experience becomes meaningful and leads to ASSESS ATAXIA
changes in attitudes, skills, knowledge, and behaviors. RELEVANCE:
Watson A1 , Tyson S1,2 , Moss S1,3 , Troop H4 , Dean-Lofthouse G5 ,
Culturally competent care is recognized as a matter of social
Jorritsma S6 , Shannon M7 ; 1 Physiotherapy Directorate, University
justice and considered critical for improving the health of those
of Salford, UK; 2 Centre for Rehabilitation and Human Performance
in ethnoculturally and socially diverse societies. Although there is
Research, University of Salford, UK; 3 Salford Primary Care Trust,
a growing body of literature addressing the need for PTs to be
UK; 4 Tameside National Health Service Trust, UK; 5 Physiotherapy
culturally competent, there is a lack of understanding regarding what
Private Practice, UK; 6 Trafford National Health Service Trust, UK;
types of educational and life experiences foster the development of 7 Salford Royal Hospital Trust, UK
cultural competence. PARTICIPANTS: Fifteen PTs (14 females, 1
male) with no more than 3 years of experience, practicing in various PURPOSE: A systematic review of measurement tools for ataxia was
clinical settings throughout a large, metropolitan area participated in carried out to assess their psychometric properties and suitability
the study. Twelve participants identified themselves as white non- for clinical use and to make recommendations for best practice.
Hispanic, two identified as Asian or Pacific Islander, and one as RELEVANCE: Ataxia is a disabling aspect of many conditions
Hispanic/Latino. Volunteers were recruited through letters, E-mails, and its management forms an important part of neurological
and flyers sent to physical therapy clinics. METHODS: Data were physiotherapy. There is little research to inform practice, particularly
gathered through audiotaped, individual, semi-structured interviews. regarding measurement and assessment. DESCRIPTION: CINAHL,
Interviews were conducted until theoretical saturation occurred. Medline, AMED, Psychoinfo, Sportsdiscuss and Embase databases
ANALYSIS: Tapes were transcribed; transcripts were individually were searched using combinations of the following keywords:
coded by the research team after establishing trustworthiness of ataxia / tremor / co-ordination and measurement / assessment
the coding schema. Constant comparative methods were used / outcome / outcome measure / measurement tool. Searches
to develop themes using concept mapping. Strategies used to were limited to English publications and those involving adult
strengthen the quality of the findings included negative case analysis, humans. The identified articles were assessed for psychometric
peer review, an audit trail, and thick description. RESULTS: Four properties (inter and intra rater-reliability, validity and sensitivity
main themes emerged regarding transforming experiences that to change) and clinical utility (cost, portability, time taken to
assisted in developing cultural competence: 1) value of local or perform and need for specialist equipment). Article quality was
international service learning experiences; 2) value of patient- independently reviewed by clinicians using criteria based on the
centered learning experiences; 3) importance of “out of comfort
Scottish Inter-Collegiate Guidelines Network and methods described
zone” experiences, including feeling different than Others; and 4)
by Jorstad et al1 . Minimum standards for weak, adequate and
signficance of reflection in learning and leading to conviction to
good quality evidence for psychometric properties and clinical utility
change. CONCLUSIONS: Local and international immersion service
were defined. EVALUATION: Five ordinal scale tools were identified;
experiences and interactions with diverse patients contribute in the
four measured the severity of ataxic tremor (Fahrs Tremor Rating
ongoing process of developing cultural competence; experiences
Scale [FTRS]2,3 , Graded Finger-Nose Test [GFNT]4,5 , Clinical Tremor
which cause cognitive and emotional discomfort are most likely
Rating Scale [CTRS]6,7 and International Cooperative Ataxia Rating
to develop cultural competence. Reflection on the experiences is
Scale [ICARS]8,9 ) and one measured disability caused by ataxia
required for learning to occur. Depth and breadth of reflection is
(Tremor Disability Questionnaire [TDQ]10 ). Only ICARS was ataxia-
enhanced during interactions with influential people, including par-
specific; all others had been tested on people with conditions causing
ents and friends. Future planned studies will examine longitudinally
all aspects of professional development and patients’ perspectives multiple impairments (including ataxia, weakness and spasticity).
on PTs’ cultural competence. IMPLICATIONS: Cross-cultural clinical Reliability, validity and clinical utility had been examined for all tools
interactions can be expected because of changing population but sensitivity to change was unaddressed for all. Reliability of the
demographics. Educators and mentors can assist early-career PTs FTRS, ICARS and upper limb and head sections of the TDQ were
to develop cultural competence by encouraging participation in adequate or good. Reliability of the GFNT, CTRS and lower limb
and reflection on cross-cultural experiences, both in the clinic section of the TDQ were weak. Compared with measures of disability
and in the community, and fostering conviction to assist them to and clinical assessment, the validity of the tools were adequate or
take action to change attitudes, skills, knowledge, and behaviors. good. Compared with instrumented measures of impairment, the
KEYWORDS: cultural competence, professional development, qual- validity ranged from weak to good. Clinical utility was good for all
itative inquiry. FUNDING ACKNOWLEDGEMENTS: Chicago Area measures. Most tools were quick to perform, cheap, portable and
Clinical Educators’ Forum and Northwestern University Department required little specialist equipment. CONCLUSIONS: The FTRS has
of Physical Therapy and Human Movement Sciences. CONTACT: the best overall score and is reliable and valid for people with ataxia
[email protected] caused by multiple sclerosis. It can be time consuming to complete
ETHICS COMMITTEE: Northwestern University Institutional Review and sensitivity to change is untested. IMPLICATIONS: None of the
Board measurement tools fulfilled all the assessment criteria and could
not be recommended for clinical use. References: 1. Jorstad EC
et al. JAGS 2005; 53: 501-510. 2. Feys PG et al. Arch Phys Med
Rehabil Jan 2003; 84: 79-82. 3. Hooper J et al. Arch Phys Med
Rehabil Sept 1998; 79: 1076-1079. 4. Swaine BR and Sullivan SJ.
Arch Phys Med Rehabil Jan 1992; 73: 55-59. 5. Swaine BR and
Sullivan SJ. Physical Therapy Feb 1993; 73(2): 71-78. 6. Matsumoto
J et al. Neurology 200; 57: 1876-1882. 7. Bain PG et al. J Neurol,
Neurosurg and Psychiatry 1993; 56: 868-873. 8. Storey E et al. Mov
Disord 2004; 19: 190-212. 9. Trouillas P et al. J Neuro Sci 1997;
145: 205-211. 10. Louis ED et al. Movement Disorders 2000; 15(1):
95-102. KEYWORDS: ataxia, systematic review, outcome measures.
FUNDING ACKNOWLEDGEMENTS: This work was unfunded but
supported ‘in kind’ by the University of Salford and Bolton Hospitals
NHS Trust, Bolton PCT, and Wigan, Ashton and Leigh PCT, UK. fitness choices. KEYWORDS: Knee osteoarthritis, gait, exercise
CONTACT: [email protected] intervention. FUNDING ACKNOWLEDGEMENTS: Support for this
study was received from Pittsburgh National Corporation Arthritis
Research Fund, Mad Dog Athletic Corporation, Venice California,
USA, and the Jewish Community Center, Pittsburgh PA, USA.
1382 Sunday 3 June 08:50 CONTACT: [email protected]
VCEC Meeting Rooms 11-12 ETHICS COMMITTEE: Internal Review Boards of Duquesne
SPINNING® GROUP STATIONARY CYCLING IMPROVES University and Mercy Hospital, Pittsburgh PA, USA
TEMPORAL AND SPATIAL QUALITY OF GAIT IN PERSONS
WITH MILD TO MODERATE KNEE OSTEOARTHRITIS
Marchetti G1 , Salicinski A2 , Krohn K3 ; 1 Duquense University, 1060 Sunday 3 June 08:50
Pittsburgh, PA, USA; 2 University of Pittsburgh, Pittsburgh, PA, VCEC Meeting Room 16
USA; 3 Mercy Hospital, Pittsburgh, PA, USA
DEVELOPMENT OF A MEASURE OF FUNCTIONING
PURPOSE: To examine the effect of a group cycling intervention POST-STROKE
on the gait characteristics of persons with mild to moderate knee
Finch L1 , Higgins J1 , Wood-Dauphinee S1,2 , Mayo N1,3 ; 1 School of
osteoarthritis (OA). RELEVANCE: Persons with knee OA have
Physical and Occupational Therapy, McGill University; 2 Department
demonstrated gait- pattern alterations. The effects of exercise
of Epidemiology and Biostatistics McGill University; 3 Faculty of
interventions on gait patterns have not been previously investigated.
Medicine, McGill University
PARTICIPANTS: Forty-one volunteers (29 females, 12 males) with
confirmed knee OA (Kellgren-Lawrence grades K-L 1-3) were PURPOSE: To develop a measure of functioning after a stroke that
recruited from physician practices and by general media notices. could be used to quantify recovery. RELEVANCE: Stroke survivors
Mean age of subjects was 57 years (range 37-74). METHODS: measure functioning compared to what they did in their pre-stroke
Subjects were randomly assigned to cycling and control groups and life, hence equating functioning and recovery. Quantifying recovery
were evaluated for baseline fitness on cycle ergometer (VO2max , requires a mathematical comparison of a stroke survivor’s current and
target heart rate zones) and gait pattern on a 12 foot walkway pre-stroke functional state: without a measure of functioning, recovery
with GAITRite® analysis system. Cycling subjects participated in cannot be quantified. Measuring a person’s ability to function is
a community-based 12-week program of supervised stationary part of a standard rehabilitation evaluation for stroke. Existing tests
cycling classes at least twice weekly designed to maximize and indices assess various aspects of functioning post-stroke, but
aerobic fitness while limiting direct knee joint stress. Classes few capture the full spectrum from basic activities to participation.
progressively increased from 40 to 60 minutes and included light Measuring function using multiple indices is methodologically difficult,
intensity warm-up/cool-down, stretching and alternating efforts of but a single index does not exist. Rasch analysis, a method of
fast-cadence pedaling efforts and simulated hills-climbs. Subjects quantifying behaviours, has helped develop, refine, and combine
were instructed to maintain an average of 70-75% of predicted items from different indices into a single measure. Rasch analysis
maximum heart rate throughout cycling classes with heart rate transforms ordinal observations from items onto an interval scale
monitors. Control subjects continued current fitness activities but did and produces a unidimensional measure on which items and people
not participate in supervised cycling. Gait parameter changes (3 trial are organized hierarchically, by difficulty and ability, respectively,
average, preferred/maximal velocity/cadence, step/stance times and on the same measurement scale in natural logarithm linear units
symmetry) were measured in groups after 12 weeks. ANALYSIS: or logits. Items that fit a Rasch model could form a measure of
Cycling/control group demographics, gait parameters at baseline functioning to determine a person’s functioning and recovery post-
and gait parameter change differences from baseline and 12 weeks stroke. PARTICIPANTS: The subjects are a subset of 202 community
were compared using independent sample t-test (type I error rate dwelling first stroke survivors from a cohort of 612 persons. The
= 0.05). Proportion of subjects in each group showing velocity survivors, aged 68, were predominately men with an ischemic stroke
improvement and number needed-to-treat (NNT) was estimated. (86%). Despite high activity of daily living scores (Barthel Index
Intent-to-treat analysis was conducted to describe study dropout mean: 92 out of 100; SD: 16), 12% of the sample were limited in
subjects. RESULTS: There was no age or self-reported weight eating, and grooming, and 20% could not bathe, walk fifty yards
differences between groups at baseline. Cycling group demonstrated or climb stairs independently. Major participation restrictions were
greater baseline mean gait velocity (preferred, maximum) and step related to the ability to travel (40%) and do recreational activities.
length differential at maximum velocity than controls. Eight cycling METHODS: A prospective longitudinal study was carried out. All 202
and five control subjects withdrew or were lost to follow-up by subjects responded over the telephone, within 9-months of stroke,
12 weeks. Cycling group subjects demonstrated greater mean to 39 questions from five indices. Data on influencing variables:
increase in preferred velocity (p = .01), preferred cadence (p < 0.01) age, stroke type and severity, and previous health, were also
and reduction in step length asymmetry at maximum velocity collected. ANALYSIS: Two statistical methods, exploratory factor
(p = 0.01) than control subjects. Analysis of improvement in preferred analysis and Rasch analysis, confirmed the item factor structure,
velocity demonstrated NNT = 2. There were no significant age or hierarchy and dimensionality of the measure. The poorest fitting items
baseline gait parameter differences between 12 week completing were removed iteratively until the best fit of the data was achieved.
and dropout subjects. Dropout subjects demonstrated significantly Fit statistics confirmed fit to the model and internal consistency
greater mean self-reported weight (p < 0.05). Two cycling (10%) was also assessed. A consensus exercise involving health care
dropout subjects reported increased knee pain as the reason professionals with expertise in stroke helped validate the measure’s
for withdrawal. CONCLUSIONS: Subjects with mild-moderate knee content. RESULTS: Twelve of the 39 items best fit the hierarchical
OA who completed a 12 week community-based Spinning® group nature of the Rasch model with reliability indices of 0.91 and
cycling class demonstrated a significant improvement in preferred 0.98 for persons and items, respectively. The item difficulty levels
gait velocity and a reduction gait asymmetry at maximum velocity extended from −7.36 to +5.35 logits with item precision (standard
over non-cycling controls. One in two cycling subjects demonstrated error) ranging from 0.14 to 0.37 logits. Gaps in measurement
preferred gait velocity improvement. Future research will examine the occurred only at the extremes of the measure. CONCLUSIONS:
effects of group cycling intervention on pain, functional abilities, and A 12-item prototype measure of functioning that combined activity
quality-of-life in persons with knee OA. IMPLICATIONS: This study and participation indices was developed. Before using this measure
provides evidence for Spinning® as a viable long-term intervention to quantify recovery test-retest reliability and responsiveness to
for persons with mild-moderate knee OA may who have limited change needs to be tested IMPLICATIONS: The measure of
functioning outlines what is necessary and important for community psychological functioning. KEYWORDS: Cerebral Palsy, Strength
functioning and its parsimony greatly reduces the response burden Training, Systematic Review. FUNDING ACKNOWLEDGEMENTS:
in capturing this important concept. KEYWORDS: Functioning, post- No funding. CONTACT: [email protected]
stroke, participation. FUNDING ACKNOWLEDGEMENTS: Fonds
de Recherché en Santé du Québec (FRSQ), the Physiotherapy
Foundation of Canada (PFC) and the Canadian Institutes for Health
Research (CHIR). CONTACT: lois.fi[email protected] 885 Sunday 3 June 08:50
ETHICS COMMITTEE: Faculty of Medicine McGill University VCEC Meeting Room 18
Institutional Review Board. EFFECT OF PHYSIOTHERAPY INTENSITY ON ACHIEVEMENT
OF INPATIENT PHYSIOTHERAPY KEY FUNCTIONAL
MILESTONES POST-TOTAL HIP REPLACEMENT IN PATIENTS
WITH OSTEOARTHRITIS
VCEC Meeting Room 17 Gibson C1 , Mawson S2 , Enderby P1 , Hamer A3 , Norman P4 ;
1 School of Health & Related Research, University of Sheffield,
A SYSTEMATIC REVIEW OF CONTROLLED TRIALS OF Sheffield, UK; 2 Centre for Health & Social Care Research, Sheffield
STRENGTH TRAINING FOR PEOPLE WITH CEREBRAL PALSY Hallam University, Sheffield, UK; 3 Department of Orthopaedics,
Taylor N, Dodd K, Zoghi M; School of Physiotherapy, La Trobe Northern General Hospital, Sheffield Teaching Hospitals NHS
University, Melbourne, Australia Foundation Trust, Sheffield, UK; 4 Department of Psychology,
University of Sheffield, Sheffield, UK
PURPOSE: To evaluate the evidence from controlled trials about
the positive and negative effects of strength training for people PURPOSE: To assess factors (psychological, demographic, medical
with cerebral palsy. RELEVANCE: The movement disorders that and physiotherapy) which affect recovery following total hip replace-
are typical of people with cerebral palsy are often characterised by ment (THR) in patients with osteoarthritis (OA). RELEVANCE: OA is
muscle weakness providing a rationale for the intervention of strength a major cause of disability in the elderly. THR is routinely conducted
training. However, the intervention of strength training has not been to relieve pain and loss of function associated with OA. Around
applied widely in neurological clinical practice due to concerns that 50,000 THR are performed annually in England, approximately 82%
strength training might exacerbate spasticity. A systematic review of these resulted from OA. This is a major burden on the NHS
of controlled trials will provide clinicians with the best available that will increase with the aging population. Increased demand
evidence about the positive and negative effects of this intervention. for THR could be tackled by optimising the rehabilitation process
PARTICIPANTS: The ‘participants’ in this study were seven papers following surgery and thus reducing the length of stay (LOS).
reporting the results of five controlled trials on strength training Recovery time and LOS following THR is hugely variable. Medical
for people with cerebral palsy. Trials were selected by searching and demographic factors account for some, but not all, of this
electronic databases for randomised controlled trials or controlled variability. It was hypothesised that patients’ personality and coping
trials that evaluated the positive and or the negative effects of strategies would affect the success of rehabilitation following THR.
strength training on adults or children with cerebral palsy. METHODS: A second hypothesis stated that intensity of treatment may affect
Quality assessment was completed using the PEDro scale and the achievement of these milestones. PARTICIPANTS: Consecutive
data were extracted using a standardised form. ANALYSIS: Data patients attending pre-admission assessment clinic (under the care
were extracted on environmental and personal contextual factors, of one of five clinicians conducting surgery at three hospitals) for
and standardised mean differences (effect sizes) were calculated for unilateral THR as a result of OA were invited to take part in the
measures of muscle strength, functional activities, and psychological study. 159 patients consented of which 99 successfully completed
functioning. Due to heterogeneity in program details a meta-analysis the pre-operative questionnaires and had their surgery within the
was not conducted. RESULTS: Quality assessment on the PEDro study time frame. METHODS: Participants completed psychological
scale ranged from 3 to 8 (M 5.6, SD 1.9) and sample sizes were and demographic questionnaires prior to surgery. Data regarding
small to moderate with a total of 138 participants in this review. time in days to achieve key physiotherapy milestones (bed transfer,
Most participants had cerebral palsy of the spastic diplegic type, chair transfer, independence with frame, independence with crutches,
were aged from 8 to 18 years, and were independent walkers with physiotherapy discharge, post-operative LOS) were recorded from
or without assistive devices. Strength training programs were varied, the patients’ notes. The physiotherapists treating the patients were
but typically included lower limb exercises. Detailed description of blinded to the purpose of the study. Physiotherapy intensity was
exercise intensity and progression was often lacking. There was calculated by dividing the number of physiotherapy sessions a patient
no consistent trend in the effect of strength training on increasing received by the number of days until discharged from the inpatient
strength with effects ranging from d = −0.71 to +1.92. There physiotherapy team. ANALYSIS: Pearson correlations were recorded
was also no consistent effect on functional activity with effects between the independent and dependent variables (key milestones).
ranging from d = −1.74 to +1.85, or on changes in self-perception Independent variables which significantly correlated (p < 0.05) with
with effects ranging from d = −1.33 to +0.99. The two trials that the dependent variable where included in a forward stepwise multiple
assessed spasticity did not find any significant differences between regression analysis. RESULTS: Physiotherapy intensity significantly
the training and control groups and no other adverse effects were correlated with all key functional milestones. Few psychological
reported. CONCLUSIONS: A systematic review of controlled trials variables have significant associations with the milestones. Multiple
finds insufficient evidence from five controlled trials to conclude that regression analysis revealed physiotherapy intensity to be linked
strength training can increase muscle strength, improve functional to only bed transfer and chair transfer. However, hospital in which
activity or improve psychological functioning in people with cerebral the patient was treated was a predictor of the other milestones.
palsy. There is no evidence that strength training leads to any A statistically significant relationship existed between hospital and
negative effects on spasticity. Further randomised controlled trials physiotherapy intensity. The regression analyses were repeated with
with larger sample sizes with well documented exercise programs of hospital excluded as a predictor. The repeat analyses revealed
sufficient intensity to provide a strengthening stimulus are required physiotherapy intensity a predictor of bed transfer, chair transfer,
to provide clinicians with the evidence to support the routine independence with frame, independence with crutches and LOS.
intervention of strength training for people with cerebral palsy. The proportion of the variance predicted solely by this factor ranged
IMPLICATIONS: Strength training appears to be a safe intervention from 3-12%. CONCLUSIONS: Intensity of treatment predicts time
for people with cerebral palsy but there is as yet insufficient evidence taken to achieve key physiotherapy milestones post-THR. As the
to determine if it helps increase muscle strength, activity and sample size was small, repeating with a larger population size
would be beneficial. IMPLICATIONS: Providing more physiotherapy in the trunk motion of individual shearers despite the pattern-
sessions per day post-THR is associated with earlier independence taught and repeatable nature of the shearing task. IMPLICATIONS:
and reduced LOS. Increasing physiotherapy input will allow a greater The clinical recommendation based on the biomechanical results
throughput of patients freeing vital bed space and contributing of this study is that the WBA should be incorporated into the
to reduction in waiting list times. KEYWORDS: physiotherapy in- practice of sheep-shearing to assist in the reduction of inherent
tensity. FUNDING ACKNOWLEDGEMENTS: unfunded. CONTACT: risks associated with the shearing task. KEYWORDS: Low-back
C.N.Gibson@sheffield.ac.uk Pain; Occupational Health; Biomechanics; Motion Analysis; Elec-
ETHICS COMMITTEE: North Sheffield Ethics Committee, Sheffield, tromyography. FUNDING ACKNOWLEDGEMENTS: The authors
UK wish to thank The Health Research Council of New Zealand
who supported this study through a contestable grant. CONTACT:
[email protected]
Research Report Platform Presentation ETHICS COMMITTEE: National Ethics Committee of the New
1542 Sunday 3 June 09:10 Zealand Health Research Council and the University of Otago Human
PP Crystal Pavilion B & C Ethics Committee.
THE INFLUENCE OF A BACK-SUPPORT HARNESS
ON THE THREE DIMENSIONAL KINEMATICS AND Research Report Platform Presentation
ELECTROMYOGRAPHY OF THE TRUNK IN SHEEP SHEARERS 2596 Sunday 3 June 09:10
Schneiders A1 , Milosavljevic S1 , Milburn P1 , Wilson B2 ; 1 School of VCEC Ballroom A
Physiotherapy, University of Otago; 2 School of Physical Education, SKIN SURFACE TEMPERATURE ASSOCIATED WITH
University of Otago EVAPORATIVE CRYOTHERAPY
PURPOSE: The purpose of this study was to investigate the Dale R; Department of Physical Therapy, University of South
effect of a back-support harness on three-dimensional kinematics Alabama, Mobile, AL, USA
and electromyography of the trunk during the occupational task of PURPOSE: Evaporative cryotherapeutic modalities often purport to
sheep-shearing. RELEVANCE: The occupation of sheep-shearing decrease skin temperature by 15 degrees Celsius (C) within 15
is classified as heavy to very-heavy physical work requiring a minutes of application. These modalities are portable and could
high level of energy expenditure while performing a repetitive task be applied outdoors. However, environmental factors, such as
in a predominantly sustained trunk flexion posture. The task is ambient air temperature, may influence skin temperature achieved by
further complicated by unpredictable animal behaviour. Shearing evaporation. RELEVANCE: No studies exist supporting the efficacy
is considered to carry a high risk of injury particularly to the of evaporative cryotherapy modalities in controlled environmental
lumbar spine and epidemiological studies have demonstrated that the conditions. Therefore, this experiment sought to determine skin
prevalence of low back pain (LBP) in shearers is high relative to other temperature (Tsk) and perceived skin cooling (Pcool) in neutral (25
occupations. The emergence of a commercial shearing-aid (Warrie C) and hot (32 C) ambient temperatures with ~50% relative humid-
Back-Aid™) that is purported to decrease loading on the spine, ity. PARTICIPANTS: Eight volunteer female subjects. METHODS:
reduce injury rate and alleviate symptoms of spinal origin has been Data collection occurred in a temperature-controlled environmental
welcomed by many sectors of the wool-harvesting industry. However, chamber. The evaporative modality was applied for 30 minutes to the
the precise biomechanical influence of the Warrie Back-Aid™ (WBA) mid-thigh region of one extremity while the contralateral thigh served
on the entire sheep-shearing task has not previously been quantified. as control during two separate trials spaced 72 hours apart. The
PARTICIPANTS: Subjects were twelve (12) voluntary participants subsequent trial was a repeat of the first, except it occurred in the
from the New Zealand geographical regions of Otago and Canterbury opposite room temperature. Pcool was measured with a visual analog
who were classified as professional sheep shearers and could scale and Tsk with thermocouples connected to a data processor
machine shear between 200 and 300 sheep over an average eight- (Columbus Instruments, Columbus, OH). ANALYSIS: Data were
hour day. METHODS: Nine distinct phases of the shearing-task analyzed by a repeated measures analysis of variance using within-
where the harness was worn during the removal of the sheep’s subject factors of condition (hot vs. neutral), treatment (modality vs.
fleece were investigated. The study used an opto-electronic motion control), and time (pre to post-treatment) using SPSS 14.0 software
analysis system and rigid body dynamic modelling. The shearer’s (Chicago, IL). The apriori alpha level was 0.05. Post-hoc analyses
trunk and pelvis were considered as a series of three coupled were performed with paired t-tests corrected for alpha inflation by
rigid segments; pelvis, lumbar, and thorax, with four passive retro- Bonferonni’s procedure. RESULTS: The evaporation rate of the
reflective markers defining each segment. An eight channel sEMG modality did not differ (p > 0.05) between the neutral (22.8 + 2.1 ml
telemetry system simultaneously recorded activity in four pairs per hour) and hot room temperatures (19.4 + 2.0 ml per hour) (means
of trunk muscles. ANALYSIS: The kinematic variables of angular + SEM). Baseline Tsk for the modality limb was 32.2 + 0.2C and 32.5
displacement, velocity and acceleration at the thoraco-lumbar and + 0.3C at time 0 in the neutral and hot room condition, respectively
lumbo-pelvic joint centres were calculated for each shearer while (p > 0.05). Also, there were no Tsk differences within the modality limb
shearing with and without the WBA. Temporal analysis of the sEMG between room temperatures at 5 and 10 minutes; however, significant
signal gave information on the duration and relative intensity of trunk differences emerged at 15 minutes and beyond (p < 0.01). Absolute
muscle activity. RESULTS: The introduction of the WBA had no effect Tsk of the modality limb after 30 minutes was 29.5 + 0.3C and 31.3 +
on the time taken to shear or trunk kinematics however it resulted in 0.3C for the neutral and hot room conditions, respectively (p < 0.01).
reductions in muscular activity of the trunk extensors. A statistically Pcool of the modality limb, however, was not different between room
significant reduction in mean intensity of muscle activity for the conditions (p > 0.05), but differed between the modality and control
left multifidus (p = 0.010), right multifidus (p = 0.001), right iliocostalis limbs by 42 and 43% during the neutral and hot room conditions,
(p = 0.004) and right longissimus (p = 0.002) occurred when the WBA respectively (p < 0.01). CONCLUSIONS: Ambient air temperature
was used. A reduction in muscular activity of the trunk extensors influenced Tsk achieved by this evaporative cryotherapeutic modality.
during the sheep-shearing task may result in a decrease in spinal Skin temperature decrease was minimal even in the neutral room
loading, energy expenditure and muscular fatigue. CONCLUSIONS: temperature, and thus, any therapeutic effect is likely due to a
The results demonstrated that the task of sheep-shearing required counterirritation-induced cooling sensation (Pcool). Further research
endurance-based muscle activity and the adoption of quasi-static needs to substantiate these findings in clinical populations and
posturing combined with complex asymmetrical trunk motion for to determine the influence of other environmental factors such as
extensive periods of the task time. There was considerable variability relative humidity. IMPLICATIONS: These data indicate that ambient
temperature influences Tsk but not Pcool with the application of this education, chronic diseases. FUNDING ACKNOWLEDGEMENTS:
evaporative cooling modality. KEYWORDS: evaporation, cryotherapy, Social Sciences and Humanities Research Council of Canada
skin temperature. FUNDING ACKNOWLEDGEMENTS: None. (SSHRC), Canadian Lung Association-Canadian Physiotherapy Car-
ETHICS COMMITTEE: University of South Alabama Institutional diorespiratory Society, Ontario Lung Association- Ontario Respiratory
Review Board Care Society, University of Ottawa,Ontario Graduate Scholarship.
CONTACT: [email protected]
Research Report Platform Presentation ETHICS COMMITTEE: University of Ottawa’s Ethics committee
VCEC Ballroom B & C
PATIENT EDUCATION GEARED TOWARDS CHRONIC DISEASE
SELF MANAGEMENT:THE ROLE OF LITERACY
King J; University of Ottawa, Ottawa, Canada VCEC Meeting Rooms 8&15
PURPOSE: The purpose of this study was to identify the barriers that THE RELATIVE MERITS OF STANDARD TURN TESTS:
adults with limited literacy and chronic diseases encounter in patient DISPARITIES IN DEGREE OF DIFFICULTY, MEASUREMENT
education experiences. RELEVANCE: There is a direct link between PROPERTIES AND ECOLOGICAL VALIDITY
literacy skill level and health. Low literacy skills affect a person’s ability Kampshoff C1,2 , Burnett M1 , Stack E1 , Ashburn A1 , Fitton C1 ;
to effectively use health services, take medications, and understand 1 University of Southampton, Southampton, UK; 2 Radboud
other information provided to them regarding their health (Health University, Nijmegen, The Netherlands
Canada, 2001). The Adult Literacy and Life Skills Survey estimates
that 22% of adults in Canada cannot determine the maximum number PURPOSE: Mobility assessment is not limited to whether people walk
of days they should take a medication by simply looking at the label safely and efficiantly in straight lines; the ability to turn is equally
(Statistics Canada & Organisation for Economic Co-operation and fundamental. To inform the clinician’s choice between established
Development, 2005). Everyday, physiotherapists therefore assess, turn tests, we compared four and identified the relative merits of
treat, and provide patient education to patients that have limited each. RELEVANCE: Turn tests have joined the plethora of mobility
literacy.Patient education includes advice regarding self-management measures: some may be more challenging than others (e.g. in the
techniques. For patients with chronic diseases this information is magnitude of turning steps) but no direct comparisons have been
seen as essential to maintain their health and quality of life. Previous made between them, whereby one group perform multiple tests on
research has demonstrated that self-management skills are poorest one occasion. PARTICIPANTS: Fourteen healthy adults, median age
among patients with limited literacy skills (Williams, Baker, Honig, 32 (range 24-56). METHODS: Ethical approval was granted by the
Lee, & Nowlan, 1998). PARTICIPANTS: A purposeful selection of School of Health Professions and Rehabilitation Sciences Ethics
14 adults who were attending a community based literacy program Committee at the University of Southampton. Participants performed
and have a chronic disease were selected. The participants were four tests following the standard protocol for each, in random order,
living with a number of chronic diseases including asthma, arthritis in our laboratory: 360 and 180 degree turns ‘on-the-spot’ (360-Spot
and diabetes. METHODS: An inductive, interpretive, hermeneutic and 180-Spot); the Standing Start 180 degree Turn Test (SS-180);
phenomenological method was used (van Manen, 1997). The and the Timed Up and Go (TUG). Using video and three-dimensional
data sources were interviews,field notes, document analysis and movement analysis, we evaluated the steps (n) and time (sec) taken,
researcher’s journal. ANALYSIS: The data sources were analyzed by floor space covered (m) and delay between onset of head rotation
reading, organizing and coding, identifying the meaning statements, and the first step (sec) during turning. ANALYSIS: We described
and grouping the aggregrate formulated meanings into clusters of
group performance for each test and examined ranked correlations
themes. RESULTS: Five themes emerged from the data representing
between tests. For the clinically measurable variables (step count
the barriers that participants encountered in patient education
and turn time) we examined inter-rater and test-retest reliability,
experiences they were; different roles and relationships, living
using the Bland-Altman method of comparison to determine the 95%
between worlds, language and health care interactions, mismatched
limits of agreement. RESULTS: The 360-Spot was completed in a
expectations, and powerlessness. CONCLUSIONS: Pressure on
median 6 steps over 3.3sec, covering an area 0.5m by 0.5m; the
patients to manage their own health is particularly detrimental to
180-Spot in 4 steps, 2.3sec, covering 0.4m by 0.4m; the SS-180 in
individuals with limited literacy due to the barriers they encounter
2 steps, 1.6sec, covering 1.3m by 0.5m; and the TUG in 4 steps,
during patient education experiences. Participants suggested to
overcome these barriers physiotherapists could use plain language; 2.4sec, covering 1.9m by 0.5m. Thus, median step time was 0.8sec
decrease reliance on written pamphlets and provide specific details in the SS-180 and 0.6sec otherwise and median step length was
on how to integrate patient education advice into their daily lives. 0.7m in the SS-180, 0.5m in the TUG and 0.1m otherwise. The
Further research is needed to test these specific patient education delay between head rotation and stepping was 0.2sec in the 360-
strategies. But it is hoped that incorporating appropriate patient Spot and 0.3sec otherwise. ‘On-the-spot’ tests correlated on steps,
education interventions into physiotherapists’ practice will help to time and space covered; walking tests did not. Inter-rater reliability
optimise the care of patients living with chronic diseases and was best (i.e. limits of agreement narrowest) for ‘on-the-spot’ turns
limited literacy leading to reduction in health care spending and and the SS-180; test-retest reliability was best for the SS-180
an improved quality of life. IMPLICATIONS: WCPT’s Declaration and the TUG. CONCLUSIONS: Walking turn tests are challenging
of Principles expects that all physical therapists provide accurate (the SS-180 necessitated the longest turning steps both spatially
treatment information and a clear explanation of the risks associated and temporally) and show good test-retest reliability. ‘On-the-spot’
with treatment. The findings from this study indicate that this turn tests provide little challenge (the Spot-360, necessitated least
may not always occur.The Adult Literacy and Life Skills Survey dissociation between head rotation and stepping), require little space
findings estimates that 20-40% of adults in over 30 countries and show good inter-rater reliability. IMPLICATIONS: Not all turn
have low literacy skills (Organisation for Economic Co-operation tests are the same. These differences (plus the dearth of correlation
and Development, 2005). Therefore many physiotherapists in the between tests) suggest the tests measure different aspects of
world will provide patient education for patients living with limited performance. Clinicians can choose a suitable turn test based on
literacy, it is hoped that the findings of this study will help increase client ability, the assessment environment (available space and
the awareness of physiotherapists of the impact of limited literacy equipment) and the need for measurement precision. KEYWORDS:
on patient education experiences. KEYWORDS: Literacy, patient Outcome Measures; Evidence Based Practice (EBP). FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT: Research Report Platform Presentation
[email protected] 1397 Sunday 3 June 09:10
ETHICS COMMITTEE: School of Health Professions and Rehabili- VCEC Meeting Room 16
tation Sciences Ethics Committee INTER-RATER RELIABILITY OF THE FUGL-MEYER
ASSESSMENT TOOL IN A PHASE III, MULTISITE, RANDOMIZED
CLINICAL TRIAL
Tilson J1 , Rose D2 , Xu L3 , Sullivan K1 ; 1 Division of Biokinesiology
1938 Sunday 3 June 09:10 and Physical Therapy, University of Southern California, Los
VCEC Meeting Rooms 11-12 Angeles, CA, USA; 2 Department of Aging and Geriatric Research,
RELATIONSHIP BETWEEN MAXIMAL STEP LENGTH AND University of Florida, Gainesville, FL, USA; 3 Department of
CHARACTERISTICS OF STEPPING OVER AN OBSTACLE Statistics, University of Florida, Gainesville, FL, USA
UNDER DUAL-TASK CONDITIONS IN OLDER ADULTS
PURPOSE: Locomotor Experience Applied Post-Stroke (LEAPS)
Goto M1 , Kanemura N2 , Shinkoda K2 ; 1 Department of PT, Faculty
is a phase III, single-blinded, multi-site, randomized clinical trial
of Nursing and Rehabilitation, Aino University, Osaka, Japan;
2 Department of PT and OT Sciences, Hiroshima University with an anticipated enrollment of 400 patients conducted in five
community-based rehabilitation hospitals in regionally distant cities
Graduate School of Health Sciences, Hiroshima, Japan
in the United States. The purpose of this study is to present
PURPOSE: Previous research suggests that maximal step length the LEAPS standardization process used to determine evaluation
(MSL) can be a good predictor of mobility performance and is closely competency across all sites and to report the results of the inter-
related to fall risk. This study was conducted to better understand rater reliability of one of the outcomes measures: the Fugl-Meyer
the relationship between maximal step length and characteristics of Motor and Sensory Assessment (FM). RELEVANCE: The use and
stepping over an obstacle while performing a secondary cognitive standardization of blinded evaluators is a crucial aspect of clinical
task. RELEVANCE: This study is undertaken as a first step in trial design. Demonstrating inter-tester reliability among clinical trial
developing an effective stepping exercise using a dual task to prevent sites and therapists is an important consideration that contributes to
falls. PARTICIPANTS: Thirty-four individuals (15 men and 19 women) the strength and validation of the clinical trial outcomes. In addition,
with a mean age of 71.2 years who use day care services more than the education of clinicians in standardized assessment procedures
once a week participated in this study. METHODS: Each subject facilitates translation of valid and reliable clinical assessments such
was tested for MSL in the front, side, and back directions in each as the FM into practice. PARTICIPANTS: Thirteen individuals (age:
lower extremity. Additionally, they were asked to ascend forward and 59.9 yrs. +/− 10.5, 62% female) with acute ischemic stroke (post-
descend backward from a 10-cm step to the beat of a metronome for stroke onset: 32.2 +/− 21.5 days) provided IRB approved consent
90-seconds, in three conditions, a single-task, an auditory stimulus, to be evaluated and videotaped. The performance of 9 physical
and a visual stimulus. In a trial with a visual-task, the subjects therapists from all 5 LEAPS clinical sites is reported. METHODS:
were asked, while stepping repeatedly, to read an animal’s name Standardization training included a lecture and demonstration style
that was displayed on a computer monitor. In an auditory-task, they workshop, practice and formal feedback with a patient under
asked to identify an instrument’s name after hearing the sound supervision of a trained Clinical Research Coordinator, and use of
while stepping repeatedly. As a stepping parameters, medial-lateral an electronic discussion board to field and respond to questions
and anterior-posterior center of foot pressure excursion (CFP) and across sites. Competency was determined by a score of>90% on a
velocity during obstacle negotiation, foot clearance and step length skills checklist of a videotaped evaluation session submitted by each
over the obstacle were recorded. To determine the relationship
therapist. Thirteen videotapes and rating sheets were submitted for
between MSL and stepping performance while performing a dual-
the upper extremity motor (UEM), lower extremity motor (LEM), and
task, subjects were divided into two groups, a lower MSL group
light touch/proprioception sensory (SFM) subcomponents of the FM.
and a higher MSL group. A static force platform (Unimec Corp.) for
Evaluation sessions were videotaped and scored by 9 competency-
CFP and a three-dimensional kinematics and kinetics system (UM-
trained physical therapists across 5 clinical sites. The observing rater
CAT II, Unimec Corp.) were used for collecting data. ANALYSIS: All
who viewed and scored all videotapes was one of the study Principal
group comparisons were performed using paired t-tests. In addition,
Investigators with expertise in the FM (KS). ANALYSIS: Data were
correlations between parameters were confirmed using simple linear
analyzed using the Intraclass Correlation Coefficient (ICC, 3,1) for
regression. RESULTS: The higher MSL group showed greater CFP
moving posteriorly during the initial phase of initiation (P < 0.05) and mean outcome scores of the UEM, LEM, and SFM components of
lateral shift towards the stance limb as the swing limb unloaded the FM. The Kappa statistic was used for individual item scores.
(P < 0.01) than the lower MSL group, when cognitive tasks were given RESULTS: Inter-tester reliability for each FM subcomponent was as
in stepping performance. Both visual and auditory task performance follows: UEM 0.99 (95% CI: 0.97-1.00), LEM 0.95 (95% CI: 0.90-
decreased vertical clearance between the top of the obstacle and 0.98), and SFM 0.75 (95% CI: 0.56-0.96). Agreement was good
the lowest point of the foot in the lower MSL group. There were to perfect (weighted Kappa: 0.60–1.00) for all except two items
no significant differences between an auditory-task and a visual- each on the UEM and LEM. CONCLUSIONS: A comprehensive
task on stepping performance. CONCLUSIONS: The net CFP is competency-based training and standardization program produced
the integrated control variable of the center of mass (COM). When strong inter-rater reliability between standardized LEAPS evaluators
both of cognitive tasks were asked, the lower MSL group showed and an experienced researcher using the FM. Establishment of
smaller CFP posterior shift at the initial phase of initiation and high inter-rater reliability will serve to strengthen the results of the
lateral shift towards the stance limb. This means that they couldn’t overall trial. The individual item analysis is instructive regarding
initiate the start of a forward fall to accelerate the COM ahead of items that require additional attention during training. Future work
the base of support and lift up the leading leg enough to avoid would include determining reliability in a larger, more diverse, cohort
obstacle contact. IMPLICATIONS: Results of this study indicate that of physical therapists. IMPLICATIONS: The standardized training
MSL is one of reliable measures to identify individuals at a risk of and competency program used for LEAPS evaluators provides an
falling and stepping exercise over an obstacle while performing a example of effective standardization of outcome measures such as
secondary cognitive task may be an effective balance-intervention the FM in community-based, regionally dispersed, clinical trials. This
program. KEYWORDS: Maximal step length, Dual-task, Center of model could be easily adapted for physical therapist training in both
foot pressure. FUNDING ACKNOWLEDGEMENTS: None. clinical practice and educational settings. KEYWORDS: Fugl-Meyer,
ETHICS COMMITTEE: The Aino University institutional review board Reliability, Clinical Trials. FUNDING ACKNOWLEDGEMENTS: Na-
tional Institutes of Health; 1 R01 NS050506-01A1. CONTACT: in Rehabilitation and Social Integration, the Laval University Chair
[email protected] in Cerebral Palsy Research, and the Cerebral Palsy Consortium.
ETHICS COMMITTEE: University of Florida Institutional Review CONTACT: [email protected]
Board ETHICS COMMITTEE: Institutional review board of the Québec
Rehabilitation Centre
1686 Sunday 3 June 09:10 Research Report Platform Presentation
VCEC Meeting Room 17 2227 Sunday 3 June 09:10
IS THE LEVEL OF PHYSICAL ACTIVITY IN ADULTS WITH VCEC Meeting Room 18
CEREBRAL PALSY ASSOCIATED WITH DEMOGRAPHIC REHABILITATION CARE PATHWAYS FOR HIP AND KNEE
FACTORS OR FUNCTIONAL ABILITIES? JOINT REPLACEMENT IN ONTARIO: SYNTHESIS OF THE
Maltais D1,2 , Dumas F1,2 , Boucher N1,2 , Corriveau D3 , LITERATURE AND ENVIRONMENTAL SCAN
Beauregard L1 , Pelletier M3 , Pichard L3 , Robitaille M1,2 , Jaglal S1,2,4 , Fancott C1 , Quan V2 , Davis A1,3 , Hawker G4 ,
Roy K1 , Richards C1,2 ; 1 Centre for Interdisciplinary Research in Mohamed N3 ; 1 Toronto Rehabilitation Institute; 2 Department of
Rehabilitation and Social Integration, Quebec City, Canada; 2 Laval Physical University of Toronto; 3 Toronto Western Research Institute;
University, Quebec City, Canada; 3 Quebec Rehabilitation Centre, 4 Women’s College Hospital
Quebec City, Canada

PURPOSE: To examine the type and amount of rehabilitation
PURPOSE: To determine, for adults with cerebral palsy (CP), the services used by the total hip and knee joint replacement population
relationship between physical activity (PA) and selected demographic in Ontario; to identify factors that may influence outcomes; and, to
factors and walking ability. RELEVANCE: It is well accepted that determine how current and future needs will be met by clarifying the
the level of PA is an important predictor of health in the general role of rehabilitation in the continuum of care. RELEVANCE: The
adult population. Even though it is typically assumed that PA is landscape of care for total joint replacement patients has undergone
low in adults with CP (since that is the case for children with enormous change in recent years. PARTICIPANTS: Twenty-three key
CP), there is little literature available about PA in these adults. informants from fifteen acute care and rehabilitation facilities across
Information regarding demographic and physical factors relevant to Ontario participated. Key informants were leaders and staff members
PA in adults with CP could therefore guide future physical therapy who had in-depth information on current practices, processes,
research and interventions, and in the long term, have health and structures. Administrative database information of hospital
implications for this group. PARTICIPANTS: All study participants discharges for total hip and knee joint replacement. The total number
(n=73 men, 72 women; 28 yr ±5.6) had a diagnosis of CP and of index discharges of patients in Ontario who received total hip and
were previous clients of the local pediatric rehabilitation centre. The knee replacement surgeries from April 1, 2002 to September 30,
distribution frequency (%) across Gross Motor Function Classification 2004 before any exclusions was 56,258. The total number excluded
Levels (GMFCS) was: (Ambulators: Level I=29.5; Level II=8.9; Level was 6,975; the remaining cohort was comprised of 49,283 acute
3=15.8; Non-Ambulators: Level IV=32.2; Level V=13.7). There was care discharges. METHODS: Information was gathered from three
no significant difference in the distribution of age across the five sources: 1) a literature review that focused on factors associated
GMFCS levels. METHODS: A questionnaire on health and lifestyle with improved outcomes for the total joint replacement population;
was administered as either a telephone or face-to-face interview, or 2) administrative data review of the Discharge Abstract Database
as a form sent to the participant by mail. The questionnaire was (DAD), the National Rehabilitation Reporting System (NRS), and the
based on that used in a province-wide (Quebec) survey of lifestyle Home Care Administrative System (OHCAS) for the years 2002–
and health (1998). ANALYSIS: Descriptive statistics were used to 2005 (where available); and 3) key informant interviews. ANALYSIS:
summarize demographic data. The relationships between PA and Administrative data analysis included descriptive statistics to examine
the other factors of interest were analyzed using the Chi-square the utilization of rehabilitation services and rehabilitation patterns
test with significance set at p = 0.05. RESULTS: The participants’ of practice across the province; and statistical models to identify
level of PA was assessed (more active = 20-30 minute activity bouts factors associated with discharge from acute care to inpatient
two or more times weekly; less active = 20-30 minute bouts less rehabilitation. A descriptive analysis of key informant interviews
than twice weekly). About half the individuals of both sexes were was conducted to identify themes related to best-practices and
more active and half were less active (n=37 men, n=42 women areas of future consideration in total joint care. RESULTS: There
more active; n=36 men, n=30 women less active; ns). For those with was geographic variation in utilization of inpatient rehabilitation
very good walking ability (GMFCS Level I, n=43), however, there based on access and availability. Practice changes were noted
was a trend towards a greater number being more active (n=27 with a shift to discharge directly home rather than to inpatient
more active; n=16 less active, p = 0.09). With individuals who had rehabilitation. Patients who are older; female; have more comorbidity,
more than a minor difficulty walking (GMFCS Levels II-V) there was or have a shorter acute care length of stay are more likely to
no significant difference in the number of those who were more or receive inpatient rehabilitation. Key informant interviews identified
less active. Whether or not walking had deteriorated over the last a principal focus of care was the reduction of lengths of stay in
three years was also assessed (n=86). Of the individuals in this acute care to allow for increasing volumes of patients and smoother
group who were more active (n=50), a greater number reported integration of care across the continuum. Two main themes emerged:
no change in walking ability (n=37 no change; n=13 deterioration, processes of care, and structures which supported these processes.
p < 0.001). CONCLUSIONS: Overall, the number of men or women CONCLUSIONS: Recommendations to improve lengths of stay in
with CP who are more active is similar to the number of them acute care facilities include the implementation of partnerships
who are less active. For those who walk, however, their level of PA and communication with key stakeholders; the management of
is related to their walking ability. IMPLICATIONS: Interventions to patient and family expectations through the preoperative process;
increase PA should target both sexes. Since a significant number of and, weekend rehabilitation services to maintain care pathways.
less active individuals were only found in the group whose walking Continued movement toward discharge directly home from acute
skills had deteriorated, interventions addressing walking skills to care can be facilitated by having appropriate outpatient and CCAC
improve PA may be most efficacious for this group. Further research supports in place, and extending acute care pathways to home
is needed to test these hypotheses. KEYWORDS: cerebral palsy, settings to ensure continuity and quality of care. IMPLICATIONS:
walking, physical activity. FUNDING ACKNOWLEDGEMENTS: This With the implementation of Local Health Integration Networks
study was supported by the Centre for Interdisciplinary Research (LHINs) across Ontario, this may be a prime opportunity to
standardize care processes and promote “best practice” for total joint and Safety Research Institute Robert-Sauvé (IRSST). CONTACT:
replacement and to ensure integration across the continuum of care. [email protected]
KEYWORDS: total joint replacement; rehabilitation; care pathways. ETHICS COMMITTEE: Ethic committee of CRIR-site Montreal
FUNDING ACKNOWLEDGEMENTS: Ontario Ministry of Health and Rehabilitation Institute
Long-Term Care. CONTACT: [email protected]
ETHICS COMMITTEE: Toronto Rehabilitation Institute Research Report Platform Presentation
VCEC Ballroom A
Research Report Platform Presentation INSTRUCTIONAL STYLE INFLUENCES PAIN PERCEPTION
1658 Sunday 3 June 09:30 DURING TENS
PP Crystal Pavilion B & C Barr J, Hird K, Koch M, Vaughan J; Physical Therapy Department,
IMPACT OF PELVIC STABILIZATION AND LOWER-LIMB St. Ambrose University, Davenport, Iowa, USA
POSITION ON TRUNK EXTENSORS ACTIVITY DURING PURPOSE: The manner in which verbal instructions are presented
DYNAMIC LUMBAR EXERCISES IN EXTENSION during active or sham (control) interventions may influence the
da Silva R1 , Larivière C2 , Arsenault B1 , Nadeau S1 , Plamondon A2 ; outcomes of those interventions. This study determined the affect
1 University of Montreal and CRIR – Montreal Rehabilitation of instructional style (directive vs. neutral) on experimental pain
Institute, Montreal (Qc), Canada; 2 Occupational Health and Safety threshold and tolerance during active and sham TENS. Enhancement
Research Institute Robert-Sauvé (IRSST), Montreal (Qc), Canada of a placebo effect by directive instructions may limit the ability of a
randomized control trial to disclose an active treatment effect. As a
PURPOSE: To examine the effect of pelvis stabilization and of two result, an intervention may be deemed ineffective. RELEVANCE: Re-
lower-limb configurations on the electromyographic (EMG) activity of searchers and clinicians assessing the effectiveness of TENS should
back and hip extensor muscles during a dynamic back extension be aware of the influence that instructions may have in enhancing
exercise on a machine. RELEVANCE: Since the lumbar extensors active and placebo effects associated with TENS. PARTICIPANTS:
and hip extensors both contribute to lumbar trunk extension, it is 40 male college students, 18-25 years old. Exclusion criteria:
important to identify specific exercises that might help to isolate cardiac disorders; decreased sensation; TENS or medications for
the activity of the back muscles relatively to the hip muscles during pain; pain ratings exceeding noxious stimulator output. METHODS:
dynamic extension movement. PARTICIPANTS: Twenty-two healthy Participants randomly assigned to either: directive instructions /
volunteers (11 males and 11 females), aged between 20 and 55 active TENS; directive / sham TENS; neutral instructions / active
years, participated in this study. METHODS: The subjects performed TENS; neutral / sham TENS. Pain induced by noxious electrical
five trunk flexion-extension cycles at 40% of their maximal voluntary stimulation of the fifth digit, dominant hand. Pain threshold and
contraction (MVC) in a machine designed for back exercise (Biodex tolerance pre-instruction / TENS. Videotaped instructions were
dynamometer system). Two different positions were used: I) seated directive (authoritative; suggestive of pain control) or neutral (neutral
position (seat horizontal, knees at 90º) and II) semi-standing position tone; not suggestive of pain control). TENS (frequency = 60pps;
(seat slightly tilted forward at approximately 15º, knees at 135º). phasewidth = 40 microsec) next given to ventromedial forearm. Active
In each position, three pelvic stabilization conditions were tested: TENS initially produced paresthesia from forearm into digit; after 4
(1) unrestrained (control condition), (2) partially restrained (pad min, readjusted to assure paresthesia; TENS continued. Sham TENS
posteriorly at the sacrum level) and (3) totally restrained (same as produced local paresthesia under electrodes only lasting <5 sec;
(2) plus one pad at the pelvis level anteriorly). The EMG signals were TENS turned off; readjusted after 4 min to produce local paresthesia
recorded with 12 pairs of surface electrodes placed bilaterally on four lasting <5 sec; TENS turned off. Pain threshold and tolerance
back muscles (at L4, L3, L1 and T10 levels), as well as on two hip again measured post-instruction / TENS. ANALYSIS: Performed via
extensor muscles (Gluteus and Biceps femoris). For each muscle, the two-way ANCOVAs, with pretreatment pain threshold and tolerance
EMG amplitude in the extension phase (concentric action) of each as covariates. RESULTS: Pain threshold was not significantly
cycle was identified and then, the Muscular Utilization Ratio (MUR), influenced by instructional style (p = 0.301), TENS (p = 0.774), or by
defined as the percentage of EMG amplitude relative to the maximal their interaction (p = 0.809). Directive instructional style significantly
EMG obtained from MVCs, were computed. These MURs were used increased pain tolerance (p = 0.015). TENS (p = 0.732), or the
to compare the level of muscular activation of each muscle group interaction of instruction and TENS (p = 0.484), did not significantly
across exercises. ANALYSIS: Two-way repeated measures ANOVA influence pain tolerance. CONCLUSIONS: A directive instructional
applied to the MUR values served to identify the effect of pelvic style used in association with TENS was the important factor
stabilization and lower-limb positions on the trunk extensor muscles. for increasing pain tolerance. IMPLICATIONS: The type of verbal
RESULTS: No significant interaction (P > 0.05) was found between instructions used can influence treatment outcomes with TENS.
the pelvic-stabilization and lower-limb position for each muscle group. Such influences can confound studies that determine TENS to
Regardless of the lower-limb position, using a pelvic stabilization be ineffective in laboratory and clinical applications. Researchers
(partially and totally restrained) significantly (P < 0.05) increased the need to carefully control the tone of verbal instructions provided
activity of all back muscles (average of 12%) but did not changed to study participants. KEYWORDS: Electroanalgesia, TENS, Pain.
the hip extensor activities. However, for the three pelvic conditions, FUNDING ACKNOWLEDGEMENTS: This study was funded by the
the semi-standing position significantly decreased (range of 10 to Physical Therapy Department of St. Ambrose University. CONTACT:
21%) the activity of hip extensors compared to the seated position. [email protected]
CONCLUSIONS: This study demonstrated that pelvic stabilization ETHICS COMMITTEE: The Institutional Review Board of St.
enhances back muscles activation during lumbar dynamic exercises Ambrose University approved this study.
performed on a Biodex system and that semi-standing position
is effective to reduce the MUR values of the hip extensors.
IMPLICATIONS: Using pelvic stabilisation and a semi-standing
position during lumbar back exercises in low back pain patients
might be a useful way to localise the effects of training at the back
muscles. KEYWORDS: Trunk extensor muscles, Electromyographic
Activity, Lumbar back exercises, Stabilization effect. FUNDING
ACKNOWLEDGEMENTS: Funded by the Occupational Health
Research Report Platform Presentation spinal cord injury (iSCI). RELEVANCE: The 10 Meter Walk Test
1511 Sunday 3 June 09:30 (10MWT) and 6 Minute Walk Test (6MinWT) are used in iSCI
VCEC Meeting Rooms 8&15 subjects to evaluate the recovery of walking function. However,
INTER-RATER RELIABILITY AND BETWEEN-DAYS long distance testing is less reliable, difficult to standardize and
REPEATABILITY OF EIGHT PHYSICAL PERFORMANCE TESTS more time-consuming. Information about maximum walking speed
in iSCI subjects is lacking. PARTICIPANTS: Fifty-one iSCI subjects
Horneij E1 , Holmström E1 , Hemborg B1 , Isberg P2 , Ekdahl C1 ; 1 Lund
performed the 6MinWT and 10MWT (preferred speed) at 1, 3 and
University, Department of Health Sciences, Section of Physiotherapy,
6 months after injury. Eighteen iSCI subjects performed both the
Lund, Sweden; 2 Lund University, Dep of Statistics, Lund, Sweden
10MWT and 6MinWT at preferred and maximum speed. Thirty-eight
PURPOSE: Results of reliability studies on physical performance iSCI and 41 healthy subjects performed the 10MWT at preferred
tests are often conflicting. The main purpose of this study was to and maximum speed. METHODS: Longitudinal and cross-sectional
analyse, by different statistical methods, the inter-rater reliability and study designs were used. The tests were applied by trained physical
between-days repeatability of a set of eight physical performance therapists. ANALYSIS: The results of the 10MWT (in seconds) and
tests on a female working population. Six of the tests were on the the 6MinWT (in meters) were converted into speed [m/s] and a
impairment level and two of the tests were on the activity level. ratio of maximum divided by preferred walking speed (M/P-ratio)
RELEVANCE: The prevalence of neck, shoulder and back pain is was calculated. Statistically, ANOVA for repeated measures, linear
higher among health care workers, especially among nursing aides, and multiple regression analyses were used. RESULTS: During
compared with employees in other occupations. Individually adapted recovery, the mean preferred 6MinWT walking speed increased
physical fitness training for women working in the health-care section from 1 month (0.37±0.52 m/s) to 3 (0.87±0.56 m/s) and 6 months
has earlier been shown to reduce symptoms from the neck, shoulder (1.14±0.52 m/s). Similarly, the 10MWT walking speed increased
and back, indicating that physical performance may have a positive from 1 (0.40±0.53) to 3 (0.88±0.51) and 6 months (1.12±0.51
impact on these disorders. However, few physical performance tests m/s; for all: P < 0.001). Walking speed did not differ between the
have been shown to predict future disorders of the neck, shoulder or tests [F(1,50) = 0.06; P = 0.81]. At preferred speed, the 6MinWT
back. This may be due to the precision of the tests, i.e. reliability speed was 1.03 × 10MWT speed + 0.05. At maximum speed, the
and validity. PARTICIPANTS: Twenty-two nursing aides/assistant 6MinWT speed was 0.91 × 10MWT speed + 0.11. The relationship
nurses (42±11 years) were tested twice, with on average, a five between preferred and maximum walking speed was constant in
days’ interval. Seventeen of these (40±11 years) were tested again, iSCI subjects who were tested between 16 days and 13.4 years
after on average 16 days. METHODS: Isometric endurance of after their injury (M/P-ratio = 1.37). This ratio was not affected
the neck flexors, abdominal, back and shoulder muscles, standing by the elapsed time after injury and it remained constant when
balance and two lifting tests (lumbar and cervical PILE tests) corrected for variables such as age, gender, body height, weight
were evaluated. ANALYSIS: The statistical analyses were carried and the need for walking aids or physical assistance. In healthy
out using the SPSS 9.0 package. Intraclass correlation coefficient subjects, the M/P-ratio was 1.74 and was influenced by age, gender
(ICC2.1), standard error of measurement (SEM), the within-subjects and body height. CONCLUSIONS: The 6MinWT and the 10MWT
coefficient of variation (CV) and limits of agreement (LOA and provide comparable information in iSCI patients, both at preferred
LOAratio) were calculated. RESULTS: The inter-rater reliability was and maximum walking speed. Comparably to stroke patients (Kollen
high for all tests. The between-days repeatability, however, differed et al. Arch Phys Med Rehabil 2006;87:358-63), iSCI subjects show
depending on the statistical method employed. Only one of the a fixed relationship between preferred and maximum walking speed.
tests: the cervical PILE test was considered reliable between-days. IMPLICATIONS: Due to the easier applicability, we recommend to
Muscular endurance tests, lumbar PILE test and standing balance use the 10MWT in the clinical setting. In central movement disorders,
tests, as performed in this study, did not give reliable between- either due to stroke or SCI, the modulation of walking speed is limited.
days results. CONCLUSIONS: The between-days repeatability was The relationship between preferred and maximum speed appears to
considered acceptable for only one of the two lifting-tests on activity remain constant, which would make additional testing at maximum
level: the cervical PILE test. IMPLICATIONS: When evaluating the speed redundant. KEYWORDS: walking capacity, timed walking
results from physical performance tests, physiotherapists should be tests. FUNDING ACKNOWLEDGEMENTS: The International Spinal
aware of within which limits the test-re test may normally vary. Research Trust (Clinical Initiative Phase II; CLI006) funded this work.
The evaluation of physical performance tests referring to absolute CONTACT: [email protected]
reliability and different types of validity is an important area for ETHICS COMMITTEE: Cantonal Ethics Comittee from Zurich
further physiotherapy research. KEYWORDS: Lifting test, muscular
endurance, standing balance. FUNDING ACKNOWLEDGEMENTS:
This work was supported by grants from The Swedish Labour Market
Insurance, AFA. CONTACT: [email protected] 2548 Sunday 3 June 09:30
ETHICS COMMITTEE: The study was approved by the Ethical VCEC Meeting Room 16
Committee of the Faculty of Medicine, University of Lund, Sweden PRACTITIONER AND ORGANIZATIONAL BARRIERS TO
(LU 286-95) EVIDENCE-BASED PHYSIOTHERAPY FOR PERSONS WITH
STROKE
Research Report Platform Presentation Salbach N1 , Jaglal S1 , Korner-Bitensky N2 , Rappolt S3 , Davis D4,5 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
VCEC Meeting Rooms 11-12 Canada; 2 School of Physical and Occupational Therapy, McGill
University, Montreal, Canada; 3 Department of Occupational Science
ASSESSMENT OF WALKING SPEED AND DISTANCE IN and Occupational Therapy, University of Toronto, Toronto, Canada;
SUBJECTS WITH AN INCOMPLETE SPINAL CORD INJURY 4 Knowledge Translation Program, University of Toronto, Toronto,
van Hedel H1,2 , Curt A2,3 , Dietz V1,2 ; 1 Spinal Cord Injury Center, Canada; 5 Li Ka Shing Knowledge Institute, St Michael’s Hospital,
Balgrist University Hospital, Zurich, Switzerland; 2 European Toronto, Canada
Multicenter Study on human Spinal Cord Injury (EM-SCI) Group;
3 ICORD, University of British Columbia, Vancouver, Canada PURPOSE: To identify practitioner and organizational barriers
to evidence-based physiotherapy for persons with stroke and
PURPOSE: To determine whether testing short and long distances sociodemographic and practice characteristics associated with each
as well as preferred and maximum speeds provides additional barrier. RELEVANCE: The integration of research evidence in
information about walking capacity in subjects with an incomplete clinical decision-making among physiotherapists is sub-optimal. An
understanding of practitioner and organizational barriers will help Research Report Platform Presentation
develop strategies to improve the implementation of evidence- 2337 Sunday 3 June 09:30
based practice (EBP) among physiotherapists, and, ultimately, health VCEC Meeting Room 17
outcomes for persons with stroke. PARTICIPANTS: Participants were DO ANKLE FOOT ORTHOSES IMPROVE BALANCE IN
270 physiotherapists providing services to persons with stroke. Age CHILDREN WITH SPASTIC DIPLEGIA?
ranged from 23 to 68 years and 89% of respondents were women.
A Bachelor degree was held by 77% of participants and 45% had Jackson D1,2 , Mayston M2 , Alderson L1,3 , Brayley K1 , Main E1,2,4 ;
1 Physiotherapy Department, Great Ormond Street Hospital,
practiced more than 15 years. METHODS: A cross-sectional postal
survey was conducted in Ontario, Canada. A questionnaire was London, UK; 2 Department of Physiology, University College,
developed to evaluate practitioner factors (education, attitudes and London; 3 University of Hertfordshire; 4 Institute of Child Health,
beliefs, interest, perceived role and self-efficacy) and organizational University College London
factors (resources and peer support) considered relevant to EBP.
PURPOSE: Ankle Foot Orthoses (AFOs) in children with spastic
ANALYSIS: Frequencies and percentages were used to describe
item-level responses. Logistic regression was used to identify diplegia are thought to prevent deformity and improve functional
characteristics associated with each practitioner and organizational balance by increasing the base of support, stabilizing the ankle
barrier. RESULTS: Education on EBP was part of the academic joint and influencing the kinematics of more proximal joints. This
preparation of 43% of respondents; education was associated with study evaluated balance in children with spastic diplegia during
young age, a high level degree and few years of practice experience. walking and other activities in AFOs, shoes alone and barefoot
Seventy-eight percent of respondents agreed that research findings using the GAITRite walkway and the Pediatric Balance Scale (PBS).
are useful and agreement was associated with participation in RELEVANCE: There is considerable debate with respect to whether
research activities. Ninety percent of respondents agreed they were the use of AFOs remains appropriate following corrective orthopaedic
interested in learning skills to implement EBP; these individuals were surgery or once skeletal maturity is attained and deformities are
more likely to hold a Bachelors degree than a Masters degree. Only unlikely to progress. Some physiotherapists believe AFOs remain
half agreed that physiotherapists should be responsible to conduct useful for improving the child’s functional balance and it is important
their own literature reviews and agreement was less likely among to provide evidence-based advice to families regarding their ongoing
clinicians treating 11-15 patients/day than among those treating 1- use. PARTICIPANTS: Ten children aged between 7-15 years with
10 patients/day. Average ratings of perceived ability (self-efficacy) spastic diplegia were recruited. They were community ambulators
were between 50% and 80% to search and appraise the literature and had been using AFOs for at least a year. None had undergone
and below 50% to appraise psychometric properties of standardized orthopaedic surgery or botulinum toxin injections in the preceding
measures and understand statistical analyses. Younger age, few year, nor had any medical problems which may have influenced
years of practice experience, being male and holding a Masters balance. METHODS: Each child was asked to walk four times
degree was associated with a higher self-efficacy summary rating. along the GAITRite electronic walkway at their preferred speed
Access to the Internet, financed continuing education, professional
in AFOs, shoes and barefoot. The order of these conditions was
journals, and a resource person was available to 80%, 74%,
randomized to limit the effects of fatigue or increasing confidence.
65% and 57% of respondents, respectively, and more often in
Normalized velocity, cadence, stride length and percentage of gait
community than acute-care hospital settings. An organizational
mandate supporting EBP was rarely reported (16%) and more cycle in single leg support were selected as surrogate measures
likely to exist in large organizations; protected time to search and of stability. The child’s balance during other functional activities was
appraise the literature was least frequently cited (8%) and had then assessed with the PBS. The 14 items were scored on the 0-4
no significant correlates. CONCLUSIONS: Substantial barriers to criterion based scale. Data for all conditions was collected on the
EBP may include perceived role of physiotherapists in EBP, self- same day by the same therapist. ANALYSIS: A two-way analysis
efficacy, availability of human resources, organizational mandates of variance (ANOVA) was conducted to explore any differences in
and protected time. Physiotherapists with many years of practice gait in AFOs, shoes or barefoot and post hoc comparisons were
may have the greatest need to enhance EBP skills; community- performed to test where these differences lay. Friedman’s test was
based practitioners appear to have little access to EBP resources. used to test for differences in PBS scores between subjects in
IMPLICATIONS: Physiotherapists lacking self-efficacy to search and AFOs, shoes and barefoot. RESULTS: Mean normalized velocity,
appraise the literature are unlikely to perform these activities when stride length and percentage of gait cycle in single leg support were
clinical questions arise. Given half of respondents do not consider significantly greater (p 0.02) when wearing AFOs compared with
the conduct of literature reviews as part of their professional role, barefoot. Whilst there were also improvements in mean values for
it is questionable whether training in these skills is indicated or an these parameters in shoes compared to barefoot, only the difference
alternate model for ensuring the integration of high quality research in stride length reached statistical significance (p 0.01). There
evidence in stroke rehabilitation. KEYWORDS: evidence-based were no significant differences in PBS scores in shoes or AFOs
practice, physiotherapy, stroke. FUNDING ACKNOWLEDGEMENTS: compared with barefoot. CONCLUSIONS: AFO’s improved balance
Nancy Salbach was supported by an Ontario March of Dimes- in gait but had no significant effect on balance in other activities
Canadian Institutes of Health Research postdoctoral fellowship to measured by the PBS in children with spastic diplegia. Whilst the
conduct this research. CONTACT: [email protected].
shoes themselves had a positive impact on the child’s gait, the
ETHICS COMMITTEE: The research ethics board at the University
most significant effects were seen in the AFO footwear combination.
of Toronto approved the study protocol.
IMPLICATIONS: Clinicians currently advising children to walk without
their AFOs should reconsider the benefits they offer in gait as well
as prevention of deformity. Therapists prescribing the AFOs should
be aware that a large proportion of the improvements observed
when wearing an AFO is from the footwear itself and so advise
families on both the AFO and the footwear worn in conjunction with
it. KEYWORDS: Cerebral Palsy, Orthotic Devices, Gait. FUNDING
ACKNOWLEDGEMENTS: There was no external funding for this
project. CONTACT: [email protected]
ETHICS COMMITTEE: The Royal National Orthopaedic/Institute of
Orthopaedics & Musculoskeletal Science Research Ethics committee
PATIENT REPORTED OUTCOMES AS A QUALITY INDICATOR A QUALITATIVE STUDY INVESTIGATING THE MORAL ROLE OF
OF STANDARDIZED CARE PLANS FOR TOTAL JOINT PHYSICAL THERAPIST: A VIEW FROM THE EXPERTS, PART I
REPLACEMENT
Triezenberg H; Central Michigan University
Brien H1 , McGlasson R2 , Mahomed N3 , Davis A4 , Flannery J5 ,
Levy C6 ; 1 Toronto Community Care Access Centre, Toronto, PURPOSE: This study investigated the moral and social factors that
Ontario, Canada; 2 Total Joint Network, Toronto, Ontario, Canada;
3 Toronto Western Hospital, Toronto, Ontario, Canada; 4 Toronto underlie the practice of physical therapy from the perspectives of 15
individuals identified as experts in the area of rehabilitation ethics.
Western Hospital, Toronto, Ontario, Canada; 5 Toronto Rehabilitation
RELEVANCE: A clearer understanding of the moral and social roles
Institute, Toronto, Ontario, Canada; 6 GTA Rehab Network, Toronto,
Ontario, Canada and responsibilities of physical therapists can inform public policy
and ethical decision-making by therapists. This understanding can
PURPOSE: To determine if Western Ontario and McMaster Arthritis also guide physical therapist educators when designing curricula
Index (WOMAC) pain and function outcomes and patient satisfaction and learning experiences in ethics. PARTICIPANTS: A purposive
were maintained after the institution of a new standardized care sample of 15 individuals in the United States who met the following
pathway for people undergoing primary hip or knee replacement criteria were invited to participate: (1) practiced physical therapy
(TJA). Relevance: The standard pathway for post TJA surgery was no
for more than 5 years; (2) completed additional education or an
longer sustainable in Toronto, RELEVANCE: The standard pathway
advanced degree in a discipline related to ethics or the psychosocial
for post TJA surgery was no longer sustainable in Toronto, Ontario
aspects of patient care; and (3) were recognized by peers as experts
Canada and a new model for rehabilitation services needed to
be tested. Based on a partnership of 23 institutions, this care and contributors to knowledge and understanding of the social or
pathway was designed to provide a seamless transition from acute ethical aspects of physical therapy practice through their history of
to rehabilitation sectors by pre-surgery streaming of patients to publication and presentations. All 15 individuals agreed to participate
inpatient or home-based physiotherapy and to reduce length of stay in the study. METHODS: Semi-structured interviews were completed
(LOS) PARTICIPANTS: 529 people consented to participate. Results with each participant followed by focus group discussions with a
are based on 279 people who returned follow-up questionnaire 3 sub-sample of participants. Interviews and focus group discussions
months post surgery METHODS: Subjects recruited to the evaluation centered around 6 primary questions. Two questions are addressed
completed the WOMAC pre-surgery with follow-up including a in this presentation: (1) What characterizes the moral role of a
satisfaction questionnaire 3 months later. The WOMAC is a 24- physical therapist in today’s health care environment?; (2) What is
item questionnaire completed by the patient that focuses on joint the single most important core ethical consideration for physical
pain and loss of function related to osteoarthritis of the knee therapy? Interviews and focus group sessions were audiotaped
and hip. Therapy destination and LOS were tracked against bench and transcribed verbatim. ANALYSIS: Transcripts were analyzed
marks of minimum 50% discharged home and an inpatient rehab using an inductive approach employing constant-comparison for
stay of 7 days. ANALYSIS: Descriptive statistics including means, within individual and across individual analysis. Codes, categories,
standard deviations, and proportions were calculated for all variables. and themes were generated to identify patterns in the data.
The sample of 500 ensured the 99% confidence interval (CI) of
RESULTS: Respondents suggested that the rehabilitation encounter
the mean of WOMAC pain and function would be within 2 and
presents a unique set of moral roles and responsibilities that
5 points respectively of a previous randomized trial where TJA
shapes the professional identity of physical therapists. Two primary
patients received home-based or inpatient rehabilitation. RESULTS:
categories of interactions were identified; each of which carry specific
On average greater than 50% of people were discharged home from
acute care and over 50% of people receiving inpatient rehab were moral and social foundations and responsibilities. Interactions and
discharged in 7 days, with 80% discharged by day 10. 529 patients relationships with patients were viewed as personal and fiduciary
(mean age 67, 295 females) have had their surgery and 279 have in nature; interactions and relationships with “non-patients” were
completed 3 month follow-up. Those patients discharged to home based more on formal and informal social contracts. Core ethical
rehabilitation have mean pain and physical scores of 80.5 and 76.6% considerations that apply to therapist encounters with both patients
(high scores are better pain relief and function) and those receiving and non-patients were identified by participants and included the
inpatient rehabilitation have pain and function scores of 77.5 and importance of respect, compassion, competence, providing benefit,
72.5%. These values are within our a priori CI for outcome. Only 5% and putting patient needs before their own. CONCLUSIONS:
of individuals reported dissatisfaction with the rehabilitation planning Findings suggest there are core ethical considerations at the
and care. CONCLUSIONS: This model of care achieved the goals center of the moral role of physical therapists. The related moral
of increasing the proportion of people discharged home following responsibilities of physical therapists may be defined by the unique
TJA and decreased rehab LOS with increased system capacity nature of, and foundations for, the relationship with patients and
for rehab. The patient outcomes are maintained. The remainder non-patients. Interactions with these individuals in the context of
of the participants will be followed and variances from the care rehabilitation practice may require differing ethical analysis and sets
pathways will be evaluated. IMPLICATIONS: This evaluation of the of behaviors. IMPLICATIONS: A clearer understanding of the unique
care pathways confirmed positive patient outcomes as measured by
characteristics and responsibilities associated with the moral role of
the WOMAC and the patient satisfaction questionnaire for people
physical therapists can help guide therapists in their interactions with
receiving rehabilitation in either home or inpatient settings. These
patients and non-patients in their everyday practice. Furthermore, it
findings provide the basis for increased dialogue between acute
care, community service settings in order to optimize the use of can assist educators in formulating ethics curricula, teaching and
less expensive home-based services for people undergoing unilateral learning experiences. Finally, these findings provide a framework
primary hip or knee replacements. KEYWORDS: TJA, WOMAC, for future studies of the moral role and attendant responsibilities
Pathway. FUNDING ACKNOWLEDGEMENTS: Ontario Ministry of of physical therapists. KEYWORDS: Ethics, Moral Role, Education.
Health and Long Term Care, Toronto Region Office. CONTACT: FUNDING ACKNOWLEDGEMENTS: Central Michigan University
[email protected] Sabbatical Award. CONTACT: [email protected]
ETHICS COMMITTEE: University Health Network, Toronto, Ontario, ETHICS COMMITTEE: The Internal Review Board (IRB) of Central
Canada. Affiliated with the University of Toronto Michigan University.
Research Report Platform Presentation METHODS: Development of the computer assisted measurement
2900 Sunday 3 June 09:50 methodology started with a literature review identifying previously
PP Crystal Pavilion A developed methodology. We critiqued the published methods and
HEALTH CARE IN THE FUTURE: WILL PHYSIOTHERAPY critical discussions, incorporating the most successful strategies into
SERVICES BE ADEQUATE FOR OLDER PEOPLE? our developing plans. We developed a Java-based computer program
Hobbs C, Dean C, Higgs J, Adamson B; The University of Sydney, for estimating the planar transformation of a rigid body. Version 3
Sydney, Australia of our program used the iterative closest point algorithm to perform
least-squares matching of cubic spline curves which were placed in
PURPOSE: The purpose of this study was to determine if students’ a graphic user interface by a mouse or pen digitiser. The parameters
knowledge of older people changed throughout their physiotherapy computed were angle of rotation, finite centre of rotation (FCR),
undergraduate program and to describe any changes over time. centre of reaction, and translation. We compared our methodology
RELEVANCE: The ageing population in Australia, as with many to the methods of Bogduk et al, Frobin et al, and Crisco et al.
countries, presents a significant challenge for healthcare provision ANALYSIS: We tested the reliability and validity of our methodology
as this population is increasing in number and in proportion to the and calculations in five phases: concurrent validity of rotation
total population. Physiotherapy service shortages for older people was tested against the NIH Image program; concurrent validity of
already exist and the magnitude will increase unless practition- translation was tested against manual constructions provided by
ers recognise the opportunities that are available. Unfortunately, an independent researcher; validity of rotation and finite centre of
beginning practitioners also seem reluctant to work with older rotation were tested by computer-simulated trials, and finally by an
people. PARTICIPANTS: Of the 208 students eligible to participate in vitro error study; reliability was assessed by analysing the results
in this study, 198 volunteered. An 80% or more participation of repeated measures. RESULTS: Intraclass correlation coefficient
rate throughout the 3-year duration of the study was achieved. (ICC) values for agreement of rotation measurement between
METHODS: The Facts on Ageing Quiz 1 (FAQ 1) measured ClaritySMART and NIH Image were ICC3,4 0.98 (95% confidence
participants’ knowledge of older people at three points of time, interval 0.92, 1.00). Agreement of centre of reaction and translation
during their education. Two variables, knowledge as percentage measurements between our method and the method of Bogduk et
FAQ1 correct responses and ignorance measured as percentage al. were ICC3,1 0.99 (0.97, 1.00) and 0.98 (0.97, 1.00) respectively.
of “don’t know” responses were examined. ANALYSIS: Changes Validity assessed by computer-simulated trials demonstrated our new
over time were analysed using paired t-tests with significance set at method to result in significantly lower angle error (p < 0.001) and FCR
p < 0.05. RESULTS: Initial knowledge about older people was poor error (p < 0.05) than competing methodologies. In vitro true FCR error
with a mean score of 43.6% and subsequent results significantly was significantly lower than competing methodologies (p < 0.001,
increased over time to a mean score of 51.7% (p = 0.0001). The and p < 0.02) at less than 7.3mm (sd 8.3). Intra-rater reliability
improvement in knowledge was accompanied by a decrease in coefficients (ICC3,1) were: rotation 0.97 (0.95, 0.98); translation
ignorance over the study period (p = 0.0001). CONCLUSIONS: 0.89 (0.80, 0.94); it is necessary for mathematical reasons to
The level of knowledge attained suggests that educational and exclude cases with rotation <1.0º to achieve satisfactory reliability
workplace sectors need to address the real issues confronting for FCR measurements of 0.82 (0.67, 0.91) for the x axis, and
workforce preparation of physiotherapists in relation to the care of 0.66 (0.41, 0.81) for the y axis, and centre of reaction 0.75 (0.57,
older people. IMPLICATIONS: This is particularly important because 0.87). CONCLUSIONS: Our new methodology for measurement
students’ ideology will become the foundation for their professional of displacement kinematics of lumbar segmental motion is more
behaviour and the norms of their profession. This suggests that the accurate and more efficient than previously available methods. We
profession runs the risk of producing beginning practitioners with recommend it for research involving lateral flexion-extension radio-
minimal base knowledge of physiotherapy practice for older people. graphs, and have made it freely available at www.claritysmart.com.
KEYWORDS: physiotherapy, older people, knowledge,. FUNDING IMPLICATIONS: This new methodology significantly reduces the
ACKNOWLEDGEMENTS: This research was supported by a grant error of measuring motion from flexion-extension radiographs, making
from the Teaching and Learning Committee at the University of possible research designs that were previously not possible due to
Sydney. CONTACT: [email protected] limitations of older technology. KEYWORDS: low back pain, lumbar
ETHICS COMMITTEE: The Ethics Committee, The University of spine, segmental motion, measurement, displacement, kinematics.
Sydney FUNDING ACKNOWLEDGEMENTS: University of Otago Research
Grants. CONTACT: [email protected]
ETHICS COMMITTEE: Otago and Canterbury Regional Ethics
Committees; University of Otago Ethics Committee
DEVELOPMENT AND VALIDATION OF THE CLARITYSMART
SPINAL MOTION ANALYSIS RESEARCH TECHNOLOGY 549 Sunday 3 June 09:50
VCEC Ballroom A
Abbott J1 ,McCane B2 ; 1 New
Zealand Centre for Physiotherapy
Research, University of Otago, PO Box 56, Dunedin 9054, New AN INVESTIGATION INTO THE EFFECTIVENESS OF
Zealand; 2 Department of Computer Science, University of Otago, CRYOTHERAPY FOLLOWING TOTAL KNEE REPLACEMENT
PO Box 56, Dunedin 9054, New Zealand Barry S1 , Wallace L1 , Lamb S1 ; 1 Coventry University, Coventry, UK;
2 Coventry University, Coventry, UK; 3 Coventry University, Coventry,
PURPOSE: To develop an accurate and time-efficient computer-
UK
assisted method for measuring displacement kinematics of lumbar
spine segments from flexion-extension radiographs. RELEVANCE: PURPOSE: Cryotherapy is commonly used during physiotherapeutic
Lumbar segmental mobility disorders, such as lumbar segmental rehabilitation of patients following total knee replacement (TKR).
instability and lumbar segmental rigidity, are believed to be associated Evidence for treatment effectiveness within the current literature
with recurrent and chronic low back pain. Research of these is contradictory and there are no clinical guidelines to inform
disorders requires accurate measurement of lumbar segmental cryotherapy treatment within this particular patient group. This
kinematics to diagnose the presence of a disorder, or measure study investigates cryotherapy treatment efficacy in the acute post-
change in movement characteristics. PARTICIPANTS: A subset operative management of TKR patients. RELEVANCE: Following
of 138 patients with recurrent or chronic low back pain, 30 TKR early postoperative recovery is hindered by a substantial degree
asymptomatic volunteers, and dried human vertebral specimens. of pain and swelling caused by a localised severe inflammatory
response in the soft tissues of the knee. This study investigates the Index, the SF36 and perceived recovery questionnaires at baseline
treatment effectiveness of cryotherapy and whether the timing of the and short-and long-term follow-up periods. Psychometric evaluation
first application of cryotherapy has any impact upon clinical outcome. of the CWOM included assessing questionnaire responses, internal
PARTICIPANTS: In total 133 consecutive TKR patients were consistency, construct validity and internal and external responsive-
recruited and consented to take part in this pragmatic randomized ness. ANALYSIS: Internal consistency was determined by calculating
clinical trial (RCT). METHODS: This RCT investigated cryotherapy Cronbach’s Alpha. Construct validity was evaluated using Pearson’s
treatment efficacy in the acute post-operative management of TKR r for continuous data (eg correlations between the total score of
patients. Patients were randomised into three groups; no cryotherapy the CWOM with the total score of the Functional Rating Index) and
(NC), delayed cryotherapy (DC) and immediate cryotherapy (IC). Spearman’s Rho was used for ordinal data (eg correlations between
The primary outcome measure was post-operative pain with knee the 5 individual items of the CWOM and the SF36 scales). Internal
swelling, active range of motion (AROM), function and levels of responsiveness was determined by calculating the effect size (mean
physiotherapy input assessed as secondary outcome measures. change score/ SD baseline score), and standardized response mean
Observations were taken pre-operatively and at 3, 7 and 42 days (mean change score / SD change score). External responsiveness
post-operatively. ANALYSIS: testing was used to compare scores was calculated with the perceived recovery scale as the external
between the three treatment groups in relation to pain scores, criterion of change. Improvement was defined as scoring 2 on
swelling, AROM and functional tests; Chi Square was used to test this scale. This information was used to plot an ROC curve for
for differences in the requirement for post discharge physiotherapy. each measure. RESULTS: Internal consistency was excellent at all
RESULTS: This RCT indicated that patients in IC group had stages of whiplash (Cronbach’s alpha=0.76 in the acute stage and
significantly less post-operative pain than the NC and DC groups at 3 0.83 in the late-chronic stage). Convergent validity was observed
days. Mean difference, with significance level set at p < 0.05, 95% CI, between the CWOM and the Functional Rating Index (Pearson’s r
in post-operative visual analogue scores (VAS, scale 0-10) was −1.6 =0. 81), the Neck Disability Index (Pearson’s r = 0.76) and the SF36
(p < 0.001, CI −2.49 to −0.707) between IC and NC groups; and Physical Health Summary Measure (Pearson’s r = −0.65). Divergent
−0.922 (p = 0.044, CI −0.183 to −0.009) between IC and DC groups. validity was observed between the CWOM and the SF36 Mental
At 7 and 42 days there were significant reductions in VAS scores Health Summary Measure (Pearson’s r = −0.45). The internal and
in both cryotherapy groups compared to the NC group. There was external responsiveness of the CWOM was similar to other neck-
significant improvement in knee swelling, AROM, ability to transfer specific outcome measures. CONCLUSIONS: We recommend the
and need for additional physiotherapy in both cryotherapy treatment 5-item CWOM as a brief clinical measure for whiplash because it
groups although no significant reduction in opiate requirement is quick to administer and score, and has excellent measurement
was found. CONCLUSIONS: The use of cryotherapy combined properties. The CWOM may need to be supplemented with other
with compression, as compared to a no cryotherapy treatment, questionnaires, for example, when assessment of psychological or
led to significant reductions in patient reported pain, less post- emotional health is required. IMPLICATIONS: The 5-item CWOM
operative swelling, greater recovery of AROM, faster return of can now be used in clinical practice to measure outcomes
function and less reliance on OPD physiotherapy treatment. However, for whiplash. Because it is briefer, yet a valid and responsive
there are no clinically significant differences in outcome between measure, it has advantages over lengthier standard questionnaires.
immediate and delayed treatment. IMPLICATIONS: It is concluded KEYWORDS: Whiplash Injuries, Outcome assessment (health care),
that cryotherapy combined with compression has an important role psychometrics. FUNDING ACKNOWLEDGEMENTS: Funding for
to play in the acute rehabilitation of TKR and should be considered this study was received from the Motor Accidents Authority of New
as part of routine management. KEYWORDS: Cryotherapy, Pain, South Wales, Australia. CG Maher’s research fellowship is funded
Knee. FUNDING ACKNOWLEDGEMENTS: The British Orthopaedic by the National Health and Medical Research Council, Australia.
Association Wishbone Fund. CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: Coventry Health Authority Ethics Committee, ETHICS COMMITTEE: University of Sydney Human Ethics Commit-
Coventry University Research Degree Committee and Walsgrave tee.
Hospitals NHS Trust’s Local Research and Development Committee.
Research Report Platform Presentation 2619 Sunday 3 June 09:50
1779 Sunday 3 June 09:50 VCEC Meeting Rooms 11-12
VCEC Meeting Rooms 8&15 KINEMATIC ANALYSIS AND MUSCLE ACTIVATION PATTERNS
EVALUATION OF THE CORE OUTCOME MEASURE IN IN GAIT OF ELDERLY WOMEN WITH KNEE OSTEOARTHRITIS
WHIPLASH Dias J, Arantes P, Kirkwood R, Alencar M, Dias R; Department
Rebbeck T, Refshauge K, Maher C, Stewart M; School of of Physical Therapy, Federal University of Minas Gerais, Belo
Physiotherapy, University of Sydney Horizonte, Brazil
PURPOSE: To comprehensively evaluate the psychometric prop- PURPOSE: This study was conducted to compare the kinematics
erties of a 5-item version of the Core Outcome Measure (COM) of hips, knees and ankles as well as the muscle activation pattern
in people with whiplash. RELEVANCE: Most outcome measures in the gait of elderly women with and without knee osteoarthritis
for whiplash have only been evaluated in neck pain populations (OA) and to investigate the association between quadriceps strength
and they are lengthy. The 7-item COM was initially proposed as and phase of load response. RELEVANCE: Knee OA is the
a brief health outcome measure for use in low back pain. To main cause of incapacity in elderly people. Understanding gait
date this measure has not been comprehensively assessed in a alterations of elderly women with knee osteoarthritis is critical for
whiplash population. A briefer, valid measure of outcome in whiplash the outlining effective physical therapy interventions to prevent the
would greatly assist practice and outcome measurement in the incapacity knee OA generates. PARTICIPANTS: The sample of
field of musculoskeletal physiotherapy. PARTICIPANTS: Data were this study was composed by 21 community-dwelling elderly women
sourced from three separate whiplash cohorts (total n = 481) with clinical and radiographic diagnosis of knee osteoarthritis and
encompassing acute, early-chronic and late-chronic whiplash among 21 asymptomatic age and mass-matched elderly women with no
primary care and insurance populations. METHODS: We re-analysed diagnosis of knee OA. This study was approved by the Federal
data derived from longitudinal cohort studies. Subjects completed a University Ethics Committee-number 2005/05). METHODS: A motion
5-item version of the COM for whiplash (Core Whiplash Outcome analysis system was used to track the usual gait of the subjects.
Measure; CWOM), the Functional Rating Index, the Neck Disability Intensity and duration of the activity of the vastus lateralis, biceps
femoris, tibialis anterior, gastrocnemius and soleus muscles while considered important to evidence-based practice (EBP), and the
walking was assessed through surface electromyography. Isokinetic frequency of use of research findings in clinical decision-making
dynamometry was used to assess the strength of the quadriceps and (rated as 0-1, 2-5 or 6+ times in a typical month). ANALYSIS:
hamstrings muscles. ANALYSIS: Shapiro-Wilk and Lilliefors tests Stepwise ordinal regression, appropriate for dependent variables
were carried-out to verify the normality distribution of the variables. with three response categories, was used to identify practitioner
ANOVA test was used to determine differences between groups and organizational factors (independent variables) associated with
and correlations were calculated using the Pearson correlation the use of research findings in clinical decision-making (dependent
coefficient. The level of significance was set at 5%. RESULTS: No variable). An alpha level of 0.05 determined statistical significance.
statistical difference was found between subject’s age (p = 0.970) RESULTS: Of 263 respondents with complete data, the number that
and BMI (p = 0.300). Elderly women in the OA group walked reported using research findings in clinical decision-making 0-1, 2-
with a significantly reduced gait velocity (p= 0.017), cadence 5 and 6+ times in a typical month was 89 (34%), 139 (53%), and
(p = 0.009) and stride length (p = 0.010), and a significantly increased 35 (13%), respectively. Univariate analyses showed that academic
gait cycle duration (p = 0.012) when compared to asymptomatic preparation in the foundations of EBP, working 31-40 hours a week,
elderly women. Subjects in the knee OA group, demonstrated participation in research, positive attitudes towards EBP, agreement
less peak knee flexion during the initial swing phase (p = 0.003), that physiotherapists should be responsible for critically appraising
less knee flexion excursion during weight acceptance (p = 0.019) research literature, high levels of perceived ability (self-efficacy) to
and stance (p = 0.046) and less hip extension excursion during perform EBP activities, perceived facility support and Internet access
stance (p = 0.007). There were no significant differences between were independently associated with a higher reported frequency of
groups with regard to muscle activation patterns during gait or using research findings in clinical decision-making. When modeled
strength of quadriceps and hamstrings. CONCLUSIONS: Elderly together, the following four variables remained statistically significant
women with knee osteoarthritis walk with different hip and knee and were retained in a final model that explained 25% of the
kinematics than matched asymptomatic subjects. There were no variability in use: the attitude that literature and research findings
differences in muscle function between groups, suggesting that gait are useful (agree/neutral or disagree; OR=3.3, 95% CI 1.7-6.3),
alterations may occur even with no decrease in strength. Further self-efficacy to perform EBP activities (OR for 30% difference in
studies are needed to clarify the effects of a rehabilitation program score=3.0, 95% CI 1.7-5.3), Internet access at work (yes/no; OR=2.3,
on the kinematics parameters of gait in elderly women with knee 95% CI 1.3-4.0) and participation in research (yes/no; OR=2.4,
osteoarthritis. IMPLICATIONS: The results of this study suggest that 95% CI 1.2-5.0). CONCLUSIONS: At the practitioner level, high self-
Physical Therapy programs for elderly women with knee OA should efficacy, a positive attitude regarding the usefulness of research
also focus on gait rehabilitation to enhance functional performance in findings and participation in research activities appear to promote
daily living activities. KEYWORDS: elderly women, knee osteoarthri- physiotherapists’ use of research findings in clinical decision-making
tis, gait kinematics. FUNDING ACKNOWLEDGEMENTS: Financial for persons with stroke. The type and extent of involvement in
support: CNPq – Brazilian Funding Research Agency. CONTACT: research activities that is beneficial, however, requires further inves-
[email protected] tigation. At the organizational level, the provision of Internet access
ETHICS COMMITTEE: Federal University Ethics Committee-number appears to facilitate use. IMPLICATIONS: The effectiveness of
2005/05 educational initiatives to enhance EBP among physiotherapists may
be increased by targeting self-efficacy and attitudes. This study is
the first to apply self-efficacy theory to EBP among physiotherapists.
Self-efficacy theory may provide a framework for understanding
2587 Sunday 3 June 09:50 and enhancing practitioner behaviour. KEYWORDS: evidence-based
VCEC Meeting Room 16 practice, physiotherapy, stroke. FUNDING ACKNOWLEDGEMENTS:
FACTORS ASSOCIATED WITH PHYSIOTHERAPISTS’ USE OF Nancy Salbach was supported by an Ontario March of Dimes-
RESEARCH FINDINGS IN STROKE REHABILITATION Canadian Institutes of Health Research postdoctoral fellowship to
Salbach N1 , Jaglal S1 , Korner-Bitensky N2 , Rappolt S3 , Davis D4,5 ; conduct this research. CONTACT: [email protected].
1 Department of Physical Therapy, University of Toronto, Toronto, ETHICS COMMITTEE: The research ethics board at the University
Canada; 2 School of Physical and Occupational Therapy, McGill of Toronto approved the study protocol.
University, Montreal, Canada; 3 Department of Occupational Science
and Occupational Therapy, University of Toronto, Toronto, Canada; Research Report Platform Presentation
4 Knowledge Translation Program, University of Toronto, Toronto,
Canada; 5 Li Ka Shing Knowledge Institute, St Michael’s Hospital, VCEC Meeting Room 17
Toronto, Canada
THE EFFECT OF A GROUP AQUATIC THERAPY PROGRAM ON
PURPOSE: To identify practitioner and organizational factors asso- MOTOR SKILLS OF CHILDREN WITH CEREBRAL PALSY
ciated with physiotherapists’ use of research findings when making
Jelley W1,2 , Albert K1,2 , Mazerolle C1,2 , Saab K1,2 ; 1 University
clinical decisions for persons with stroke. RELEVANCE: Research
of Ottawa; 2 Centre régional de réadaptation La RessourSe
findings indicate that physiotherapists need to more consistently
incorporate research evidence in clinical practice. Identification of PURPOSE: The objective was to evaluate the effect of a 10 week
practitioner and organizational factors that are associated with the group aquatic therapy program on gross motor skills of children
use of research evidence in clinical decision-making will help guide with cerebral palsy (CP). RELEVANCE: In the current Canadian
the development of educational interventions aimed at increasing health care system, children with CP who are able to ambulate
the quality, and, ultimately, the effectiveness of physiotherapy independently without aids are not regularly treated in physiotherapy
services for persons with stroke. PARTICIPANTS: A total of 270 once they reach school age. Despite their functional independence,
Canadian physiotherapists providing services to persons with stroke they still demonstrate areas of weakness in their gross motor skills. A
participated. Average age was 40 years (SD=10, Range 23-68 years) group intervention program, such as aquatic therapy, can be effective
and 89% of participants were women. For 77%, a Bachelor degree in addressing motor deficits. However, presently there is a lack of
was the highest degree obtained. METHODS: A cross-sectional research on the effect of group aquatic therapy programs on motor
postal survey was carried out in Ontario, Canada. A questionnaire skills in children with CP. PARTICIPANTS: The 6 participants, 3 girls
was developed to measure practitioner factors (sociodemographics, and 3 boys, were children between 8.5 and 10.5 years of age. All 6
education, attitudes and beliefs, interest, perceived role and self- had a diagnosis of CP, Level I or II on the Gross Motor Functional
efficacy) and organizational factors (resources and peer support) Classification System. None of the children were currently being
treated by a physical therapist. METHODS: The participants took part walk independently for a minimum of 10 meters on a repeated
in a 10 week aquatic therapy program. The program consisted of 1- basis. METHODS: Kinematic and kinetic data of the lower limb and
hour weekly sessions at a rehabilitation centre pool. The program kinematic data for the lumbar spine were collected when walking over
activities focused on balance and general strengthening. Each of 10m at self selected walking speed using a six camera Kinemetrix
the participants was accompanied by a friend. The study employed Motion analysis system (MIE Ltd, Leeds, UK) and one Bertec Force
a repeated-measures design with the participants acting as their Platform (MIE Ltd, Leeds, UK). Static lumbar posture and dynamic
own controls. Participants were evaluated using the Gross Motor hip and lumbar spine range of movement data were collected using
Function Measure −66 (GMFM-66) 4 weeks prior to the start of standardised clinical measures. ANALYSIS: Key variables included
the program and 4 weeks after the program’s completion. As well for analysis were: temporal characteristics, lumbar spine/hip/knee
an individualized goal attainment scale (GAS) was established for angles, and external hip/knee/ moments, during self selected walking
each participant based on the results of the initial GMFM-66.The speed and clinical measures of hip and lumbar spine movement.
GAS was used to monitor the participants’ status over the course of One way ANOVA was performed to determine possible significant
the program. ANALYSIS: The data from the two administrations of differences between participants with THR and controls. Statistical
the GMFM-66 were entered into the Gross Motor Ability Estimator significance was defined as p < 0.05. RESULTS: Analysis of clinical
which allowed for the scores to be accumulated and graphically measures show that those at 2 years post THR had significantly
represented. The participants’ scores on the GAS were looked at less sagittal (p < 0.0001) and frontal plane (p < 0.05) hip movement
to see if and when improvement in motor skills occurred. RESULTS: than the controls. Lumbar spine flexion was greater in the controls
Based on the GMFM-66 results the participants’ scores on a scale (p < 0.001) but extension was less although not statistically significant.
of 100% increased in a range from 1.65% to 16.89%, with an Walking speed and cadence were significantly reduced in the THR
average improvement of 5.89% on the overall score. Similarities were group. The movement patterns between the hip and the lumbar
found between participants on the GMFM-66 items that demonstrated spine in the frontal and sagittal plane were analysed through angle/
the most improvement. These items were static balance and one time and angle/ angle diagrams showing significant differences in
foot hopping. The outcomes of the GAS showed that the motor their interaction and these will be demonstrated graphically. The
improvements were gradual and consistent over the 10 week length interaction of hip and lumbar spine movement during walking in those
of the program. CONCLUSIONS: The results suggest that an with THR is significantly different to those with no hip pathology.
aquatic therapy program which includes balancing and strengthening CONCLUSIONS: Results indicated that at two years post THR hip
activities may have beneficial effects on gross motor abilities, such and lumbar spine kinematics and movement pattern interactions have
as static and dynamic balance as measured by the GMFM-66, for not recovered to those of a matched population with no hip pathology.
children with CP. IMPLICATIONS: The aquatic therapy program that IMPLICATIONS: There is no indication at this stage that altered
was developed could be reproduced in a community pool and carried kinematics and movement patterns present at two years post surgery
out by a qualified swim instructor. For children who are no longer may cause consequent joint problems or damage the prosthesis. The
actively followed by a physical therapist but who still have areas long term benefits of THR surgery however may be in jeopardy and
of weakness in their gross motor skills community-based programs this warrants further investigation with an intervention and longevity
are necessary. KEYWORDS: Aquatic therapy; Cerebral Palsy; Gross study. References: Keener JD, et al (2003). J.Bone & Joint Surgey
Motor Function Measure. FUNDING ACKNOWLEDGEMENTS: This 85-A(6): 1066-72. Andriacchi TP, Hurwitz DE (1997) Gait & Posture 5:
project was funded by the School of Rehabilitation Sciences at the 256-264. KEYWORDS: Total Hip Replacement, Functional Recovery,
University of Ottawa. Movement Patterns. FUNDING ACKNOWLEDGEMENTS: This study
ETHICS COMMITTEE: Centre de recherche interdisciplinaire en was not funded. CONTACT: [email protected]
réadaptation ETHICS COMMITTEE: University of East London, London, UK

FUNCTIONAL MOVEMENT PATTERNS AND KINEMATICS OF A QUALITATIVE STUDY INVESTIGATING THE MORAL ROLE OF
THE HIP AND LUMBAR SPINE AT 2 YEARS POST TOTAL HIP PHYSICAL THERAPIST: A VIEW FROM THE EXPERTS, PART II
REPLACEMENT Triezenberg H; Central Michigan University
Coutts F1 , Scott O2 , Nicol A3 ; 1 Queen Margaret University
PURPOSE: This study investigated the moral and social factors that
College, Duke Street, Edinburgh, EH6 8HF; 2 School of Health &
underlie the practice of physical therapy from the perspectives of 15
Bioscience, University of East London, London, UK; 3 Department
individuals identified as experts in the area of rehabilitation ethics.
of Bioengineering, University of Strathclyde, Glasgow, UK
RELEVANCE: A clearer understanding of the moral and social roles
PURPOSE: This ethically approved study explores movement and responsibilities of physical therapists can inform public policy
patterns and hip and lumbar spine kinematics during walking and ethical decision-making by therapists. This understanding can
in participants at 2years post Total hip replacement (THR) and also guide physical therapist educators when designing curricula
compares these to age matched adults with no pathology. It was and learning experiences in ethics. PARTICIPANTS: A purposive
hypothesised that individuals with THR will have altered hip and sample of 15 individuals in the United States who met the following
lumbar spine kinematics and movement patterns whilst walking at criteria were invited to participate: (1) practiced physical therapy
a self selected walking speed. RELEVANCE: THR is a common for more than 5 years; (2) completed additional education or an
place surgical event for patients with hip osteoarthritis and although advanced degree in a discipline related to ethics or the psychosocial
successful at reducing pain (Keener et al, 2003), full functional aspects of patient care; and (3) were recognized by peers as experts
recovery is not guaranteed (Andriacchi & Hurwitz, 1997). Accelerated and contributors to knowledge and understanding of the social or
rehabilitation programmes are now the norm in the UK but there ethical aspects of physical therapy practice through their history of
is minimal evidence to assess their effect on return of functional publication and presentations. All 15 individuals agreed to participate
recovery. PARTICIPANTS: 24 participants at 2 years post THR, in the study. METHODS: Semi-structured interviews were completed
5M 19F mean age 74.81 years (+4.89) were matched by age with each participant followed by focus group discussions with a
and gender with 24 adults 8M, 16F mean 73.04 years (+4.05), sub-sample of participants. Interviews and focus group discussions
with no lower limb joint pathology, injury, pathology of the back centered around 6 primary questions. Two questions are addressed
or pelvis, systemic or neuromuscular disease. All were able to in this presentation: (1) Are there aspects of our professional
behaviors that need to be examined in relation to the ethical role Regarding accessing the Internet in the institution, 98% of the
of the physical therapist; (2) How is the ethical position of physical teachers and students refer having access to Internet linked
therapy similar different from other professions? Interviews and computers. When inquired about the usage of the computer for
focus group sessions were audiotaped and transcribed verbatim. academic activities, 99% of the teachers and students answered
ANALYSIS: Transcripts were analyzed using an inductive approach affirmatively, of which 35% of the teachers use it more than 10
employing constant-comparison for within individual and across hours per week and 28% between 5 to 10 hours. As for the
individual analysis. Codes, categories, and themes were generated to students, the percentage of weekly usage is 42.6% between 0 and
identify patterns in the data RESULTS: The reponses identified three 3 hours and 36.7% between 3 and 5 hours. Furthermore 81% of
general areas, with many components, of professional behaviors the inquired teachers and 57.4% of the inquired students referred
that need further examination. These include: (1) aspects of the to fully agree in the matter of the importance of ICT usage in the
therapist’s interaction with patients, (2) the therapist’s relationships school context. Although 84% of the inquired teachers reported
to other professions and groups (non-patients), and (3) the ethical to have knowledge in the area of the ICT, almost 51% pointed
decision making process(es) used by physical therapists. Responses out the lack of specific training for integration/usage of the ICT
to the second question described both similarities and differences as being the main barrier in the usage, then followed by the
of physical therapy to other professions. The comparisons were inexistence of strategies that facilitate the integration of the ICT in
primarily in the areas of: (1) goals for intervention with patient/client, education/learning (44%). CONCLUSIONS: Through the analysis
(2) the characteristics of the relationship that is established, and (3) of the results of this study it is demonstrated that although the
professional boundaries or scope of practice. The professions that good accessibility to the ICT by teachers and students in their
were compared most often included: social work, teaching, nursing, institutional and home environment, it is yet scarce due to the
clergy, and medicine. CONCLUSIONS: The respondents suggested lack of specific training in this area. IMPLICATIONS: There seems
areas of professional behaviors that need to be further examined in to be the need to create institutional programs and projects that
relation to the ethical role of physical therapy. Responses to the sec- promote the usage of ICT by investing in the training of teachers
ond question suggested that other professions share aspects of our and through the integration of those skills in the Physiotherapy
ethical role in the characteristics of goals of intervention, patient/client course. KEYWORDS: Education, Information and Communication
relationships, and professional boundaries. Suggested differences Technologies(ICT), Survey. FUNDING ACKNOWLEDGEMENTS:
in these characteristics also identified aspects the uniqueness the This work was unfunded. CONTACT: [email protected]
the ethical role of the physical therapist. IMPLICATIONS: This study
suggests areas for further investigation of professional behaviors in
relation to the ethical role of the physical therapist. It also suggests Research Report Platform Presentation
that understanding the points of similarity and difference in the 2788 Sunday 3 June 10:10
ethical position of physical therapy as compared to other professions PP Crystal Pavilion B & C
will provide insights for understanding and guiding our behaviors. MUSCULAR AND KINEMATIC RESPONSES OF THE TRUNK
KEYWORDS: Ethics,. FUNDING ACKNOWLEDGEMENTS: None. AND LOWER LIMB TO SUDDEN LOADING: EFFECTS OF
CONTACT: [email protected] POSTURE, WARNING, AND FATIGUE
ETHICS COMMITTEE: Internal Reiew Board (IRB) of Central Mawston G, McNair P, Boocock M; Physical Rehabilitation
Michigan University Research Centre, Auckland University of Technology, New Zealand
PURPOSE: This study investigated muscular and joint responses
to sudden anterior loading of the trunk in a stooped and an erect
3146 Sunday 3 June 10:10 standing posture, with two levels of warning, before and after fatigue.
PP Crystal Pavilion A RELEVANCE: A significant percentage of low back injuries are
USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES attributed to sudden anterior loading of the trunk. During such a
(ICT) IN PHYSIOTHERAPY EDUCATION IN PORTUGAL loading event the neuromuscular system must respond quickly to
produce appropriate muscle and joint responses to counter the
Lopes A1 , Ferreira C2 , Grazina M, Casaquinha P, Godinho J;
1 Escola Superior de Saúde do Alcoitão, Estoril, Portugal; external load in such a way that maintains stability, without placing
2 Faculdade de Motricidade Humana (UTL), Cruz Quebrada, Portugal excessive forces on the lumbar spine. Postural responses to sudden
loading may also be influenced by the posture adopted at the time of
PURPOSE: This study aims to determine the use of Information perturbation, the degree of muscular fatigue, and whether sufficient
and Communication Technologies (ICT) in Physiotherapy teaching forewarning of the loading event has been provided. Understanding
in Portugal, namely the characterization of the usage of the ICT by how posture, fatigue, and level of warning affect muscle and joint
the institutions that offer the Physiotherapy course, as well as by responses will allow an insight into the mechanisms of low back injury,
Physiotherapy teachers and students. RELEVANCE: The European as well as providing essential information for the rehabilitation and
Region of the World Confederation for Physical Therapy refers in its prevention of injuries of clients returning to vocational activities that
document European Benchmark Statement that the Physiotherapist include lifting tasks. PARTICIPANTS: Thirty male subjects between
should have skills in the area of ICT, so that he/she is able to the age of 18 and 35 years with no recent history of low back
search for the required evidence to validate his/her practice, as well pain participated in the study. METHODS: Subjects in either an
as managing the data and records stemming from his/her clinical upright or stooped standing posture held a pre-weighted box that was
practice. Therefore those skills should be developed during their basic suddenly pulled downwards. Surface electromyography was used to
training, and so should teachers be able to introduce the ICT in detect onset latencies of the right lower limb and trunk muscles.
the teaching process, keeping in mind the institutional framework Two-dimensional video data of trunk and lower limb motion in the
of this process. PARTICIPANTS: The sample of teachers(n=116) sagittal plane were simultaneously collected. Subjects were exposed
and students(n=982)in the school year of 2003/2004 was taken to a series of randomised sudden loading trials in the upright and
from a population comprising the total of institutions(n=16) that offer stooped standing posture, with and without prior warning of the
Physiotherapy course. METHODS: A questionnaire was especially loading event. This was then repeated immediately following either a
set up and was validated by a panel of experts and by a pre- lifting induced fatigue task or light catechistic exercises. ANALYSIS:
test. This questionnaire was subdivided into 6 dimensions (sample Muscle and joint onset latencies were calculated using purpose
characterization, equipment characterization, usage characterization, built software (LabVIEW version 6i, National Instruments, Austin,
attitudes and knowledge, barriers and necessities. ANALYSIS: The TX, USA). A mixed model MANOVA with repeated measures was
procedures used were essentially descriptive statistics. RESULTS: used to determine main effects for posture, warning, and fatigue.
RESULTS: The provision of warning decreased all muscle response Parametric or nonparametric tests examined differences between
times in the erect standing posture, but only the lower erector spinae conditions; linear pain scales and weighted-rank MPQ – Pain Rating
onset latencies were shown to decrease in the stooped posture Index (PRI) scores For all statistical tests p < 0.05. RESULTS: In
(p < 0.05). Perturbation in the stooped posture was less reliant on E1, pain ratings at 300, 600, 900 12000 seconds showed similar
abdominal muscle activation and produced an overall different joint incremental increases in pain intensity that are typical of SMETT
movement initiation pattern, with less joint displacement than in induced ischemic pain, over time. In E2, TENS significantly raised
the upright standing position (p < 0.05). Prior to fatigue, warning the mean pain threshold and tolerance levels, and reduced MPQ-PRI
reduced joint displacement of the lower limb and lumbosacral region scores, compared to controls (P < 0.01 all comparisons). Qualitative
in response to sudden loading (P < 0.05). However, following fatigue MPQ descriptions reliably identified 4 sensory and 1 affective
warning had no influence on joint displacement. CONCLUSIONS: subclass of words to describe induced LLI pain. CONCLUSIONS:
Findings from this study showed that prior warning of a sudden Lower limb ischemic pain induced with a modified SMETT can
loading event in the upright standing resulted in earlier initiation be modified by continuous TENS. IMPLICATIONS: A study into
of postural responses, decreasing overall joint motion. In contrast, the efficacy of TENS during exercise in patients with PAD is
warning had minimal effect on postural responses in the flexed indicated. Ref. 1. ROCHE PA et al.Physiotherapy Theory and Practice
posture. Fatigue appears to have minimal influence on muscle 2001, 18: 129–138 KEYWORDS: Pain; laboratory model, electrical
and kinematic response to sudden loading. IMPLICATIONS: These stimulation. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
findings provide the therapist with greater insight into the mechanisms [email protected]
of low back injury and serve to direct the physiotherapy management ETHICS COMMITTEE: Ethics Committe, Queen Margaret University
of postural instability. KEYWORDS: Sudden loading; low back injury; College, Edinburgh
Posture. FUNDING ACKNOWLEDGEMENTS: New Zealand Society
of Physiotherapy. CONTACT: [email protected]
ETHICS COMMITTEE: Auckland University of Technology Ethics
Committee 882 Sunday 3 June 10:10
VCEC Meeting Rooms 8&15
DEVELOPMENT AND PSYCHOMETRIC PROPERTIES OF THE
HIGH-LEVEL MOBILITY ASSESSMENT TOOL
VCEC Ballroom A Williams G1 , Robertson V2 , Greenwood K3 , Morris M4 , Goldie P5 ;
1 Epworth Hospital, Melbourne; 2 The University of Newcastle,
A MODEL OF ISCHEMIC PAIN IN THE CALF AND TENS
Newcastle; 3 RMIT University, Melbourne; 4 The University of
MODIFICATION OF LOWER LIMB PAIN: PRELIMINARY RESULTS
Melbourne and NHMRC CCRE Clinical Gait Analysis and Gait
Roche P1 , Santos D1 , Snijder J1 , Seenan C1 , Weddell A1 , Rehabilitation, Melbourne; 5 La Trobe University, Melbourne
Ballantyne E1 , Sweers I; 1 School of Health Sciences, Queen
PURPOSE: To develop a new high-level mobility assessment tool
Margaret University College, Edinburgh, UK
(HiMAT) for traumatic brain injury (TBI). RELEVANCE: High-level
PURPOSE: To develop a model of laboratory induced ischemic mobility is poorly measured following TBI despite its importance for
calf pain; to test the analgesic efficacy of TENS for calf pain, and social, leisure and sporting activities and quality of life in general.
to describe induced calf pain, in healthy volunteers. RELEVANCE: Existing scales used to quantify mobility following TBI are susceptible
We aimed to modify the sub maximum effort tourniquet technique to a significant ceiling effect. PARTICIPANTS: Data were collected
(SMETT), a standardised method of inducing experimental ischemic from 103 TBI patients, aged 14-60 who were willing and able
pain into the upper limb of volunteers, to create a laboratory model of to provide informed consent and had no pre-existing neurological
lower limb ischemia (LLI). With exercise, LLI could serve as a model deficits. METHODS: The 20 original HiMAT items included walking
of intermittent claudication (IC) – the exercise induced ischemic tasks, running tasks, balance tasks, and skipping, hopping, jumping
pain that is the main symptom of Peripheral Arterial Disease (PAD). and stair tasks. Performances were recorded quantitatively (i.e.
Testing TENS for LLI pain could indicate its potential efficacy in time or distance) and qualitatively (a rating based on quality of
IC related to PAD. PARTICIPANTS: 14 healthy males volunteered performance) modified from the coding qualifiers scale in the ICF.
for Experiment 1 (E1) and 20 healthy females for Experiment 2 Data on the gross function component of the Rivermead Mobility
(E2). Subjects met inclusion and exclusion criteria for SMETT. Assessement (RMA) and motor FIM were also collected to investigate
METHODS: E1 was a within subject, crossover, single-blind study. concurrent validity and presence of a ceiling effect. ANALYSIS:
A pilot study was undertaken with 4 independent subjects. The Due to the confounding influence of cognition, behaviour and
SMETT technique (with broad pressure cuff) was applied to the upper limb function on higher level mobility tasks, all items were
thigh. Subjects then performed 20 resisted plantar-flexion / dorsi- analyzed to ensure unidimensionality. Rasch analysis was used
flexion exercises, using a pulley and weight apparatus developed for to identify 1) items that quantify mobility with minimal influence
the study, in order to induce ischemia over a period of 5 minutes. from other domains, and 2) items that discriminate ability over a
Measurment of the Post Occlusive Reactive Hyperaemic response large range of performance. Correlations were performed between
(PORHmax), demonstrated that ischemia had occurred in the calf the quantitative and qualitative data to determine which method
of each subject, via the adapted SMETT technique. The main study was better for measuring high-level mobility. Further correlations
in E1 applied (A) the standard SMETT in the upper limb and 20 were performed to investigate the concurrent validity of the HiMAT.
minutes later (B) the modified SMETT (minus PORHmax) in the RESULTS: Rasch analysis identified several misfitting items which
lower limb. Each application was for a maximum of 20 minutes. A were removed from the item pool. Further analysis showed that
linear pain scale rated subjective reports of pain intensity, at intervals quantitative data and qualitative data were very highly correlated,
between self-reported ‘pain threshold’ and ‘pain tolerance’. The cuff but the qualitative ratings of performance suffer from a ceiling
was deflated at ‘pain tolerance’, or at 20 minutes, whichever came effect when compared to quantitative measures. Rasch analysis
first. Subjects retrospectively described the ischemic pain in (i) the also identified a hierarchical ordering of high-level items in motor
forearm and (ii) the calf, five minutes after cuff deflation. E2 utilised performance difficulty, and demonstrated a significant ceiling effect
the E1 procedure for inducing lower limb ischemia and recording of the gross function RMA and motor FIM when compared to the
pain, to conduct an independent subject study of continuous TENS HiMAT. The correlation between the HiMAT and motor FIM was
(100Hz, 200us) for induced LLI. Subjects were randomly allocated poor (r = 0.53, p < 0.01), largely due to a substantial ceiling effect
to a Control or TENS group. In the TENS group, electrodes were of the motor FIM. The correlation between the HiMAT and gross
placed proximal and distal to the area of pain in the calf. ANALYSIS: function RMA was good (r = 0.87, p < 0.01), but the gross function
RMA was also susceptible to a ceiling effect with 51.5% achieving Individuals with varus alignment and medial compartment knee OA
the maximal score. CONCLUSIONS: The HiMAT is a unidimensional exhibit gait patterns that include lateral trunk lean and toe out
mobility scale that quantifies mobility to a higher level than existing and contribute substantially to lessening the dynamic knee joint
scales. The utilization of Rasch analysis in the initial stages of scale load. IMPLICATIONS: Identification of dynamic gait compensations
development allows for identification of discriminative items that can may enable a better understanding of the ability to cope with
be used to generate an efficient measurement tool. This process also knee OA and may aid in the development of more targeted
increases the likelihood that a measurement tool will be responsive rehabilitative interventions such as gait retraining. KEYWORDS:
to change because items that are evenly spaced throughout the knee, osteoarthritis, gait. FUNDING ACKNOWLEDGEMENTS: This
mobility continuum can be identified. IMPLICATIONS: The HiMAT research was undertaken, in part, thanks to funding from the Canada
is a simple clinical tool that requires little training to use and can be Research Chairs Program and the Canadian Institutes of Health
performed in 5-10 minutes in most clinical environments. It can be Research.
used to quantify if people with TBI have the mobility prerequisites for ETHICS COMMITTEE: University of Western Ontario Research
participation in many employment, social, leisure and sporting ac- Ethics Board for Health Sciences Research Involving Human
tivities. KEYWORDS: traumatic brain injury, mobility, measurement. Subjects
FUNDING ACKNOWLEDGEMENTS: La Trobe University Faculty
Research Grant. CONTACT: [email protected]
ETHICS COMMITTEE: La Trobe University (FHEC 01/140, FHEC
02/094) Epworth Hospital (No. 20902) 2629 Sunday 3 June 10:10
VCEC Meeting Room 16
CLINICAL PRACTICE GUIDELINE IN PHYSIOTHERAPY STROKE
MANAGEMENT IN THE NETHERLANDS, BASED ON A
3071 Sunday 3 June 10:10 SYSTEMATIC REVIEW OF AVAILABLE EVIDENCE
Van Peppen R1−3 , Hendriks E4 , Van Meeteren N1,2,5 , Helders P6 ,
LESSENING THE LOAD: GAIT COMPENSATIONS AND KNEE Kwakkel G5,7 ; 1 Department of Physiotherapy-Research,
JOINT LOADING IN PATIENTS WITH KNEE OSTEOARTHRITIS Academy of Health Sciences, University Medical Center,
Hunt M1,2 , Birmingham T1,2 , Bryant D2 , Jones I1 , Giffin R1 , Utrecht, the Netherlands; 2 Master of Science Programme
Jenkyn T1 ; 1 Wolf Orthopaedic Biomechanics Laboratory: London, in Physiotherapy-Research, Utrecht University, Utrecht, the
Ontario, Canada; 2 School of Physical Therapy, University of Netherlands; 3 University for Professional Education Utrecht, Institute
Western Ontario: London, Ontario, Canada for Human Movement Studies, Department of Physiotherapy; 4
Maastricht University, Department of Epidemiology, Maastricht,
PURPOSE: To evaluate the effect of commonly observed gait
the Netherlands; 5 Rudolf Magnus Institute of Neuroscience,
compensations on knee joint loading in patients with medial compart-
Department Neurology and Neurosurgery, Section Rehabilitation,
ment knee osteoarthritis (OA) and varus alignment. RELEVANCE:
University Medical Center Utrecht, Utrecht, the Netherlands; 6 Chair
The substantial burden of knee OA, the weight bearing joint
of Physiotherapy Utrecht University and University Medical Center
most commonly affected, on individuals and society has led to
Utrecht; 7 Department of Physical Therapy, VU University Medical
increased attempts to identify modifiable risk factors and develop
Center, Amsterdam, the Netherlands
appropriate interventions. Lower limb malalignment and excessive
joint loading during walking gait have been identified. Although it PURPOSE: To develop a clinical practice guideline for the physiother-
has been proposed that patients with varus alignment and medial apy management of persons with stroke, as support for the clinical
compartment knee OA may benefit from adopting compensatory gait decision-making process, especially with respect to selection of
characteristics that lessen the load on the knee, the relationships appropriate interventions, prognostic factors and outcome measures.
among commonly observed gait compensations and knee joint RELEVANCE: Physiotherapists have a high caseload of persons
loading are presently unclear. PARTICIPANTS: 75 patients were with stroke, so there is a need to identify effective evidence-based
recruited from a consecutive sample of individuals presenting to an physiotherapy procedures. The availability of a guideline that includes
orthopaedic injuries clinic for treatment of knee pain. All patients information about prognostic factors, interventions, and outcome
had radiographically confirmed varus alignment of the lower limb measures would facilitate clinical decision-making. PARTICIPANTS:
and knee OA predominantly affecting the medial compartment. literature search METHODS: A systematic computerized literature
METHODS: Double-limb standing anteroposterior radiographs were search was performed to identify evidence concerning the use of:
used to measure static varus alignment (mechanical axis angle). 1) prognostic factors related to functional recovery; 2) physiotherapy
Participants underwent three dimensional gait analyses during which interventions in persons with stroke; and 3) outcome measures to as-
they were instructed to walk barefoot across the 8-meter lab floor sess patients’ progress in functional health. Experts, physiotherapists
at their self-selected comfortable pace while kinematic and kinetic working in the field of stroke rehabilitation, and a multidisciplinary
data were collected using an 8-camera optical motion capture system group of health professionals reviewed the clinical applicability and
and floor mounted force platform. An indirect measure of dynamic feasibility of the recommendations for clinical practice and their com-
knee joint load (knee adduction moment), the magnitudes of toe- ments were used to compose the definitive guideline. ANALYSIS:
out and lateral trunk lean, and walking velocity were calculated Of 9482 relevant articles, 322 were selected. These were screened
based on five-trial averages. ANALYSIS: Pearson product moment for methodological quality. RESULTS: Seventy-two recommendations
correlations were used to assess the relationships among individual for clinical practice were retrieved from these articles and included
variables. Two multiple regression models were constructed to in the guideline: 6 recommendations concerned the prediction of
predict the magnitude of knee joint load: one with static varus functional recovery of activities of daily living (ADL), including walking
alignment as the only independent variable, and one with static ability and hand/arm use; 65 recommendations concerned the choice
varus alignment, plus toe-out, lateral trunk lean, and velocity during of physiotherapy interventions; and 1 recommendation concerned
walking as independent variables. RESULTS: Knee joint load was the choice of outcome instrument to use. A core set of seven
most highly correlated with lateral trunk lean (r = −0.58), followed reliable, responsive, and valid outcome measures was established,
by toe-out angle (r = −0.42), and static varus alignment (r = 0.34). to determine impairments and activity limitations in persons with
Knee joint load and velocity were not significantly correlated (r=0.18, stroke. CONCLUSIONS: The guideline provides physiotherapists
p > 0.05). Static varus alignment accounted for 12% of the variation with an evidence-based instrument to assist them in their clinical
in knee joint load. Addition of the compensatory gait characteristics decision making regarding persons with stroke. IMPLICATIONS:
explained a further 43% of knee joint load variance. CONCLUSIONS: As most of the recommendations included in the guideline came
from studies of persons in the post acute and chronic phase may bypass the early mobility constraints experienced by infants with
of stroke, and in general involved patients with less severe and motor disability and helps facilitate not only their motor but other
uncomplicated stroke, more needs to be learned about the more domains of development. KEYWORDS: Infants, Mobility, Cerebral
complex cases. KEYWORDS: clinical practice guideline, physiother- Palsy. FUNDING ACKNOWLEDGEMENTS: This work was partially
apy, rehabilitation, stroke, prognostic factors, interventions, outcome funded by the Presbyterian Health Foundation, Oklahoma Health
measures. FUNDING ACKNOWLEDGEMENTS: This project is Sciences Office of Vice Provost for Research, and College of Allied
supported by a grant from the Dutch Physiotherapy Association Health. CONTACT: [email protected]
(KNGF), grant reference number: IKPZ/KNGF/05/2000. CONTACT: ETHICS COMMITTEE: Institutional Review Board of the University
[email protected] of Oklahoma Health Sciences Center

VCEC Meeting Room 17 PP Crystal Pavilion A
MOVEMENT STRATEGIES USED BY INFANTS WITH CEREBRAL WHICH INFORMATION SOURCES DO PHYSIOTHERAPISTS
PALSY AND DOWN SYNDROME DURING SELF-INITIATED USE WHEN SELECTING TREATMENT TECHNIQUES: SURVEY
PRONE PROGRESSION OF MANUAL THERAPY AND PRIMARY CARE PRACTITIONERS
Kolobe T1 , Pidcoe P2 ; 1 University of Oklahoma Health Sciences Ni Choirbin M1 , Turner P2 , Connell A1 ; 1 Physiotherapy Department,
Center; 2 Virginia Commonwealth University University of Limerick Ireland; 2 Department of Social Sciences
and Law, University of Teesside, UK
PURPOSE: A fundamental barrier to learning and independence in
children with or at risk for cerebral palsy is mobility. The earliest PURPOSE: Physiotherapy has been perceived in the past as a
form of movement that is compromised in these children is prone profession that bases its practice primarily on anecdotal evidence;
progression. This study examined prone progression strategies that physiotherapists use treament techniques that have little or
used by children with CP and Down syndrome. A self-initiated no scientific support and select these techniques without regard to
prone progression crawler (SIPPC) was used to gather movement the evidence (Bohannon & LeVeau 1986, Turner & Whitfield 1999,
data. The SIPPC is designed as a mobility aid and consists of a Palfreyman 2003). This research aimed to establish what sources of
wheeled platform, interdependent drive wheels controlled by an on- information Irish Chartered Physiotherapists are using when selecting
board computer, and load cells that collect information about the treatment techniques and whether practice is evidence based.
infant’s effort to move. RELEVANCE: Prone progression is important RELEVANCE: Evidence based practice (EBP)is firmly established
because it affects other areas of development that children use to as the gold standard of healthcare requiring the integration of
solve problems that require movement, interact with others, and current research, clinical expertise and patient preference when
meet the demands of learning later in school. Recent theories on making clinical decisions(Sackett 1997). Degree programmes equip
brain plasticity in children provide a compelling argument for new physiotherapists with the skills to use current research in their clinical
and innovative strategies that take advantage of the experience- practice. The Irish healthcare system is undergoing considerable
expectant and experience-dependent characteristics of learning and reform and it is important that physiotherapists are able to respond
skill acquisition to address mobility constraints. Such innovation can to the call for EBP. The Irish Chartered Society of Physiotherapists
help link interventions to theories that have been empirically tested, (ISCP)requires all its members to attain degree standard education
and be used to maximize functional independence. PARTICIPANTS: to practice standard and to promote EBP. PARTICIPANTS: Following
Participants were 10 infants, aged 4–22 months, who were stratified ethical approval, the ISCP special interest groups in Manual Therapy
into 3 groups based on diagnosis: 3 with CP, 3 with Down syndrome, (n=217) and Community Care (n=92)members were selected. These
and 4 were typically developing. METHODS: The infants were placed groups were chosen to provide a sample of physiotherapists working
on the SIPPC and encouraged to propel it using a set protocol of 3 in the three clinical service areas of acute services, primary care and
timed trials. The protocol was repeated twice a week for 8 weeks. private practice. A convenience sample of 50% from each group were
Data from the computer on board the SIPPC and load cells were sent questionnaires by taking alternate names on the lists to limit the
recorded to a laptop computer attached to the SIPPC. In addition, effect of geographical location. METHODS: Turner and Whitfield’s
a camera was used to records the infants’ movements. ANALYSIS: (1999) questionnaire was piloted and adapted for the Irish context.
Data collected from the SIPPC provided movement direction, speed, The questionnaire asked for information on the 1)year of qualification
and support force from the infants. Movement data and its derivatives 2) treatment techniques used and frequency of use 3) reasons
were correlated with the force data collected from the load cells. for the choice of treatment techniques. A postal questionnaire was
Data from the camera were digitalized, coded, and correlated with distributed to 45 physiotherapists with a special interest in community
movement data. RESULTS: Movement direction and speed data care and 105 to the manual therapy group. Consent to participate
showed that in all cases, infants with CP and Down syndrome was assumed by return of the completed questionnaire which
performed with less amplitude, disorganized direction and purpose were anonymous. ANALYSIS: All data was entered onto an Excel
when compared to the typically developing infants. Unlike infants with database. Main themes were identifieded for technique selection and
typical development who were able to use the SIPPC independently information sources. RESULTS: The response rate was 54%. 45%
between 6–7 months of age, infants with CP and Down syndrome of the manual therapy group qualified in the last 10 years, 40%
a slow learning curve. Qualitative differences were noted from the of the community care group qualified over 10 years ago. There
video recordings. CONCLUSIONS: These preliminary findings are were no significant differences between the two special interest
promising, and suggest that the SIPPC can be used effectively to groups. Undergraduate education and clinical experience are the
study: a) early movement strategies used by infants with motor most influential factors in determining the selection of treatment,
disabilities during prone locomotion, b) their learning styles, and cited as the primary reason by 65%. Use of research literature
c) the impact of experience-expectant and experience-dependent accounted for a further 9% and continuing professional development
characteristics of learning and skill acquisition. IMPLICATIONS: (CPD)activites a further 6%. Exercise was selected or prescribed by
The development and use of the SIPPC is based on theories 98% of physiotherapists. Electrotherapy was not used 64% of the
of neuroplasticity, particularly the neuronal group selection theory, participants. CONCLUSIONS: In line with previous studies, under-
which emphasizes the importance of environmental experience graduate education continues to be a primary influence in clinical
(experience-dependent plasticity) in shaping the development of the practice. Clinical experience is equally important. The use of research
brain and function. Providing stability through the use of the SIPPC and CPD in informing practice is higher than previously reported.
Exercise is central to practice. Electrotherapy does not have a Research Report Platform Presentation
large role in physiotherapy practice in Ireland. IMPLICATIONS: EBP 1580 Sunday 3 June 10:45
is evident within this study population. Undergraduate curriculum VCEC Ballroom A
content and design should reflect the needs of the future health PAINFUL RESPONSE TO MEDIAN NEURODYNAMIC TEST 1 IN
demand given the persistent influence of training KEYWORDS: prac- HEALTHY SUBJECTS
tice; education; ebp. FUNDING ACKNOWLEDGEMENTS: None. Barbero M1,2 , Castelli E3 , Gatti R3 ; 1 School of Physiotherapy,
CONTACT: [email protected] University of Applied Sciences of Southern Switzerland; 2 Master
ETHICS COMMITTEE: University of Limerck Research Ethics in Rehabilitation of Musculoskeletal Disorder, University of Genoa,
Committee Italy; 3 School of Physiotherapy, Vita-Salute University, San Raffaele,
Milan, Italy
PURPOSE: Patients affected by minor nerve injury or neuritis
show an increased neural tissue mechanosensitivity with adverse
Research Report Platform Presentation response to median neurodynamic test 1 (MNT1). Parameters that
933 Sunday 3 June 10:45 must be considered during MNT1 are pain provocation, range of
PP Crystal Pavilion B & C motion and resistance through range. Normal response to MNT1 and
TO INVESTIGATE THE LEVEL OF KNOWLEDGE ABOUT OSTEO- modifications have been described and variability between subjects
POROSIS AMONG PHYSIOTHERAPISTS AND OCCUPATIONAL reported. The aim of this study is to verify the inter-tester and intra-
THERAPISTS WORKING IN PRIMARY CARE IN IRELAND tester reliability of painful response to MNT1 in healthy subjects
by performing the test in a purely clinical set-up. RELEVANCE:
Farrell C, Culleton -Quinn E; Trintiy College Dublin Knowledges on normal painful response to MNT1 are useful to
assess neurogenic pain disorder. PARTICIPANTS: Fifteen healthy
PURPOSE: The aim of this study is to investigate the level students (22.1+/−0.7 years; 11 females, 4 males) from the school
of knowledge about osteoporosis among physiotherapists and of physiotherapy with no history of upper quadrant disorder were
occupational therapists working in primary care in the Republic recruited. None of the subjects had any previous experience with
of Ireland. RELEVANCE: Osteoporosis is a preventable disease neural provocation tests All students signed an informed consent
affecting millions of people. It is a major cause of long-term form and the study was approved by the ethical committee of the
disability and creates dependency on the world’s health services. It San Raffaele Hospital METHODS: Three physiotherapists (M, R,
is characterised by decreased bone mass with micro-architectural E) after a period of training on MNT1 were involved in the study
deterioration of bone tissue, resulting in bone fragility and thus as assessors. The fifteen participants were randomly allocated to
increasing risk of fractures (O’Brien 1995). Primary care physio- five sessions in group of three. During each session assessors
therapists and occupational therapists have a role in dealing with performed the MNT1 twice (t1, t2) on both sides (R,L) to all the
promotion of “Bone Health” throughout the lifespan. It is essential subjects. Assessor and side order were randomized and subjects
that therapists have sufficient knowledge so as to facilitate effective wait at least fifteen minutes before receiving a test on the same
patient care. PARTICIPANTS: A list of all physiotherapists and side. Subjects were instructed to stop the test at submaximal pain
occupational therapists working in the primary care setting, in the and to record the response on a body chart. ANALYSIS: To analyze
Republic of Ireland, was drawn up from an up to date hospital pain distribution body charts were divided into seventeen anatomical
community resource file. The results include responses from 40 regions and data were extracted. Significant differences between
physiotherapists (response rate 50%) and 34 occupational therapists left and right were investigated using Wilcoxon test. To verify intra-
(response rate 49%), a total of 74 questionnaires. METHODS: A tester and inter-tester reliability correlation analysis was performed
self-administered postal questionnaire was distributed to primary using Spearman’s rank test. RESULTS: Pain response: 91.1% of
care therapists throughout the Republic of Ireland. ANALYSIS: the body charts reported pain in the hand, 87% in the forearm and
The questionnaire was initially coded and the responses were 17.9% in the arm. Wilcoxon test showed no significant difference
then entered onto the Microsoft Excel Package. Data analysis was between left and right (Mt2R to Mt2L p = 0.84; Rt1Rto Rt1L p = 0.22,
primarily descriptive in nature. RESULTS: The results of this study Rt2R to Rt2L p = 0.2; Et1R to Et1L p = 0.45; Et2R to Et2L p = 0.84)
indicate dissatisfaction with knowledge levels among therapists. Only except one case (Mt1R to Mt1L p = 0.3). All the assessors showed
15% of physiotherapists and 12% of occupational therapists were a good correlation between the first and the second test in both
sides (Mt1R to Mt2R R=0.85; Mt1L to Mt2L R=0.94; Rt1R to Rt2R
satisfied with their knowledge. Physiotherapists demonstrated good
R=0.91; Rt1L to Rt2L R=0.87; Et1R to Et2R R=0.87; Et1L to Et2L
knowledge regarding incidence of osteoporosis for women, the age
R=0.76). Also good correlation between assessors for both sides
one reaches peak bone density, age at which osteoporosis occurs,
was verify (Mt1R to Rt1R R=0.93; Mt1R to Et1R R=0.76; Rt1R to
bones commonly effected, some risk factors and management.
Et1R 0.71; Mt1L to Rt1L R=0.89; Mt1L to Et1L R=0.79; Rt1L to Et1L
Knowledge gaps existed regarding incidence of osteoporosis for men,
R=0.8). All correlations were significant (P < 0.05). CONCLUSIONS:
definitions of osteopenia and osteoporosis, RDA calcium and some Our results indicate that on healthy subjects painful response to
risk factors. Occupational therapists demonstrated good knowledge MNT1 has a good reliability. IMPLICATIONS: Additional studies
regarding the age one reaches peak bone density, age at which on pathological subjects are needed to determine the diagnostic
osteoporosis occurs, bones commonly affected, some risk factors potential of MNT1 KEYWORDS: neurodynamic tests, neurogenic
and management. Gaps in knowledge existed regarding incidence pain, reliability. FUNDING ACKNOWLEDGEMENTS: N.A.
of osteoporosis for women and men, definition of osteoporosis and ETHICS COMMITTEE: Ethical committee of the San Raffaele
osteopenia, RDA calcium and some risk factors. CONCLUSIONS: Hospital
Further education is required for both physiotherapists and oc-
cupational therapists, although physiotherapists appear to have
greater baseline knowledge. IMPLICATIONS: Therapist knowledge
plays an integral part in managing osteoporosis and without this
vital tool, therapists are unable to appropriately manage this silent
disease. KEYWORDS: Osteoporosis Knowledge. Physiotherapists
and Occupational Therapists. FUNDING ACKNOWLEDGEMENTS:
None received. CONTACT: [email protected]
ETHICS COMMITTEE: Trinity College Dub;in Ethics Committee
VCEC Meeting Rooms 11-12 VCEC Meeting Room 16
PILLOW TYPE AND WAKING CERVICO-THORACIC SYMPTOM COMPARISON OF HOME-BASED PHYSIOTHERAPY WITH
BEHAVIOUR IN SIDE SLEEPERS ADHERENCE ENHANCING STRATEGIES VERSUS CLINIC-
Gordon S1,2 ; 1 University of South Australia, Adelaide, Australia; BASED PHYSIOTHERAPY REHABILITATION FOR PATIENTS
2 James Cook University, Townsville, Australia WITH ANKLE SPRAINS
Bassett S1 , Prapavessis H2 ; 1 School of Physiotherapy, Auckland
PURPOSE: To compare the prevalence and temporal behaviour
University of Technology, Auckland, New Zealand; 2 School of
of cervical pain, cervical stiffness, headache and scapular pain
Kinesiology, University of Western Ontario, London, Ontario, Canada
reports when subjects slept on their usual pillow and the five
most commonly used pillows in the general Australian population: PURPOSE: This study compared the effects of home-based
polyester, foam, feather and rubber pillows of a regular shape and physiotherapy steeped in adherence enhancing strategies with its
foam contour pillows. Sleep quality and pillow comfort ratings were clinic counterpart on rehabilitation adherence, ankle function and
also used as outcome measures. RELEVANCE: Physiotherapists psychological factors in ankle sprain patients. Correlations amongst
in clinical practice are frequently asked by patients with cervical the adherence, ankle function and psychological factors were also
spine symptoms to recommend a pillow. No previous study has investigated. RELEVANCE: Poor attendance at physiotherapy has
investigated the association between pillow use and cervical spine caused inferior physiotherapy treatment outcomes for patients with
related temporal symptom behaviour. PARTICIPANTS: One hundred ankle sprains. Also psycho-social factors and physical function are
and six participants who reported preference for the side sleep known to influence rehabilitation adherence. PARTICIPANTS: 47
position with one pillow aged over 18 years were recruited to people with new or recurrent ankle sprains, who were about to start
the study. METHODS: A comparative field study was undertaken. a course of physiotherapy were recruited from four physiotherapy
Participants completed a baseline diary of waking and retiring clinics. METHODS: A prospective experimental design was employed
symptoms, sleep quality and pillow comfort for one week while whereby participants were randomly assigned to either the clinic or
sleeping on their usual pillow, then randomly allocated to sleep on home physiotherapy groups before commencing rehabilitation. Both
each of the trial pillows while completing a diary. Subjects slept on groups received a standard physiotherapy programme, with only
their own pillow for one week between trial pillows to ameliorate any the number of clinic appointments differing (clinic 8.44±4.12, home
interaction effect between trial pillows. ANALYSIS: Percentages were
4.68±1.78). The clinic group’s physiotherapy was supplemented with
used for descriptive analysis and to test for strength of association
a small home programme, whilst the home group’s rehabilitation
statistical analysis was conducted using odds ratios in Epiinfo Version
was done predominantly at home, aided by equipment, a treatment
5, an epidemiological statistical program (Epiinfo Users Manual
booklet and cognitive-behaviour strategies. Clinic- and home-
1985). RESULTS: Feather pillows were significantly associated with
based adherence and attendance were measured throughout the
increased reports of waking symptoms, production of symptoms
rehabilitation. Before and after the rehabilitation, questionnaires
overnight, low pillow comfort ratings and low sleep quality ratings
evaluated psychological factors (motivation, and recovery locus of
when compared to the other pillows. In contrast the rubber pillow was
control) and ankle function, and the Motor Activity Scale tested
significantly associated with decreased reports (protective) of waking
function objectively. ANALYSIS: Group comparisons involved Chi-
cervical pain, headache and scapular pain, overnight production of
square tests, Analysis of Variance (ANOVA), and repeated measures
all waking symptoms, low pillow comfort and sleep quality ratings
ANOVA investigated change over the physiotherapy rehabilitation.
when compared to the other pillows. Regular shaped polyester
pillows were significantly associated with waking headache reports Pearson correlations examined relationships between adherence,
and the abolition of cervical stiffness overnight when compared with ankle function and psychological factors. The alpha level was set
regular pillows of other contents. Regular foam pillows were found at 0.05. RESULTS: The home group had a significantly higher
to have no significant association with any symptom production percentage of attendance (p < 0.04) and rate of completion of
or abolition when compared with all other regular shaped pillows their physiotherapy (p < 0.004). The groups were similar for their
and also when compared to a contour foam pillow. The use of adherence to the clinic and home based physiotherapy (all p values
a contour foam pillow had no affect on symptom behaviour when >0.05). Over the rehabilitation participants’ ankle function scores
compared to a regular shaped foam pillow. CONCLUSIONS: This improved significantly (all p values <0.0001). While the groups’ scores
study found that rubber pillows performed best in terms of waking were similar on the objective function measure (p > 0.05), initially
symptom prevalence reports, overnight symptom production, sleep the clinic group had significantly poorer self-reported ankle function
quality and pillow comfort. Feather pillows performed the worst (p < 0.024), but at the end of the rehabilitation the groups did not
IMPLICATIONS: Recommendation for pillow use with regard to differ(p > 0.05). The groups’ scores did not differ on the psychological
patient reports of temporal cervical spine related symptoms can factors over the duration of the rehabilitation (all p values >0.05).
now be provided to patients. KEYWORDS: Pillow, cervical spine, Significant positive correlations existed between adherence and
symptom behaviour. FUNDING ACKNOWLEDGEMENTS: Tontine psychological factors (all p values <0.05) and between adherence
for providing the polyester pillows. Dentons for providing the regular and ankle function (all p values <0.05). Furthermore, significant
and contour shaped foam pillows. University of South Australia for positive correlations were found between psychological factors and
providing the rubber pillows. CONTACT: [email protected] ankle function (all p values <0.05). CONCLUSIONS: Physiotherapy
ETHICS COMMITTEE: Ethics approval supplied by the ethics with a large home based component and adherence enhancing
committee of the University of South Australia. adjuncts is a safe option physically and psychologically for patients
with sprained ankles. Pre-physiotherapy ankle function appears
to have cued the participants to adhere, and those who were
adherent were also motivated and felt in control of their recovery.
IMPLICATIONS: While home-based physiotherapy programmes with
adherence enhancing strategies and few clinic appointments are
suitable for patients with ankle sprains, not all patients will cope
with this method of rehabilitation, particularly those who lack
motivation and do not feel in control of their recovery. KEYWORDS:
adherence, home-based physiotherapy, ankle sprains. FUNDING
ACKNOWLEDGEMENTS: New Zealand Society of Physiotherapists
(Inc.) Scholarship Trust Fund, Wellington, New Zealand. CONTACT: children, parents. FUNDING ACKNOWLEDGEMENTS: This work
[email protected] was unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: Auckland Ethics Committee X, Auckland ETHICS COMMITTEE: Ethics approval was granted by the La
Ethics Committees, Ministry of Health, Auckland, New Zealand, Trobe University Ethics Committee and the Royal Children’s Hospital,
Melbourne Ethics Committee.

SELF-CONCEPT IN CHILDREN WITH CEREBRAL PALSY- EFFECTIVENESS OF PROLONGED USE OF CONTINUOUS
COMPARISONS WITH THEIR PARENT’S PERCEPTION OF PASSIVE MOTION (CPM) AS AN ADJUNCT TO PHYSIOTHERAPY
THEIR COMPETENCE FOLLOWING TOTAL KNEE ARTHROPLASTY
Shields N, Dunn N, Dodd K, Taylor N; School of Physiotherapy,
Lenssen T1 , Crijns Y1 , Waltje E1 , Roox G1 , van Steyn M2 ,
La Trobe University, Melbourne, Australia
Geesink R2 , van den Brandt P3 , de Bie R3 ; 1 Department of
PURPOSE: To determine if a difference existed between the self- Physical Therapy, University Hospital Maastricht, Maastricht,
concept ratings of children with cerebral palsy and their parent’s Netherlands; 2 Department of orthopeadics, University Hospital
perception of their child’s abilities and attributes. RELEVANCE: Maastricht, Netherlands; 3 Department of epidemiology, Maastricht
Physical therapists need to take into account the view a child with University, Maastricht, Netherlands
cerebral palsy has of themselves (their self-concept) when deciding PURPOSE: Adequate and intensive rehabilitation is an important
on appropriate treatment, as the child’s sense of self-worth can requirement for successful total knee arthroplasty (TKA). The primary
influence treatment decisions. With family-centered practice, physical focus of early rehabilitation is ambulation and regaining range of
therapists also need to consider the views of the child’s parents, as motion (ROM) in the knee. Rapid return of knee ROM accompanied
they provide important insights into the child’s abilities and make by earlier return to functional activities of daily life is one of the
decisions on their child’s behalf. Balancing the views of the child potential effects of continuous passive motion (CPM) treatment.
and their parents could be potentially difficult if the parent’s and Although research findings favour the use of CPM in the first
the child’s perceptions differ. It is important that physical therapists rehabilitation phase following surgery, there is substantial debate
know if discrepancies exist so that therapy is directed appropriately. about the total period of CPM application and the duration of
A systematic review identified only three studies comparing the individual sessions. RELEVANCE: A Cochrane review on the topic
self-concept of children with cerebral palsy to their parent’s rating, concluded that short-term use of CPM leads to a more rapid
but all used different outcome measures for the parents and the recovery of ROM. It also suggested, however, that future research
children. PARTICIPANTS: Thirty children (16 male, 14 female) and should concentrate on the period during which CPM should be
their parents were recruited from the orthopedic department of a administered, and therefore called for research into longer-term
metropolitan pediatric hospital. The children were aged between 8 use, involving long-term follow-up. PARTICIPANTS: 60 patients were
and16 years (mean 11 years 5 months, SD 2 years 6 months), included in the study. All patient received a unilateral primary TKA
had been diagnosed with spastic cerebral palsy (hemiplegia or as a result of osteoarthritis of the knee. Patients were included if
diplegia) and had gross motor skills classified as level I and II they had less than 80º of total passive ROM 4 days after surgery,
on the Gross Motor Function Classification Scale. METHODS: were able to understand and speak Dutch, were not suffering
The Self-Perception Profile for Children was used to measure from mental disabilities and were resident inside the ‘Maastricht’
the self-concept of the children and the accompanying Parent region. Patients were excluded if showing relevant co-morbidity
Rating Scale was used to measure the parent’s perception of their influencing mobility (e.g. claudicatio, other prosthesis) or were
child’s abilities and attributes. Comparisons were performed for five operated upon through minimally invasive surgery. METHODS: The
domains of self-concept: Scholastic Competence, Social Acceptance, study design was a randomised controlled trial, with blinded treatment
Athletic Competence, Physical Appearance and Behavioral Conduct. allocation, assessment and analysis, in which patients undergoing
ANALYSIS: Correlation tests (Pearson’s correlation coefficient, r) a unilateral TKA were evaluated to assess the added value of 14
were performed to determine if there was a relationship between days of CPM use at home, when added to regular physical therapy
the scores of the children and their parents. If no correlation treatment. All patients received daily CPM treatment in combination
was found, comparisons were made using independent t-tests and with physical therapy sessions during the in hospital period. After
if a significant correlation was found, data were analyzed using discharge the control group received regular Physical therapy. In the
paired t-tests. RESULTS: No significant differences were found experimental group daily CPM treatment was added. Main outcome
between the ratings of children and their parents for the domains of was function and range of motion. ANALYSIS: Ancova techniques
Scholastic Competence, Social Acceptance and Behavioral Conduct. were applied using the ‘intention-to-treat’ principle. Primary and
Parents rated the Physical Appearance of their children significantly secondary outcome measures ware reported for the in-hospital and
higher than the child’s rating (t = −4.85, p < 0.01) and Athletic home situations, and for 6-week and 3-month follow-up. RESULTS: A
Competence significantly lower compared to the child’s rating (t= significant short term difference was found on the primary outcome
3.45, p < 0.01). CONCLUSIONS: This is the first study to compare measure ROM (increase in rom of 17.6º(12.9) in the CPM group
the self-concept of children with cerebral palsy with their parent’s vs 11.6 (9.4) in the control group). No differences were found in
perception of their child’s abilities using a directly comparable function (Knee Society Score) nor on any of the secondary outcome
rating scale. Parents can provide reliable information about their measures. At follow up (six weeks and three months after surgery)
child’s Scholastic Competence, Social Acceptance and Behavioral no significant differences were found on any outcome measure.
Conduct. However, there may be discrepancies between child and CONCLUSIONS: Two weeks of cpm use after hospital discharge
parents ratings of Athletic Competence and Physical Appearance. leads to better short term range of motion, when added to regular
IMPLICATIONS: The routine assessment of self-concept in children physical therapy in TKA patients with limited range of motion at
with cerebral palsy and the concurrent assessment of their parent’s discharge from the hospital. Better range of motion does not relate
perceptions of their child’s abilities and attributes may enlighten to detectable better functioning. The short term benefits diminish
the goal setting process of family-centered practice. It may also within six weeks after surgery. IMPLICATIONS: Although there are
be a useful method of stimulating discussion on disability between short term effects on range of motion of prolonged use of cpm after
the parent and child. KEYWORDS: Self-concept, cerebral palsy, total knee arthroplasty, administration should be reconsidered since
it does not seem to generate any detectable longer term benefits. Research Report Platform Presentation
KEYWORDS: Total knee artroplasty Knee osteoarthritis; continuous 1633 Sunday 3 June 11:05
passive motion. FUNDING ACKNOWLEDGEMENTS: This work was PP Crystal Pavilion A
funded by the Maasticht university Hospital and Maastricht university. PHYSICAL THERAPY DIAGNOSIS IN CLINICAL PRACTICE: A
CONTACT: [email protected] SURVEY OF ORTHOPEDIC CERTIFIED SPECIALISTS IN THE
ETHICS COMMITTEE: Maastricht University Hospital and Maastricht UNITED STATES
University Medical Ethics Committee
Miller Spoto M, Collins J; Nazareth College of Rochester Rochester,
NY US
815 Sunday 3 June 10:45 PURPOSE: The purpose of this study is to investigate how
VCEC Meeting Rooms 19-20 orthopedic physical therapists view and approach diagnosis in the
United States. RELEVANCE: Diagnosis is a central element of
EFFECTS OF AGING ON LEARNED MOVEMENTS
patient management in the health care professions. Much of the
Braden H1 , Shea C2 ; 1 Department of Physical Therapy, University of attention given to physical therapy diagnosis has been devoted to
Texas Health Science Center, San Antonio, Texas; 2 Department of specific but disparate classification systems utilized in orthopedic
Health and Kinesiology, Texas A&M University, College Station, Texas practice in the treatment of low back pain. What is not well
PURPOSE: The purpose of this research is to examine the manner in understood is how orthopedic clinicians engage in the diagnostic
which sequence movement information is used to optimize response process in the “trenches” of practice, and whether or not there is
in the aging population. Recent laboratory studies of movement a uniform concept of physical therapy diagnosis. PARTICIPANTS:
tasks demonstrate how structure in the sequence of motion result Subjects consisted of 253 board certified orthopedic physical therapy
in more efficient execution (e.g., Park & Shea, 2002, Park, Shea & specialists. METHODS: A survey was developed to collect both
Wilde, 2003). RELEVANCE: Movement skills are practiced in order quantitative and qualitative data related to diagnostic process and
to optimize efficiency and enhance performance. While sequential classification in orthopedic practice. The survey was mailed to
motor tasks generally become more efficient with practice, the extent a published list of orthopedic certified specialists who indicate
to which older people follow this trend is unknown. PARTICIPANTS: low back pain as a practice focus. A total of 850 surveys were
Participants were young (N=8: Age 19-23) and older adults (N=8: Age administered; 253 surveys were completed, representing a return
65-68). METHODS: The task required participants to move a lever as rate of 30%. ANALYSIS: Demographic and quantitative data were
quickly as possible to targets sequentially projected on a table top. At analyzed with SPSS. Qualitative data was first hand coded, then
various stages during practice, random practice blocks were inserted analyzed with Ethnograph (TM). Common themes for how physical
between the repeated sequence blocks. Retention and random therapists approach diagnosis in practice were identified by two
sequence tests were administered after 24 hours. ANALYSIS: To investigators. Each investigator coded responses independently
analyze the acquisition performance on the random and repeated according to the agreed upon themes. RESULTS: Eighty-four
sequences, we analyzed mean element duration in a 2 (practice percent of the respondents report patient care as their primary
group: young or older) x 16 (blocks: 1-16) analysis of variance professional practice area. Seventy-six percent of the subjects utilize
(ANOVA) with repeated measures on block. Repeated and random a diagnostic classification system distinct from the medical diagnosis
sequence retention tests performance was analyzed in a 2 (practice when managing patients with low back pain. Of those, the largest
group: young or older) x 3 (test: repeated or random) x 16 (Element: percentage, 38%, utilize a general pathophysiologic classification
1-16) ANOVA with repeated measures on test and element. Element system, 32% utilize the McKenzie system, and in decreasing
is included in the retention test analysis in order to determine if the order of frequency, treatment-based classification (9%), movement
response structure used on the repeated and random retention tests impairment classification (7%), and the practice patterns found in
differed. The post-experiment recognition and completion tests were the “Guide to Physical Therapist Practice” (7%). The majority of
analyzed using separate Practice group x Response frequency Chi
those surveyed, 67%, agree that it is important for the profession
squares. RESULTS: Young adults performed the repeated sequence
to develop a standard classification system for low back pain.
substantially faster than the older adults and this difference increased
Qualitative data suggest considerable variation in how orthopedic
over practice F(15,239)= 9.36, p < 0.01. The effective organization
specialists approach diagnostic classification in patient management,
of response elements into subsequences by the younger adults
with several themes emerging: (1) physical therapy diagnosis may
resulted in the most fluent production of the movement sequence.
On the retention tests, there were no differences in response time incorporate the medical diagnosis, but moves beyond it, (2) physical
for the random blocks, but the young performers were substantially therapy diagnosis occurs across multiple levels or systems, (3)
faster than the older on the retention test where the repeated physical therapists tend to view diagnosis in a process-oriented way
sequence was used F(30,480)= 10.33, p < 0.01. No differences were with its primary purpose to guide treatment decisions, (4) the focal
detected in the interview or on the recognition and completion tests point of physical therapy diagnosis lies in the relationship between
designed to determine explicit/implicit knowledge of the sequence. body structure and function. CONCLUSIONS: Although there is a
CONCLUSIONS: Analysis of the sequence structure indicated that lack of consensus on the basis for classification in physical therapy
the older adults did not organize their responses into subsequences diagnosis, clinicians largely agree on the role of diagnosis in patient
as effectively as the young adults IMPLICATIONS: The failure of older managment. The majority of orthopedic practioners diagnose patient
adults to optimally arrange movement sequences may contribute to conditions within a framework that reflects the complex relationship
the overall slowing of movement production. KEYWORDS: Aging, between structure and function. IMPLICATIONS: As physical therapy
Movement Tasks, Sequential Movement, Motor Learning. FUNDING evolves from a profession that treats by prescription to a doctoring
ACKNOWLEDGEMENTS: n/a. CONTACT: [email protected] profession, it should give serious attention to diagnosis – the very
ETHICS COMMITTEE: Texas A&M University foundation of evidence-based practice. Striving for consensus on
a conceptual model of physical therapy diagnosis should become
a priority, as well as the development of a more standard,
multiaxial taxonomy. KEYWORDS: Diagnosis; Classification; Low
Back Pain. FUNDING ACKNOWLEDGEMENTS: Nazareth College
Faculty Grants Program. CONTACT: [email protected]
ETHICS COMMITTEE: The Human Subjects Research Committee
of Nazareth College
VCEC Ballroom A VCEC Meeting Rooms 11-12
EXPLORING THE MULTIDIMENSIONALITY OF THE TAMPA THE EFFECT OF CERVICAL MOBILISATION ON MOTOR
SCALE FOR KINESIOPHOBIA FUNCTION AND PAIN PERCEPTION IN PAIN-FREE INDIVIDUALS
Lundberg M1 , Styf J1 , Jansson B2 ; 1 Division of Occupational Wright A1 , Schmid A2 , Soon B3 , Fridriksson E4 , Gresslos E5 ,
Orthopaedics, Sahlgrenska University Hospital & Göteborg Cheong P6 ; 1 School of Physiotherapy, Curtin University of
University, Göteborg, Sweden; 2 Department of Psychology, Technology, Perth, Western Australia; 2 University Hospital Balgrist,
Göteborg University, Sweden Zurich, Switzerland; 3 National University Hospital, Singapore; 4
Hospital of Westman Islands, Iceland; 5 Manuell Terapi Klinikken,
PURPOSE: The aim of the present study was to explore the
Sarpsborg, Norway; 6 Advance Physiotherapy Services (APS),
conceptual dimensions of the TSK questionnaire based on a large
Perth, Australia
Swedish sample of patients with persistent musculoskeletal pain.
RELEVANCE: The Tampa Scale for Kinesiophobia is one of the most PURPOSE: Spinal manual therapy (SMT) has been shown to elicit
frequently employed measures. It has been in use for more than a effects on pain perception, autonomic function and motor function in
decade and has proved valuable for research as well as in clinical subjects who experience musculoskeletal pain. The improvement in
settings. Since kinesiophobia is about fear of movement it is a central motor function may be a direct effect of the treatment or secondary
phenomenon for physical therapists. The psychometric properties to a hypoalgesic effect. This study aims to demonstrate whether it
of the Tampa Scale for Kinesiophobia have been evaluated. It is possible to alter motor function following joint mobilisation, where
has, however, been emphasized that it is not sufficient to examine motor performance is not impaired by pain. RELEVANCE: This study
the reliability and validity of a psychometric scale. It must also adds to our further understanding of potential mechanisms of action
be examined whether or not a specific scale is uni-dimensional, for manual therapy techniques. PARTICIPANTS: 24 healthy subjects
as the uni-dimensionality or otherwise of a specific scale must without any previous experience of manual therapy participated in the
also be investigated. Usually, the uni-dimensionality of a concept study. METHODS: The study used a double-blind, controlled, within-
is analysed by means of factor analysis. PARTICIPANTS: Seven subjects design comparing three different interventions performed
hundred and eleven patients (361 women, 350 men) attending three at the left C5/6 segment: SMT involving a grade III unilateral
different orthopaedic outpatient clinics in Region Västra Götaland postero-anterior mobilisation, manual contact control which involved
were invited to participate. Inclusion criteria were as follows: light manual contact on the segment without mobilisation and a
18 to 65 years of age, non-malignant persistent musculoskeletal control condition without any physical contact. The following outcome
pain and good knowledge of the Swedish language. Exclusion measures were investigated before and after the interventions:
criteria were malignant pain, neurological and rheumatic diseases. EMG signals of the left sternocleidomastoid muscle (SCM) were
METHODS: The questionnaires were posted to the patients prior to recorded during the staged cranio-cervical flexion test (CCFT).
their first visit to the orthopaedic clinic. The patients returned the Decreased SCM EMG activity during the CCFT has been shown
completed questionnaires to an independent researcher. Informed to be associated with increased activity of the deep neck flexors.
consent was obtained from all subjects before inclusion in the Moreover, pressure pain threshold (PPT) was measured on the
study. ANALYSIS: An exploratory factor analysis was conducted posterior aspect of the left articular pillar of C5/C6 using an electronic
to investigate the factor structure of the TSK-SV, after which the digital algometer. ANALYSIS: One-way repeated measures ANOVA
five-factor model was validated against convergent measures which was used to analyse the PPT data and two-way ANOVA was
assessed general anxiety (STAI), physical disability (DRI), fear- used for the CCFT EMG data. RESULTS: The results indicate no
avoidance beliefs (FABQ), general fearfulness (FSS-II), and pain significant change in PPT following unilateral cervical mobilisation
intensity (VAS). RESULTS: The factor analysis indicated a five- (P = 0.846). There was no significant difference in superficial neck
factor solution, which accounted for 60% of the variance. The five flexor activity (P = 0.713). Post-hoc power analysis demonstrated the
factors were labelled: Factor I; Fear of bodily harm, Factor II; Fear of ability to detect a 15% difference in EMG activity with 70% power.
movement/(re)injury, Factor III; Bodily anxiety, Factor IV; Importance CONCLUSIONS: The findings of this study suggest that there is
of activity and Factor V; Avoidance of activity. The strongest no significant influence of SMT on motor function of the deep neck
correlations were found between the TSK-SV and physical disability flexors in painfree individuals. The improvement in motor function
and anxiety. CONCLUSIONS: The TSK-SV is a multidimensional demonstrated in previous studies was not replicated suggesting
questionnaire which measures different conceptual aspects related that either it is only possible to produce an effect when motor
to the phobic components of fear and avoidance. IMPLICATIONS: function is impaired, or the change in motor function is secondary
TSK was constructed as a one-dimensional instrument. The problem to the pain inhibitory effect of the treatment. Further research
of evaluating the construct validity of kinesiophobia boils down to the is required to establish a clear understanding of the mechanism
lack of a consistent conceptual definition of the phenomenon. Instead by which SMT influences motor function. Future studies should
of continuing to divide the TSK into smaller factor models, consensus investigate the effect of mobilisation on motor function in subjects
should be reached regarding conceptual and operational definitions. with impaired motor function who are not currently experiencing
Since kinesis is about movement it is of relevance that physical pain. IMPLICATIONS: The mechanisms behind previously shown
therapists are involved in reaching such a consensus. KEYWORDS: improvement in motor function after SMT remains to be further
Construct validity, explorative factor analysis, persistent pain, psycho- elucidated. KEYWORDS: spinal manual therapy, motor function,
metric properties, Tampa Scale for Kinesiophobia (TSK). FUNDING cervical mobilisation. FUNDING ACKNOWLEDGEMENTS: This
ACKNOWLEDGEMENTS: This study was supported by grants from study was part of the Master of Manipulative Therapy course at Curtin
the Health and Medical Care Executive Board of the Region Västra University of Technology in Perth. No additional funding sources were
Götaland. CONTACT: [email protected] available. CONTACT: [email protected]
ETHICS COMMITTEE: Göteborg University ETHICS COMMITTEE: Curtin University Human Research Ethics
Committee
RESPONSIVENESS OF CLINICAL OUTCOMES AND THEIR DO PARENTS OF CHILDREN WITH CEREBRAL PALSY
VALUE AS INDICATORS OF RECOVERY DURING THE FIRST EXPRESS DIFFERENT CONCERNS IN RELATION TO THEIR
TWO MONTHS FOLLOWING LATERAL ANKLE SPRAIN DIAGNOSIS, AGE AND LEVEL OF DISABILITY?
Perron M1,2 , Luc J. H2,3 , Hélène M2,4 , Sylvain B2,5 ; 1 Canadian Knox V; Bobath Centre, 250 East End Road, London N28AU,
Forces, Valcartier Garrison, 5th Field Amb, CSV, Quebec City, England
Canada; 2 Laval University, Faculty of Medicine, Quebec City,
Canada; 3 Canadian Forces Health Services Headquarters, Ottawa, PURPOSE: This retrospective study aimed to investigate the range
Canada; 4 Center for Interdisciplinary Research in Rehabilitation of parents’ concerns for their children with cerebral palsy and
and Social Integration, Quebec Rehabilitation Institute, Quebec whether concerns varied according to age, type of cerebral palsy
City, Canada; 5 Centre Hospitalier Universitaire de Québec, Quebec (diagnosis) and level of disability. RELEVANCE: It is important that
City, Canada health professionals are aware of which issues parents consider
priorities for their child’s therapy. Currently there is little information
PURPOSE: To assess the responsiveness of clinical outcome within published research literature regarding what concerns parents
measures commonly used with patients with a lateral ankle sprain may have for their children. This information would be useful
(LAS) and to determine which of these measures are the best in understanding the needs of families and planning treatment.
indicators of functional recovery during the first two months following PARTICIPANTS: Past medical records of children with cerebral
a LAS. RELEVANCE: The responsiveness of currently used outcome palsy, who attended the Bobath Centre in London over a two year
measures in the early phase of recovery following LAS is unknown. period were analysed, with information collected from 170 visits.
PARTICIPANTS: A sample of convenience of 26 soldiers with an METHODS: Information was collected on the parents’ concerns,
acute grade I or II LAS. METHODS: The subjects participated in two child’s age, diagnosis, and level of disability, as measured on the
evaluations at 5 days or less (E1) and 8 weeks (E2) after a LAS. The Gross Motor Function Classification System (GMFCS). This classifies
following tests were administered: the Lower Extremity Functional children into five levels, according to their degree of independent
Scale (LEFS), the measurement of ankle girth, the weight bearing mobility. ANALYSIS: Data was analysed using conceptual analysis
(WB) and non-WB (NWB) ankle range of motion and pain intensity to search for common themes and quantitatively using cross
at the end of the range, and the maximal isometric strength of the tabulation and Chi squared tests to determine if differences existed
ankle muscles. ANALYSIS: A paired t-test was computed to compare between the concerns for different ages, diagnoses or disability
the test scores at E1 and E2. Pearson correlation coefficients were levels. RESULTS: Twelve categories of concerns were identified:
calculated to establish the relationships between changes in the activities of daily living, hand function, eating/drinking, floor mobility,
LEFS scores and all other variables. The Standardized Response sitting, stand/walk, transfers, stiffness, communication, therapy, visual
Mean (SRM) with a 95% confidence interval (95% CI) was computed perception and behaviour. Significant differences were found to
to compare the relative responsiveness of each measure. RESULTS: exist between the concerns of parents of children of different
A significant improvement (p < 0.05) was observed from E1 to E2 ages, diagnoses and levels of disability. In relation to diagnosis,
in most measures. The largest changes occurred in the LEFS concerns regarding hand function (p = 0.012) were higher for children
score, ankle girth, pain intensity during inversion and strength of with hemiplegia, concerns about standing /walking (p = 0.0001)were
the evertor muscles. Changes in the isometric strength of ankle highest in children with spastic diplegia, and concerns about sitting
evertors (r = 0.70) and in the range of plantarflexion in NWB (r (p = 0.001), communication (p = 0.0001), floor mobility (p = 0.001),
= 0.63) were significantly (p < 0.001) correlated with the change in eating/drinking (p = 0.018) were highest in children with spastic
the LEFS score. The LEFS (SRM 1.81; 95% CI 1.06-2.55) and pain quadriplegia and athetosis. In relation to age, significant differences
intensity during inversion (SRM 1.31; 95% CI 0.81-1.81) were the in the number of concerns were seen for stiffness (p = 0.004)
two most responsive measures, followed by ankle girth (SRM 0.93; where concerns increased with age, floor mobility (p =0.006) where
95% CI 0.14-1.71), pain intensity during dorsiflexion with knee flexed concerns reduced with age; communication (p = 0.014) concerns
in NWB (SRM 0.81; 95% CI 0.21-1.41) and with knee extended peaked between 4 and 6 years; and standing and walking (p = 0.037)
in both WB (SRM 0.76; 95% CI 0.22-1.31) and NWB (SRM 0.68; which increased after 2 years. Significant differences in the number
95% CI 0.15-1.22), isometric strength of the evertors (SRM 0.74; of recorded concerns related to level of disability occurred within
0.08-1.39) and range of dorsiflexion with knee flexed in NWB sitting (p =0.0001) and communication (p = 0.03) which were highest
(SMR 0.65; 95% CI 0.03-1.26). CONCLUSIONS: Eight of the 22 in level V children, standing/walking (p = 0.0001) was a concern for
outcomes measured had moderate to high levels of responsiveness all children but especially levels II and III; and floor mobility concerns
(SRM > 0.50). The level of disability (LEFS) and the pain intensity (p = 0.01) increased with reducing level of ability. CONCLUSIONS:
during ankle inversion showed the highest levels of responsiveness. Within this sample it is apparent that clear themes emerge regarding
These results apply to the early phase of recovery after LAS. The parents’ concerns related to their child’s diagnosis, age and level of
level of responsiveness of the outcomes may vary considerably in disability. Concerns appeared to be appropriate in relation to their
the later phase of recovery. In particular, the evertor’s strength, which child, for example having more concerns about hand function in a
was both moderately responsive and associated to function, may be child with hemiplegia, but more concerns about floor mobility in a
more appropriate to monitor clinical changes. Future studies will aim young child. This suggests that parents have specific, realistic and
at confirming these results in a larger patient population and evaluate appropriate concerns in relation to what might be possible for their
longer time intervals. IMPLICATIONS: Measures of impairment and child to achieve. IMPLICATIONS: This information can be helpful for
disability with known responsiveness can now be used to track therapists, to understand the range of concerns which are important
changes in the early phase of recovery in patients with a LAS. to parents for their children, to enable working in collaboration
KEYWORDS: ankle sprain, responsiveness, outcome measures. with parents, and to set joint goals. KEYWORDS: Cerebral palsy;
FUNDING ACKNOWLEDGEMENTS: Funded by the REPAR and the Parents; Concerns. FUNDING ACKNOWLEDGEMENTS: Work was
OPPQ. CONTACT: [email protected] unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: This study was approved by the ethics ETHICS COMMITTEE: Barnet, Enfield & Haringey Local Research
committee of the Centre de santé Valcartier Ethics Committee, North London, UK
AGILITY AND PERTURBATION TRAINING FOR PATIENTS AFTER THE IMPACT OF AGE AND STROKE ON COMPLEX MOTOR
TOTAL KNEE ARTHROPLASTY. A CASE-CONTROL STUDY SEQUENCE LEARNING
Bizzini M1 , Croci-Maspoli I2 , Buechele S2 , Maffiuletti N1 , Boyd L1,2 , Vidnoi E2 , Siengsukon C2 ; 1 University of British
Munzinger U3 ; 1 Research Department, Schulthess Clinic, Columbia, Vancouver, Canada; 2 University of Kansas Medical
Zürich, Switzerland; 2 Physical Therapy Department, Schulthess Center, Kansas City, USA
Clinic, Zürich, Switzerland; 3 Department of Orthopaedic Surgery,
Schulthess Clinic, Zürich, Switzerland PURPOSE: Our purpose was to determine if age or stroke
differentially effects motor sequence learning of a complex task
PURPOSE: The purposes of this study were: a) to describe
with embedded motor, spatial and temporal sub-sequences. The
the development and implementation of an adapted agility and
impact of aging on motor sequence learning has been debated;
perturbation training program for patients after primary total knee
however, no past work controlled for nor quantified task complexity.
arthroplasty; and b) to compare the functional outcome of these
This study did both. RELEVANCE: Past work examining motor
patients with patients following standard rehabilitation in the first three
postoperative months. RELEVANCE: Modern surgical techniques in learning has shown that neither age nor stroke uniformly impact the
total knee arthroplasty allow for quicker range of motion recovery, acquisition of learned motor sequences. Worldwide the population
rapid pain reduction, and earlier full weight-bearing. Standard at large is aging. Increasing knowledge of the effect of age and
rehabilitation includes range of motion/strengthening exercises, and stroke on complex motor learning is critical for the design of
gait training. Neuromuscular control of the operated knee may be effective therapeutic interventions. PARTICIPANTS: Neurologically
enhanced by a specific agility and perturbation training. Therefore, intact younger (mean 27 years; n=12) and older (mean 77 years;
adding this type of training to traditional rehabilitation exercises, n=17) adults, and people with stroke (mean 64 years; n=10) in the
patients may achieve better functions in the activities of daily living. middle cerebral artery distribution participated. METHODS: Each
PARTICIPANTS: 15 patients (8 females, 7 males, mean age 64.8 subject signed an approved consent form. All practiced a novel serial
years) followed standard rehabilitation and a specific agility and response task containing repeated motor, spatial and temporal sub-
perturbation training program (mean number of sessions: 12.9) in sequences (2 days, 50 sequence trials = 5 blocks/day). Two blocks
the first three months after undergoing total knee arthroplasty (group of random sequence responses were collected (1/day). A delayed
I). 15 patients (9 females, 6 males, mean age 63.9 years) followed retention test assessed learning (day 3, 1 block). Performance and
standard rehabilitation (mean number of sessions: 12.1), and served learning were indexed by change in response time (RT; difference
as a control group (group II). All patients received the same type of between RT for random versus repeated sequences). Information
implants by the same surgeon. METHODS: The study utilized a case- theory quantified task complexity. Learning the repeated sequence
control design (non-matched, non randomized), and was approved by required encoding 57 bits of information; past research typically
the Local Committee on Human Research (Schulthess Klinik Zürich). used single-element sequences that demanded learning 12 bits
Measurements were taken before and after discharge of physical of information. ANALYSIS: Analysis of variance (ANOVA) with a
therapy. Outcome variables were: passive range of motion in flexion repeated measures correction was used to assess differences in
and extension, visual analogue scale for pain, get up and go test, performance during acquisition (Group (younger, older, stroke) X
and the knee outcome survey for activities of daily living (KOS-ADLS; Block (1-10)). A one-way ANOVA of change scores from retention
scale: 0-70 points) questionnaire. ANALYSIS: A two-way ANOVA on tested for between group differences in learning. Last, regression
all outcome measures was performed to study the effect of group (I analyses determined the relationships between age, stroke and
versus II) and time (baseline versus follow up). Independent Student ability to learn a complex motor sequence. RESULTS: A group
t-tests were performed to search for pre-post differences (outcome by block interaction revealed differences in acquisition practice
measures) between groups. Statistical analysis were undertaken by (p = 0.003). Post-hoc tests demonstrated that the younger group
using SPSS 11.0. RESULTS: There were no significant group by time made more change in RT as compared to the stroke (p = 0.022) or
interactions on all outcome measures (two-way ANOVA, p > 0.05). older (p = 0.023) groups. These between group differences persisted
The patients following the additional agility and perturbation training at retention where the younger group showed larger change in RT
program showed a significant (t-test, p < 0.05) larger improvement
as compared to the older (p = 0.023) or stroke (p = 0.017) groups.
of the KOS-ADLS score (mean ± SD = 18±9.3) compared to
A strong inverse relationship between age and ability to learn (as
the patients following the standard rehabilitation (mean ± SD =
demonstrated by RT change) was evident in the regression analysis
10.2±5). CONCLUSIONS: Supplementing rehabilitation programs
(R2=.462). No relationship existed between stroke and the ability to
for patients after total knee arthroplasty with an adapted agility
learn (R2=.063). CONCLUSIONS: Our data demonstrate an age-
and perturbation training program may allow them to regain better
related deficit in the ability to learn complex sequences of action.
functions in the activities of daily living within the first three
postoperative months. Considering the limitations of this (pilot) study, Stroke did not predict the ability to (or not to) learn complex motor
further research is needed. IMPLICATIONS: This study may deliver sequences. It appears that age is a more powerful influence on
interesting information for optimizing the postoperative rehabilitation complex motor sequence learning than stroke. Our results extend
and improving treatment effectiveness in patients after total knee our understanding of learning because we examined complex motor
arthroplasty. KEYWORDS: agility/perturbation training, rehabilitation, sequence learning which more closely approximates activities of
total knee arthroplasty. FUNDING ACKNOWLEDGEMENTS: This daily life. IMPLICATIONS: In this work, older adults were unable to
work received no funding. CONTACT: [email protected] take advantage of regularities in their responses to show learning;
ETHICS COMMITTEE: The study was approved by the Local the net result was a failure to improve performance with practice.
Committee on Human Research (Schulthess Klinik Zürich). As the population worldwide continues to age, physical therapists
will have to design novel interventions to stimulate motor learning
in older adults regardless of stroke. KEYWORDS: Human, Aging,
Stroke, Learning. FUNDING ACKNOWLEDGEMENTS: This work
was funded by a KUMC SAH grant awarded to LB. CONTACT:
[email protected]
ETHICS COMMITTEE: University of Kansas Medical Center Human
Subject Committee
PP Crystal Pavilion A PP Crystal Pavilion B & C
CONTROLLING MANUALLY APPLIED FORCES IN MANUAL EFFECTS OF HIGH-IMPACT TRAINING AND DETRAINING ON
THERAPY TECHNIQUES FEMORAL NECK STRUCTURE IN PREMENOPAUSAL WOMEN:
Waddington G1 , Adams R2 ; 1 University of Canberra; 2 University AN 18-MONTH RCT WITH A 5-YEAR FOLLOW-UP
of Sydney Heinonen A1,2 , Mäntynen J1 , Kannus P2,3 , Uusi-Rasi K2 ,
Nikander R2 , Kontulainen S2 , Sievänen H2 ; 1 Department of Health
PURPOSE: To control force applied in manual therapy an experi-
Sciences, University of Jyväskylä, Finland; 2 Bone Research Group,
mental version of a mobilizing device incorporating a dynamometer.
UKK Institute for Health Promotion Research, Finland; 3 Department
RELEVANCE: In both simulation and manual therapy studies,
of Surgery, University of Tampere, Finland
substantial variability has been shown when therapists attempt to
replicate an applied force. Knowledge about the forces employed PURPOSE: The purpose of this study was to evaluate training effects
during treatment could reduce this variability and improve both and their maintenance of an 18-month exercise intervention with
reliability and clinical safety. PARTICIPANTS: Thirty physiotherapists the 5-year follow-up on femoral neck structure in premenopausal
were recruited from two major teaching hospitals in the Canberra women. RELEVANCE: Exercise seems to be a promising action to
Australia region. METHODS: Therapists used the device to apply promote bone health also in adulthood. Total bone strength is known
applied a randomised sequence of the standard grade I, II, III or IV to be a combination of material and structural properties most of
mobilisation forces to a plinth surface. The dial was obscured and the the exercise studies have focused on measuring only bone mineral
therapists were using their concept of the force appropriate for each mass as an outcome of the exercise intervention. A little is known
grade to guide force production with no feedback. Comfort ratings also about the maintenance of the exercise-induced benefits on
of grade III force applied by hand and a 100N force applied with bone structure. PARTICIPANTS: In the original study design, 84 (of
the device dial visible were also obtained. After each condition the the 98 participants), sedentary premenopausal women aged 35-45
therapist was asked to rate their comfort during the performance of years completed the initial randomized controlled 18-month exercise
the PA pressure on a 100mm visual analogue scale. ANALYSIS: intervention. At the 18-month and 5-year follow-up measurements,
Reliability: The ICC(2,1) reliability index was calculated for manual DXA image data of 22 trainees and 22 controls were available for Hip
force production without feed back and whenusing the dial readout of Strength Analysis (HSA). METHODS: The DXA derived HSA method
the dynamometer to control force application. To compare variance in was used to estimate the section modulus (Z, an index of a bending
concept-guided and device-guided forces, F-ratios were formed using resistance), cross-sectional area (CSA) and subperiosteal width (W)
the variance between the mean forces generated over three attempts at the narrowest section of the femoral neck. Besides the DXA scans
by thirty physiotherapists in the numerator, and the variance over the physical performance was assessed at baseline, after 18 months
10 repetitions of visually guided force application on a set of digital and after 5 years. ANALYSIS: The univariate general linear model
scales in the denominator. Scores for hand comfort during a PA force (GLM) was used to calculate the between-group differences at 18
application using the mobilisation dynamometer or the therapist’s months and 5 years. The differences between the groups for bone
hands alone were compared with a repeated measures ANOVA. and neuromuscular variables were adjusted for the baseline values.
RESULTS: The ICC(2,1) was found to be 0.63 (95% CI = 0.36-0.93) RESULTS: The body height, weight and age adjusted between-
for manual force production without feed back on occasions. When group differences were observed after the 18-month intervention in
three forces (50, 100 and 200 N) were applied ten times to digital favour of trainees in Z (3.2%, p = 0.047) and CSA (2.8%, p = 0.043).
scales, using the dial readout of the dynamometer to control force At the 5-year follow-up point the exercise intervention benefits in
application, the ICC (2,1) was 0.999 (95% CI 0.996-0.9999). Relative Z and CSA were lost. Between-group differences were observed
variance in force production values was significant with all p values in favour of trainees after the intervention (4.2%, p = 0.002) and
<0.001. The mean (sd) scores for hand comfort during a PA force at 5-year follow-up (5.1%, p = 0.003) in lower limbs power and
application using the mobilisation dynamometer or the therapist’s in maximal oxygen uptake 5.6% (p = 0.002) and 4.6% (p = 0.005),
hands alone were 8.3 (0.8) and 5 (2.0) respectively. Comfort ratings respectively CONCLUSIONS: The results of this study indicate that
were higher when using the device than when using the pisiform high-impact type of exercise can increase the femoral neck strength
grip [F(1,29) = 86.1, p < 0.01]. CONCLUSIONS: Forces produced by in addition of bone mineral gain by improving structural properties
different physiotherapists trying to push at the same grade varied, and of bone. Although the differences between the groups were not
to a significantly greater extent than force productions made with the statistically significant a positive trend in favour of the trainees was
same device but guided by the use of the dynamometer dial readout. observed also in the maintenance at least some of the exercise-
The device was found to be significantly more comfortable to use induced bone benefits on femoral neck. IMPLICATIONS: Even the
than the hands in the pisiform grip. IMPLICATIONS: Physiotherapy training effects on bone mineral amount and on bone structure are
mobilization techniques require the application of specified forces, biologically quite small in adulthood exercise can offer an inexpensive
quantification of these forces, to determine the amount of force and safe option to prevent or slow down age-related bone loss
corresponding to pain onset (for reference in future treatment and promote bone health both in women and men. KEYWORDS:
sessions), and to allow inter-therapist treatment comparisons, has Bone strength, bone structure, exercise, osteoporosis prevention.
previously only been possible with instrumented plinths. Development FUNDING ACKNOWLEDGEMENTS: The Ministry of Education,
of a device that improves therapist feedback regarding force Finland.
and improves therapist comfort in a clinical environment may ETHICS COMMITTEE: The study was approved by the Ethics
lead to improved patient outcomes. KEYWORDS: Manual therapy, Committee of the Pirkanmaa Hospital District, Tampere, Finland
dynamometer, force variability. FUNDING ACKNOWLEDGEMENTS:
Nil. CONTACT: [email protected]
ETHICS COMMITTEE: University of Sydney Ethics Committee
IS ULTRASOUND USING TISSUE DOPPLER IMAGING A VALID DECREASED NECK MUSCLE ENDURANCE IN NON-SPECIFIC
AND RELIABLE METHOD TO DETERMINE THE ONSET OF NECK-PAIN PATIENTS AND IN PATIENTS AFTER ANTERIOR
SKELETAL MUSCLE ACTIVITY? CERVICAL DECOMPRESSION AND FUSION
Pulkovski N1 , Schenk P1 , Maffiuletti N2 , Mannion A2 ; 1 University Peolsson A, Kjellman G; Dept of Health and Society, Div of
Hospital Zürich, Department of Rheumatology and Institute of Physiotherapy, Faculty of Health Sciences, Linköping University,
Physical Medicine, Zürich, Switzerland; 2 Schulthess Clinic, Zürich, Linköping, Sweden
Switzerland PURPOSE: To investigate differences in ventral and dorsal neck
muscle endurance (NME) among patients with non-specific neck
PURPOSE: This study investigated whether ultrasound Tissue
pain (NP) or cervical disc disease (ACDF) and healthy controls (C).
Doppler Imaging (TDI) gives a reliable and valid measure of the
RELEVANCE: There is no knowledge of proportions of patients
onset of activity in Musculus vastus lateralis (VL) compared with
with disability of NME either before or after treatment for neck
the gold standard, electromyography (EMG). RELEVANCE: The
disorders. Furthermore there is no knowledge if there are differences
onset of muscle contraction during a given functional activity is in NME between NP and ACDF patients. PARTICIPANTS: NME
often investigated in relation to suspected motor control dysfunctions. was measured in NP (n=77) and ACDF (n=34) patients before
For example, in knee pathologies such as osteoarthritis and treatment and at 12-month follow-up and results was compared
patellofemoral pain, patients show a delayed onset of VL during to gender-specific reference values from C (n=116) both on
stair climbing. The onset of skeletal muscle activity is typically individual and group levels. METHODS: Ventral and dorsal NME
recorded using EMG. However, surface EMG is susceptible to was measured in seconds in a standardized and reliable manner
cross-talk (i.e. the electrodes overlying one muscle may also in lying down position. Neck pain on Visual Analogue Scale and
pick up signals from a neighbouring muscle) and more selective neck specific disability (NDI) were obtained. NP, and after anterior
alternatives require invasive techniques (needle or fine-wire EMG). cervical decompression and fusion also ACDF group were treated
We therefore investigated whether TDI velocity could provide an polyclinically by physiotherapists. ANALYSIS: Statistical significance
alternative, non-invasive method for determining the onset of muscle within and between groups was analyzed by paired and unpaired
activity. PARTICIPANTS: 10 healthy active adults (5 women, 5 men) two-tailed Student’s t-test and by factorial Analysis of Variance with
31.3 (±1.9) years old; with no history of knee pain were tested. the Bonferroni/ Dunn post-hoc test. Deficit in NME on individual
METHODS: Subjects performed maximal knee extension exercises level was defined as>1 Standard Deviation below the gender specific
at 0º/s (isometric) and 60, 120, 180 and 240º/s (5 times each, on each mean value of the control group and on group level defined as below
side), using an isokinetic dynamometer (Biodex II). Simultaneous 95% lower Confidence Interval (CI). Pearson correlation coefficient
recordings of the electromyographic signal (using bipolar surface analysis was used to investigate relationship between NME and pain
electrodes) and of muscle tissue velocity (using M-mode ultrasound intensity or NDI. Significance was accepted at a level of p < 0.02
and TDI (Philips HDI 5000 with a linear array transducer L12- in the ANOVA and otherwise p < 0.05. RESULTS: Patients had
5 MHz)) were made from the VL. All tests were repeated one mainly significantly (p < 0.01) decreased NME compared with C.
week later. Muscle onsets were determined by visual inspection of ACDF women had lower ventral NME than NP women (p < 0.01).
blinded EMG and TDI-velocity signals and expressed relative to the 29-100% of patients had disability (>1 SD below mean of C) in
start of the movement (isokinetic) or the rise in torque (isometric). NME, mainly with group mean below 95% CI of C. Only NME in
ANALYSIS: Pearson correlation coefficients were used to express NP women (p < 0.05) improved after treatment. Flexion/ extension
the strength of association between the time of onset of VL measured ratio normalized after treatment in NP (p = 0.36) but not in ACDF
by EMG and by TDI-velocity changes. The mean difference and SD (p < 0.0001). NME in ACDF group correlated with both pain intensity
between the two methods was analysed. The standard error of the and neck specific disability (NDI) (r = −0.51 to −0.78, p < 0.01). NME
measurement or “typical error” was used to indicate the range of in NP group were mainly uncorrelated to pain but mainly weakly
scores that could be expected on retesting. RESULTS: There was correlated to NDI (−0.31 to −0.38, p < 0.02). CONCLUSIONS: A
a highly significant correlation (p < 0.0001) between the onset-times great deal of patients had impairment in NME before, but also
after treatment. IMPLICATIONS: Specific training of NME and
determined with TDI-velocity and with EMG: r = 0.78 (day 1), and
longer treatment period may improve outcome and should be taken
r = 0.80 (day 2). The mean difference (and SD) in muscle onset-
into consideration in clinical practice. KEYWORDS: Neck muscles,
time between the two methods (TDI − EMG) was −20.3 ±31.0 ms
physical endurance, treatment. FUNDING ACKNOWLEDGEMENTS:
(day 1) and −17.4 ±27.2 ms (day 2). The between-day standard
This study was supported by the Faculty of Health Sciences,
error of measurement (“typical-error”) for the difference in onset-times
Linköping University. CONTACT: [email protected]
between methods was 15.3 (95% CI 13.7-17.4) ms. CONCLUSIONS:
ETHICS COMMITTEE: Linköping Ethics Committee
Measures of tissue velocity using ultrasound TDI represent a reliable
and valid means of detecting the onset of muscle activity. The
mean difference between the onset-times for the electrical and the Research Report Platform Presentation
mechanical signals (approximately 20 ms) is likely explained by 1533 Sunday 3 June 11:25
the electromechanical delay. IMPLICATIONS: Ultrasound using TDI VCEC Meeting Room 16
represents a valid, non-invasive and accurate alternative to EMG for EFFECT OF FOCUS OF ATTENTION ON REHABILITATION OF
the measurement of the time of onset of a muscular contraction. Its POSTURAL CONTROL FOLLOWING LATERAL ANKLE SPRAIN
future application in the assessment of deep-lying or small muscles
requires further investigation. KEYWORDS: Motor control, Musculus Rotem-Lehrer N1 , Laufer Y1 , Ronen Z2 , Khayutin G2 , Rozenberg I2 ;
1 Department of Physical Therapy, Haifa University, Haifa, Israel;
vastus lateralis and Isokinetic. FUNDING ACKNOWLEDGEMENTS: 2 Physical Therapy, Medical Corps, IDF, Israel
The equipment for this project was supported by the National
Research Programme NRP53 “Musculoskeletal Health – Chronic PURPOSE: To determine the effect of training utilizing an internal
Pain” of the Swiss National Science Foundation (Project 405340- (IFA) versus an external focus of attention (EFA) on performance,
104787/2). CONTACT: [email protected] retention and transfer of a postural control task in participants
ETHICS COMMITTEE: Local Ethic Comity (Kantonale Ethikkommis- following a lateral ankle sprain (LAS). RELEVANCE: Motor learning
sion Zürich) research focuses on the principles underlying the acquisition,
retention and transfer of motor skills. Current evidence suggests that CP, ages 3 to 9 years, in Gross Motor Function Classification
instructions directing an external focus of attention (EFA) towards System (GMFCS) Levels I, II and III. Convenience sample, pediatric
the effect of a given movement, may be more effective at promoting rehabilitation center-based. METHODS: A prospective one-group
learning than instructions inducing an internal focus of attention before-after design with measures of ‘impairment’ (modified Tardieu
(IFA) in which the focus of attention is on the movement itself. scale, 20 metre timed walk), ‘activity’ (GMFM Stand/Walk, PEDI),
However, the effect of attentional direction has not been tested in and ‘participation’ (POSNA measure). Assessments occurred pre-Bt-
populations following a disease or injury in which postural control A (baseline [b]), 2 and 6 months (m) post-Bt-A. Repeated-measures
is impaired. PARTICIPANTS: Forty participants, referred to physical ANOVA evaluated change. Linear regression assessed relationships.
therapy following a LAS were recruited and randomly allocated to Regression predictors included baseline and change scores, age,
a group training either with an EFA or with an IFA METHODS: GMFCS Level. ANALYSIS: Repeated measures analysis of variance
Balance assessment and training were carried out using the Biodex determined change over time, and regression techniques evaluated
Stability System (BSS). Postural control training consisted of ten, 20- score relationships. Predictors included the various baseline (b) and
sec trials, performed on three consecutive days, at stability levels change score values as well as age group and GMFCS Level
6 and 4 of the BSS. Training instructions directed the participants RESULTS: Spasticity decreased 2 m post-Bt-A (Tardieu R1 gains
either to an internal or to an external focus of attention. Assessments for gastrocnemius [P = 0.0009] and hamstrings [P = 0.048]), and
at the trained stability levels were conducted pre- and post-training, partially recurred by 6 m. Timed walk scores improved at 2 m (P =
and 48 hours following the last session (retention test). Additionally, 0.03), and were maintained at 6 m. There were significant GMFM
assessments of stability at an untrained less stable level (level 2) and POSNA gains at 2 m (P < 0.02) with continuing improvement
were conducted pre-training and at the retention assessment to at 6 m. PEDI gains occurred at 6 m (P 0.001). Baseline score
determine skill transfer. Outcome measures obtained were: Overall relationships were moderate to strong for impairment vs. GMFM
Stability Index (OSI); anterior-posterior stability (APS); and medio- scores (0.49 < r < 0.73), and fair to strong for impairment vs. PEDI
lateral stability (MLS). ANALYSIS: Separate mixed-model two-way and POSNA scores (0.30 < r < 0.73). GMFM, PEDI and POSNA
(2X3) repeated-measures analyses of variance (ANOVAs) were b relationships were strong (r>0.65). Change score relationships
utilized for each variable at levels 6 and 4. Similarly, two-way at 2 m and 6 m were poor to fair (r < 0.40) between impairment,
(2X2) ANOVAs were used for the level 2 assessments. Alpha error timed walk, GMFM, PEDI and POSNA change scores. Predictor
level was set at p < 0.05. RESULTS: Stability at the trained levels combinations accounted for <60% of change score variation.
improved in both groups immediately post training. An interaction Impairment scores accounted for <50% of explained variation within
effect in OSI and APS indicates greater improvement in the group GMFM, PEDI and POSNA models. Predictors often pertained
practicing with an EFA. Gains in stability made immediately following to underlying child characteristics (b score, GMFCS level, age).
training were retained two days later. Improvements in postural CONCLUSIONS: Relationships among changes at different ICF
control in the untrained level demonstrate that EFA is more effective levels are complex. Despite moderate/strong relationships between
for skill transfer as determined by all stability indices used in the measures at b and similar directions of change at 2 m, change
study. CONCLUSIONS: Directing subjects to an EFA during balance scores were not strongly correlated. ‘Activity’ and ‘participation’ gains
training may enhance the acquisition and transfer of balance control post-Bt-A likely were greatly influenced by individual factors such
following an ankle injury. IMPLICATIONS: Rehabilitation of balance as physical therapy, motivation, skill practice and integration into
control following injury may be enhanced by directing the focus of daily life. IMPLICATIONS: Challenges to the assumption about direct
attention during training towards the effect of the movement and associations between change scores at different ICF levels need to
away from the movement itself. Principles of motor learning obtained be considered by physiotherapists when deciding on the goal focus
from the study of individuals without impairment are applicable to of interventions, and in the interpretation of observed outcomes.
treatment of individuals with impairments. KEYWORDS: Balance- KEYWORDS: Pediatrics, Outcomes, International Classification of
training, attention, focus. FUNDING ACKNOWLEDGEMENTS: un- Function. FUNDING ACKNOWLEDGEMENTS: Bloorview Childrens
funded. CONTACT: [email protected] Hospital Foundation, 2002-2005. CONTACT: [email protected]
ETHICS COMMITTEE: Medical Corps Ethical Review Board. ETHICS COMMITTEE: Bloorview Kids Rehab REB, Toronto, Canada

HOW DO CHANGES IN IMPAIRMENT, ACTIVITY AND CLINICAL IMPLICATIONS OF 1-YEAR LOWER EXTREMITY
PARTICIPATION RELATE TO EACH OTHER IN A GROUP OF FUNCTIONAL STATUS RECOVERY PROFILES POST TOTAL
CHILDREN WITH CEREBRAL PALSY KNEE ARTHROPLASTY
Wright V1 , Rosenbaum P2 , Goldsmith C2 , Fehlings D1 , Law M2 ; Kennedy D1,2 , Stratford P2 , Hanna S2 , Gollish J1 ; 1 Sunnybrook
1 Bloorview Research Institute/Bloorview Kids Rehab, Toronto, Holland Orthopaedic & Arthritic Centre, Toronto, Canada; 2 School
Canada; 2 McMaster University, Hamilton, Canada of Rehabilitation Sciences, McMaster University, Hamilton, Canada
PURPOSE: The overall goal was to evaluate associations among PURPOSE: To describe change in lower extremity functional status
changes in spasticity and changes in higher level activities and of patients over 1-year following total knee arthroplasty (TKA). Secon-
participation following lower extremity Botulinum Toxin Type-A (Bt- darily, to illustrate how this information can be applied to set treatment
A) injections in children with cerebral palsy (CP). RELEVANCE: goals, establish prognosis and determine optimal assessment times,
Rehabilitation today is focused increasingly on ‘activity’ and including endpoints in clinical trials. RELEVANCE: Osteoarthritis
‘participation’ goals with less emphasis on ‘body structure and (OA) accounts for significant disability in older adults. Information
function/‘impairment’ changes as primary outcomes. Moderate to about expected rate of change post arthroplasty is critical to making
strong associations have been reported between measures at appropriate rehabilitation decisions including establishing prognosis.
these different International Classification of Function (ICF) levels PARTICIPANTS: A convenience sample of 84 patients (44 females)
at a single time, but change score relationships are unknown. For with a mean age of 66 years (s=9) and an average body mass index
this study, it was necessary first to identify an intervention for of 31 kg/m2 (s=5) was chosen. All had knee OA and underwent
which impairment changes are known to occur. This has been primary TKA. METHODS: The institution’s research and ethics board
demonstrated with Bt-A injections, a common spasticity-reducing approved the study and written informed consent was obtained.
intervention. PARTICIPANTS: Thirty-five ambulatory children with Repeated measurements of the Lower Extremity Functional Scale
(LEFS) and 6-minute walk test (6MWT) were taken over 1-year. numbness), clinical features (e.g. palmar thickening) and specific
To allow for a more accurate representation of change over time, clinical tests (e.g. Phalens) was undertaken. Participants were
measurements were scheduled at different time points. The earliest classified as HOA (American College of Rheumatology criteria),
assessment point was approximately 1-week post arthroplasty. CTS (classification without nerve conduction Birmingham, UK), D
ANALYSIS: Data were plotted to gain an impression of the pattern and TF. Participants with inflammatory arthritis were excluded.
of change over time. Subsequently, we evaluated several nonlinear Hand pain and disability were measured using subscales of the
models of change which related the dependent variable of functional Australian/Canadian (AUSCAN) Osteoarthritis Hand Index. Grip
status – either LEFS scores or 6MWT distances – to the independent (Jamar) and pinch strength (B&LTM gauge) were measured and
variable, number of weeks post arthroplasty. The final equation was: averaged across hands as bilateral problems frequently occurred
functional status = limit + (y0 − limit) × e(−e(change rate) × weeks), (83%). ANALYSIS: We compared pain, disability and hand strength
where functional status is the LEFS or 6MWT, e is the base of the in each of the separate clinical subgroups (HOA, CTS, D, TF).
natural logarithm, weeks equals number of weeks postoperatively; y0 Using analysis of covariance (ANCOVA), pain, disability and hand
is the parameter representing the y-intercept value; limit represents strength were compared between those with single and multiple
the maximum LEFS or 6MWT value; and change rate is the rate conditions (adjusting for age, gender and duration of hand problem).
of improvement at which patients approach the limit of functional RESULTS: Of 1369 participants invited to take part, 623 (46%)
status. Parameters were estimated using the nonlinear mixed-effects attended clinical assessment (mean age 64yrs; 62% Female). After
modeling package in S-Plus. Different models were explored; our allowing for exclusions and missing data (N=50), 218 had a single
final model specification named the limit, y-intercept and change classification (HOA, CTS, D or TF), 202 had multiple conditions and
rate parameters as fixed effects, and the limit and y-intercept as 153 could not be classified into any of the 4 groups. In participants
random effects. Separate models were created for females and with a single condition, 49 had HOA alone, 93 CTS, 50 D and 26
males. RESULTS: The results from the nonlinear mixed effects TF. Participants with HOA alone had higher levels of self-reported
models were applied to generate profiles of change in functional pain and disability than any other single group (HOA versus other
status characterized by the predicted LEFS and 6MWT values. The single conditions: pain −2.02 (95% CI = −3.22, −0.81), disability −2.38
greatest change period occurred over the first 10-weeks post TKA (95% CI = −4.48, −0.28)), however hand strength measures were
and was similar for males and females. On average no clinically similar (grip 0.49 (95% CI = −5.68, 4.70), pinch 0.38 (95% CI = −0.70,
important change was noted beyond 6-months. Limit values for the 1.46)). Participants with multiple hand conditions reported increased
LEFS scores for males and females were 60 and 54 respectively pain and disability and reduced hand strength compared to those
(t82 =1.97, p2 =0.053). Limit 6MWT distances for males and females with a single clinical condition (p-value to detect group difference
were 578 and 467 meters (t82 =4.63, p2 =<0.001). CONCLUSIONS: <0.006 in all outcome models). CONCLUSIONS: In community
Our findings demonstrate that the greatest improvement occurs dwelling older adults with hand problems, hand OA had the greatest
in the first 12-weeks post arthroplasty; improvement continues to impact in terms of pain and disability. Having multiple conditions
occur from 12-weeks to 26-weeks, however at a slower rate; and led to increased pain and disability and reduced hand strength
little improvement occurs beyond 26-weeks post arthroplasty. Future compared to those with a single clinical condition. However a large
work will include replication of the results in a larger sample. group of people could not be classified according to the criterion
IMPLICATIONS: Our results can be used to make prognoses and this warrants further investigation. IMPLICATIONS: Evaluation
concerning the rate of improvement in functional status post TKA of the impact of musculoskeletal hand problems contributes to a
and the expected time specific and terminal functional status scores. greater understanding of the clinical presentation of such condi-
KEYWORDS: Activity Limitation, Knee Arthroplasty, Functional tions. KEYWORDS: clinical epidemiology, musculoskeletal, hand.
Recovery. FUNDING ACKNOWLEDGEMENTS: A Research Grant FUNDING ACKNOWLEDGEMENTS: Medical Research Council,
from the Orthopaedic and Arthritic Foundation supported this UK, Support for Science funding North Staffordshire Primary Care
research. CONTACT: [email protected] Research Consortium, Arthritis Research Campaign. CONTACT:
ETHICS COMMITTEE: The Sunnybrook and Women’s College [email protected]
Health Sciences Centre Research Ethics Board ETHICS COMMITTEE: North Staffordshire Local Research Ethics
Committee UK
VCEC Meeting Rooms 19-20 2229 Sunday 3 June 11:45
IMPACT OF MUSCULOSKELETAL HAND CONDITIONS IN A PP Crystal Pavilion A
COMMUNITY DWELLING POPULATION OF OLDER ADULTS THORACIC SPINE MOBILITY AND POSTURE IN YOUNG
Dziedzic K1 , Nicholls E1 , Myers H1 , Peat G1 , Handy J1 , FEMALE OPERA SINGERS. A PRELIMINARY INVESTIGATION
Thomas E1 , Wood L1 , Tyson C2 , Hay E1 ; 1 Primary Care Johnson G, Skinner M; Centre for Physiotherapy Research, School
Musculoskeletal Research Centre, Keele University, Staffordshire, of Physiotherapy, University of Otago, Dunedin, New Zealand
United Kingdom; 2 North Staffordshire Combined Healthcare Trust,
PURPOSE: The aim of this study was to examine the hypothesis
Leek, Staffordshire, United Kingdom
that mastery of postural techniques necessary for the effective
PURPOSE: The impact of musculoskeletal hand conditions such as voice production in female opera singers would be reflected in
osteoarthritis of the hand (HOA), carpal tunnel syndrome (CTS), both their thoracic spinal posture and range of motion parameters.
Dupuytren’s contracture (D) and trigger finger (TF) has not been RELEVANCE: Adverse changes in thoracic spinal mobility and
studied in a community dwelling population of older adults. The aim posture of elderly women, particularly secondary to osteoporosis,
of this study was to investigate hand pain and disability in older adults are well documented. However there is little information about factors
with self-reported hand problems. RELEVANCE: Musculoskeletal such as occupation that may maintain thoracic mobility and limit the
hand problems are common in older people, but their impact on potential for such changes. Instructors in vocal performance hold
everyday life is unclear. PARTICIPANTS: Consenting participants in that postural alignment is not an inherent trait. Thus when training
the North Staffordshire Osteoarthritis Project – Clinical Assessment young opera singers, selected exercises for training postural muscles
Study of the Hand (CAS-HA), aged 50 years and over, reporting are incorporated to enhance vocal performance. PARTICIPANTS:
hand pain or problems in the previous twelve months in a survey Thirty five healthy female volunteers agreed to participate in the
questionnaire were invited for a clinical assessment. METHODS: study. Eight of the participants (mean age 21.3±4.9 years, mean
A standardised clinical assessment of hand symptoms (e.g. pain, body mass index (BMI) 23.88±1.79kg/m2 ) were enrolled in a
professional voice programme. The second group of 27 participants sample of women residing in Canada was used. Disability in this
(mean age 41.0±12.2 years, mean BMI 22.97±1.78kg/m 2 ) had survey was defined in a number of ways. Living with “disability”
no singing background. Participants were excluded if they had could mean: living with a long term health condition; loss of specific
current or a recent (4 weeks) history of backpain and/or a physical functions (e.g. seeing); activity limitations; and use of personal
limitation in maintaining a standing posture. METHODS: The Spinal assistance. METHODS: A self-completed mailed survey was used
Mouse(Idiag,Voletswil, Switzerland), an electronic computer-aided to gather information. A modified Dillman procedure was used
device and licensed to the School of Physiotherapy was used to to facilitate the response rate. Given the cross-disability nature
collect the thoracic spine measurements. A previous study has of the survey, alternate forms of the survey (e.g. computer disk)
demonstrated that the Spinal Mouse can be reliably implemented were used to increase the accessibility of the study to women.
for in-vivo studies of the sagittal profile and range of motion of ANALYSIS: We used descriptive statistics to describe the sample
the human spine. The sagittal thoracic profile and spinal range of and the type of abuse (physical, emotional and sexual) experienced
movement were recorded for each participant, twice on a single by the women. In the bivariate and multivariate analyses, the
occasion, in the upright standing and maximum flexed and extended dependent variable of abuse was experienced physical and/or sexual
positions. ANALYSIS: Descriptive statistics and unpaired t-tests were abuse – yes or no. Bivariate analyses were conducted to screen
used to examine the group mean segmental and global values variables (p 0.15) for inclusion into the logistic regression. Co-
describing thoracic upright posture and maximum ranges of thoracic linearity was checked for all relevant variables prior to sequential
flexion and extension for the singing (n=8) and healthy control logistic regression. RESULTS: Preliminary results suggest that
(n=27) group. Significance was accepted at the 5% level. RESULTS: women who were older (OR=0.455, 95% CI: 0.282-0.733) and
No difference(p = 0.86) was found between the singers’ group women who had not received information about sexuality (OR=0.638;
mean global thoracic angle (34.68º±8.13º)and the healthy control 95% CI: 0.423-0.961) were less likely to have experienced abuse.
group (34.94º±4.80º). Similarly, there was no difference(P = 0.39) Not identifying primarily as Canadian (OR=1.927; 95% CI: 1.117-
between the total range of flexion and extension in the group mean 3.324) was associated with having experiencing abuse. Having an
global kyphotic angle for the singers’ group (19.11º±11.39º) and income which was less than $20,000/year (OR=3.21, 95% CI: 1.966-
the control group (16.53º±11.36º). However, when group mean 5.249) or an income between $20-49,999 (OR=2.078, 95% CI: 1.285-
segmental (T1-T12) values were examined significant differences 3.359) were also associated with abuse. Having more than one
in the segmental ranges of movement were identified in the lower health condition was associated with having experienced abuse
thoracic spine of the singers when compared to those of the (OR=3.2, 95% CI: 1.926-5.318). Finally, being limited in activities
control group. CONCLUSIONS: The preliminary data suggest there by pain was associated with having experienced abuse (OR=1.611,
is an association between physical tasks undertaken by opera 95% CI: 1.079-2.407). CONCLUSIONS: These findings show that
singers and that of spinal mobility, namely, an increased segmental both sociodemographic and disability variables are associated with
mobility specific to the lower thoracic spine but not the upper experiences of victimization. Physical therapists can help women
thoracic spine. This is preliminary work and further investigation seek information and resources in this area. Future research should
is required with age-matched controls and a wider population focus on educating PT in this important area so they can provide
sample in order to establish whether the increased lower thoracic appropriate services. IMPLICATIONS: The implications for PT are
mobility is a feature specific to young female opera singers alone. multi-faceted. First, PT education in this area should be integrated
IMPLICATIONS: A clear, quantified understanding of the potential into university curriculum and continuing education courses. The
relationship between the physical attributes of thoracic spine and practice of PT should see issues of abuse/victimization for women
the influence of occupation in young women will provide insight into with disabilities and those without as a priority area and create
more precise directions for therapeutic and educative interventions. policies that reflect this priority. KEYWORDS: violence, women,
KEYWORDS: Thoracic spinal posture, Spinal mobility, Occupation. abuse, health. FUNDING ACKNOWLEDGEMENTS: Grant funded
FUNDING ACKNOWLEDGEMENTS: The study was supported by by the Social Science and Humanities Research Council. CONTACT:
the Mark Steptoe Memorial Fund and an Otago Research Grant from [email protected]
the University of Otago. The donation of the Spinal Mouse by Dr Vert ETHICS COMMITTEE: University of Toronto Research Services
Mooney, to the School of Physiotherapy, University of Otago is also
acknowledged. CONTACT: [email protected]
ETHICS COMMITTEE: Human Ethics Committee, University of
Otago, Application #’s(04/166 & 05/135). 2488 Sunday 3 June 11:45
VCEC Ballroom A
THE EFFECT OF UPPER LIMB TENSION TEST 1 ON BRACHIAL
Research Report Platform Presentation BLOOD PRESSURE
Kerry R1 , Newey L1 , Peebles C2 , Taylor A3 ; 1 Division of
Physiotherapy Education, University of Nottingham, UK;
VIOLENCE AMONG CANADIAN WOMEN LIVING WITH DISABIL- 2 Department of Physiology, University College London, UK;
ITIES: IMPLICATIONS FOR PHYSICAL THERAPY PRACTICE 3 Nottingham Nuffield Hospital, Nottingham, UK
Yoshida K, Odette F, Du Mont J, Lysy D; Department of Physical

PURPOSE: This study investigated the effect of upper limb neural
Therapy, University of Toronto, Toronto, Canada
tension test 1 (ULNTT1) on brachial blood pressure as part of a
PURPOSE: Violence among women living with “disablities” has been programme of studies designed to test the theory of a vascular
largely under-studied within PT (physical therapy) research. We basis to tension test arm positioning. Results of this study will
will present victimization data from a survey of 1095 women with serve to inform the manual therapy knowledge base with regards
disabilities. This information will include: 1)Who experienced abuse? to differential diagnosis of non-specific arm pain. RELEVANCE:
2) What forms of abuse were experienced?, 3)What factors were Non-specific arm pain is often attributed to a neurogenic cause.
associated with being abuse? RELEVANCE: Physical therapists This diagnosis is often supported by a positive upper limb neural
are primary health service providers who work with women with tension test (ULNTT) result. The mechanical basis of the ULNTT
disabilities across the continuum of service. We need to be aware is well-documented as being a mechanical stress applied to a
of the circumstances and forms of victimization for women living neural structure with adverse movement. Early work surrounding the
with disabilities. This knowledge and understanding will allow us ULNTT suggested that the procedure was structurally differentiating
to provide support and services for these women. PARTICIPANTS: as the arm movement involved in the test was selective to neural
Survey participants were 18 years of age and older. A convenience structures, and not to any other anatomical structures in the arm.
However, later studies reported that the commonly used ULNTT (n=214). ANALYSIS: Logistic regression formulae for predicting
for the Median Nerve (ULTT1) may produce a significant strain outcome at the completion of the program were developed on one
on the subclavian artery, thereby questioning the true mechanical sample (n=122) data and tested on another (n=214). RESULTS:
basis of neural tension testing. Other authors have reported changes In the first sample, NDI scores and item responses predicted
in brachial blood pressure of above 30mmHg in response to arm response or non-response with approximately 70% accuracy. When
tension positioning as being diagnositic for arterial pathology in the tested on the second sample, a prediction model using NDI item
subclavian vessels. PARTICIPANTS: 48 asymptomatic subjects were scores predicted responders (positive predictive value 56%) and
recruited to this study (mean age 28y, 4y SD). METHODS: The non-responders (negative predictive value 74%) with considerable
subjects rested in supine lying for 15mins. Resting bilateral brachial loss of responder prediction accuracy. Participants with low initial
systolic blood pressure (sBP) (mmHg) was taken at 5 minute intervals NDI scores (higher functional ability) appeared to benefit less from
during this rest period. The subject’s arm (subjects were randomly the exercise program. CONCLUSIONS: Functionally able patients
assigned to either dominant arm (DA) first or non-dominant arm may benefit less from exercise for chronic neck pain than those
(NDA) first) was placed in a standardised ULNTT1 position and sBP with greater functional limitations. IMPLICATIONS: Functionally able
was recorded in both arms. This test procedure was repeated 3 patients may benefit less from exercise for chronic neck pain
times with 5 minutes rest intervals in between. The test procedure than those with greater functional limitations. KEYWORDS: chronic
was then repeated with the other arm (DA or NDA depending on neck pain, prediction, strengthening. Multi-Cervical Unit. FUNDING
group) in the test position. ANALYSIS: Recordings were tested ACKNOWLEDGEMENTS: nil. CONTACT: [email protected]
for difference using student t-tests for pairs of all combinations of ETHICS COMMITTEE: Ethics Committee – La Trobe University
measurements (DA rest v NDA rest; DA ULNTT v NDA rest; DA rest
v DA ULNTT; DA rest v DA rest during NDA ULNTT, and repeated
with reverse order of NDA/DA). RESULTS: Significant differences
were found between DA rest v DA ULNTT (p = 0.0356; mean = 2503 Sunday 3 June 11:45
2.3mmHg); DA rest v DA rest during NDA ULNTT (p = 0.0067; mean = VCEC Meeting Room 16
3mmHg); NDA rest v NDA rest during DA ULNTT (p = 0.0267; mean = THE MANAGEMENT OF ACUTE ANKLE SPRAINS: A
2.3mmHg). All measurements were decreased when the arm was in SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
ULNTT1 position. CONCLUSIONS: The results of this study suggest Bleakley C1 , McDonough S1 , MacAuley D2 ; 1 Health and
that sBP is influenced by the ULNTT1 position in asymptomatic Rehabilitation Sciences Research Institute, University of Ulster,
subjects. However the degree of change is considerably less than Northern Ireland; 2 Hillhead Family Practice, Belfast, Northern Ireland
previously reported measures said to indicate vascular pathology.
IMPLICATIONS: As the participants used in this study were PURPOSE: This study aimed to enhance the evidence base for
asymptomatic, these results may support the diagnositic utility of this managing acute soft tissue injuries. The specific objective was to
test for arterial dysfunction. The mechanical basis of neural tension undertake a systematic review to assess the clinical evidence base
test positions, and the true diagnostic utility of this testing, are, for the treatment of acute ankle sprains. RELEVANCE: Lateral ankle
however, still uncertain. The clinician should consider results of such sprains are common soft tissue injuries; however there is no evidence
testing with this in mind. KEYWORDS: Differential diagnosis; Man- to suggest which intervention best augments functional treat-
ual Therapy; Neuromuscular. FUNDING ACKNOWLEDGEMENTS: ment, and currently practitioners treat ankle sprains pragmatically.
Manipulation Association of Chartered Physiotherapists (Elsevier PARTICIPANTS: Randomised controlled trials METHODS: A com-
Research Award). CONTACT: [email protected] puterized literature search using nine databases (Medline, CINAHL,
ETHICS COMMITTEE: 1) University of Nottingham School of Health AMED, Proquest, ISI Web of Science, CDSR, DARE, CCTR, PEDro)
and Community Sciences (Faculty of Medicine). 2) Nottingham City was carried out up to April 2005. This was supplemented with citation
Hospital Research and Development Unit tracking of primary and review articles (n=88), hand searching of key
journals (n=10), and a related articles search on Pubmed (NLM).
Eligible studies were randomized-controlled trials (RCT’s), published
Research Report Platform Presentation in English, describing human adults recovering from an acute ankle
996 Sunday 3 June 11:45 sprain with the therapy consisting of a physiotherapeutic, electrother-
VCEC Meeting Rooms 11-12 apeutic or pharmacological intervention. Comparisons should have
PREDICTING SHORT TERM RESPONSE AND NON-RESPONSE been made to no treatment, placebo, or a different physiotherapeutic,
TO NECK STRENGTHENING EXERCISE FOR CHRONIC NECK electrotherapeutic or pharmacological intervention. ANALYSIS: Data
PAIN was extracted for the following outcomes measures: pain, swelling,
function, re-injury, subjective instability, objective instability and or
De Nardis R1 , Keating J2 ; 1 Melbourne Whiplash Centre, Melbourne
overall improvement. Two reviewers independently assessed the
Australia; 2 Monash University, Peninsula Campus, Melbourne,
validity of included trials using the PEDro scale, disagreement arising
Australia
between the first two raters, were resolved by either consensus
PURPOSE: People with chronic neck pain respond variably to discussion or by consultation with the PEDro project officer.
exercise therapy. The likely success of exercise for chronic neck Individual study-effect estimates were calculated using the Cochrane
pain cannot be predicted. RELEVANCE: This prospective study Collaboration Review Manager (4.2) software program. RESULTS:
tested the relationship between patient characteristics assessed prior 21 trials met the inclusion criteria. The mean PEDro score was 5.1
to intervention and response to an exercise program for chronic / 10. There was little evidence to suggest that electrotherapeutic
neck pain PARTICIPANTS: Data were collected on 336 consecutive modalities have any significant effect after ankle sprains. However
patients receiving physiotherapy for chronic neck pain METHODS: due of the lack of RCTs employing clinically appropriate parameters,
Subject age, sex, duration of symptoms, compensation status, Neck in particular with regards to the cryotherapy, it is not yet possible
Disability Index (NDI) item and total scores, cervical spine range of to come to any definitive conclusion in this area. Non-steroidal
movement and isometric strength were assessed prior to treatment. anti-inflammatory drugs (NSAID’s), both oral and topical, are of
Response to therapy was defined as a change of 14/100 or more significant benefit in short term recovery after injury, but they may
NDI points. Subjects received a progressive, concentric/eccentric, cause increased mechanical instability, and no studies included
strengthening program using computerized equipment designed for a long term follow up. There is evidence from two lower quality
cervical spine assessment and rehabilitation. Logistic regression studies that neuromuscular exercises may decrease complaints of
formulae for predicting outcome at the completion of the program functional instability and re-injury, and evidence from one high
were developed on one sample (n=122) data and tested on another quality study that physiological mobilisations can increase range of
movement. CONCLUSIONS: More high quality studies will provide of their children’s rehabilitation and thus contribute to family centered
further evidence of which modalities, or combination of modalities rehabilitation. KEYWORDS: Feasibility study, PEDI, Questionnaire.
can best supplement functional recovery after ankle sprains. Future FUNDING ACKNOWLEDGEMENTS: Grants from Pampers & Fisher
studies into the effectiveness of electrotherapeutic modalities must Price and the Danish Association of Physiotherapists.
aim to employ higher quality study methodologies in combination with
clinically appropriate treatment doses. Although there is moderate
evidence that NSAID’s can significantly reduce pain in the early Research Report Platform Presentation
stages of ankle sprain, their long-term efficacy is not yet known, and 2551 Sunday 3 June 11:45
future studies must include a long term follow-up. IMPLICATIONS: VCEC Meeting Room 18
Lateral ankle sprains are a very common soft tissue injury. Based
A SYSTEMATIC REVIEW OF PHYSIOTHERAPY EXERCISE
on the current review, practitioners may have difficulty adopting an
PROGRAMMES FOLLOWING DISCHARGE FROM HOSPITAL
evidence based management approach. KEYWORDS: ankle sprain,
AFTER TOTAL KNEE ARTHROPLASTY
management, evidence base. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: [email protected] Minns Lowe C1,2 , Barker K1,2 , Sackley C2 ; 1 Physiotherapy
Research Unit, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK;
2 School of Health Science, Birmingham University, Birmingham, UK
1034 Sunday 3 June 11:45 PURPOSE: To evaluate the extent to which post discharge physio-
VCEC Meeting Room 17 therapy exercise is effective, in terms of improving function, mobility,
range of motion, quality of life and strength, for osteoarthritic patients
PEDI, USED AS A QUESTIONNAIRE
following elective primary total knee arthroplasty. RELEVANCE:
Christensen J; Department of Physiotherapy, Glostrup University Although knee joint arthroplasty is a common orthopaedic procedure,
Hospital, DK-2600 Glostrup, Denmark there are surprisingly few published evidence-based rehabilita-
PURPOSE: The purpose of the study was to develop and examine tion guidelines/programmes available for use in clinical practice.
a Danish questionnaire version of Pediatric Evaluation of Disability This research was undertaken to inform the development of
Inventory (PEDI).Proper outcome measurements are important tools an evidence-based physiotherapy interventions for these patients.
for planing and evaluating interventions in all parts of physiotherapy. PARTICIPANTS: The participants for inclusion in this review were
Outcome measurements should be valid and reliable and if possible patients undergoing elective total hip or knee arthroplasty for
translated to different languages, so that international comparison osteoarthritis who have received a physiotherapy exercise rehabili-
studies can be made. PEDI is one such measurement tool aimed at tation intervention following discharge from hospital post-operatively.
children with disabilities. RELEVANCE: Until now very few standard- METHODS: The Cochrane Collaboration guidelines and the Quorom
ized outcome measurement tools for children have been translated statement were followed throughout. The review identified and
into Danish. Looking for a suitable measurement tool for children included prospective comparative clinical trials relevant to the review
with disabilities, PEDI was the obvious choice, having already been question. For this review the term physiotherapy exercise referred
translated into several languages and validated internationally. In to any exercises or exercise programme advised or provided by
addition PEDI is a generic measurement tool for children, with good physiotherapists/physical therapists during the rehabilitative period
psychometric properties. We therefore found PEDI suitable for use after discharge from hospital after surgery occurring in the out patient,
in a Danish context. PARTICIPANTS: Parents to 39 children with community or home setting. Trials were included if they compared
Cerebral Palsy (age 2-7.5 years) filled in the Danish PEDI ques- a physiotherapy intervention versus usual or standard care or
tionnaire. All the parents had Danish as their primary language and compared two different types of relevant physiotherapy intervention.
their children followed the common outpatients program at the Neuro- The quality of trials was independently assessed by two reviewers.
pediatric Department, Glostrup Hospital, Denmark. METHODS: The The outcomes included in this review were: self report measures of
original American version of PEDI was translated into Danish and function, walking, muscle strength, quality of life and range of joint
transformed into a questionnaire. Pilot trials was performed among motion. ANALYSIS: Narrative and Meta-Analyses were performed
professionals and parents. The questionnaire was then given to using fixed effect models, weighted mean differences, standardised
parents along with a brief standardized instruction. The parents filled effect sizes, and tests for heterogeneity. RESULTS: 6 trials were
in the questionnaire on their own at home. After completing PEDI, the identified, 5 of which were suitable for inclusion in meta-analyses.
parents were asked to assess PEDI for difficulties, comprehension A small to moderate standardised effect size, in favour of functional
of instructions, doubts, relevance and the time spend on completing exercise, was seen for function at 3-4 months post operatively.
the questionnaire. The final Danish questionnaire version has then Small to moderate weighted mean differences, in favour of functional
been translated back into English for approval by the authors of exercise, were seen for range of joint motion and quality of life at 3-
PEDI. ANALYSIS: Descriptive statistics was used for data analysis. 4 months post operatively. Post treatment benefits were not carried
Problematic items was reviewed for further conceptual and semantic through to 1year. CONCLUSIONS: The review supports the use of
improvements. RESULTS: The majority of parents were able to com- functional exercise interventions following discharge, over traditional
plete PEDI (95%). In total only 5.7% of answers were problematic – physiotherapy, to obtain short term benefit following elective primary
mainly on items concerning activities that were no longer relevant knee arthroplasty. Although the results are not conclusive, they
for the child. Almost all parents found PEDI relevant. However some indicate that functional exercise interventions following discharge
parents found PEDI long and complicated, but in general instructions show promise for this patient group. The results also support the need
and content were considered understandable. Completion of PEDI for further research in this area. IMPLICATIONS: From the evidence
took on average 55 minutes. CONCLUSIONS: The PEDI question- to date, the authors propose that functional exercises should be
naire version was tested for feasibility and parents impressions with considered for inclusion in post discharge physiotherapy programmes
success. The Danish questionnaire version of PEDI can be used following knee arthroplasty. Traditional programmes, which concen-
by parents at home or as an interview guide for professionals. The trate on isometric muscle exercises and exercises to increase joint
parents found PEDI relevant and were in favour of incorporating range of motion, may be less effective in the short term following total
PEDI into the children’s test program. Many parents commented that knee arthroplasty. KEYWORDS: Total knee arthroplasty, rehabilita-
PEDI gave better insight to the abilities of their children during daily tion, systematic review. FUNDING ACKNOWLEDGEMENTS: This
activities. Further reliability and validity studies using questionnaire research has been funded by a Department of Health Allied Health
versions of PEDI is recommended. IMPLICATIONS: PEDI used as a Professional Researcher Development Award from the Department
questionnaire can involve parents in the measuring and goal setting of Health, UK. CONTACT: [email protected]
VCEC Meeting Rooms 19-20 VCEC Ballroom A
THE PREVALENCE AND CHARACTERISTICS OF THORACIC ARE THERE RELIABLE AND VALID CLINICAL METHODS FOR
DISC DEGENERATION AND OTHER PATHOLOGY IN MEN MEASURING LEG LENGTH DISCREPANCY?
Niemeläinen R1 , Videman T, Battié M; 1 Faculty of Rehabilitation Oosterveld F1 , Kamp N1 , de Jong R1 , ten Brinke A1,2 , van den
Medicine, University of Alberta, Edmonton, Canada Engh F2 ; 1 Saxion University, Enschede, The Netherlands; 2 Hospital
Medisch Spectrum Twente, Enschede, The Netherlands
PURPOSE: This study examined the prevalence of degenerative and
pathological findings in the thoracic spine in a general population PURPOSE: There is significant inconsistency regarding research into
sample of adult men, for which little is currently known. The objective measurements of leg length discrepancy. RELEVANCE: The aim of
of the study was to obtain normative data on thoracic degenerative this study was to investigate the intra observer reliability and validity of
findings which is essential for recognizing the clinical significance four different methods that are currently being used in clinical settings
of related observations in patients. RELEVANCE: The occurrence to determine leg length discrepancies. PARTICIPANTS: 25 Healthy
of degeneration and pathology have been extensively studied in the male subjects, with a mean age of 49 years were enrolled in the study.
cervical and lumbar spines, however, the extent of these findings Women were excluded from the study, because their reproductive
in the thoracic spine still remains unknown, as well as the possible organs cannot be protected adequately during the X-rays. In addition,
role of disc degeneration in symptoms. Yet, thoracic pain is common also volunteers who had actual complaints of the musculoskeletal
and can be disabling among men. A prior analysis revealed that system and those who were unable to assume the desired position
17% of the subjects in the current study had thoracic pain in the without complaints of pain were excluded. METHODS: The methods
previous year and, of those, approximately one-quarter reported under study were 3 standing methods (the Calliet method, the Laser
difficulties in daily activities because of the pain. PARTICIPANTS: method and the Pelvic-leveling device method) and 1 supine method
A population sample of 532 men aged 25-70 years, representative (the DeltaLeg method). The iliac crest symmetry was assessed and
of the general population of Finnish men selected from a twin expressed on a nominal scale (left higher / even / right higher) and
cohort containing all twins born before 1958 and alive in 1975. the difference, if present, was measured in cm (continuous scale).
METHODS: Qualitative and quantitative assessments of thoracic All measurements of the four different methods were performed
disc degeneration were obtained from MR images (levels T6-L1). twice by an experienced observer in the morning and twice by
Qualitative assessments were performed by a spine surgeon and an inexperienced observer in the afternoon on the same subjects.
custom-made software was used to acquire quantitative data on Subjects were kept unaware of their own measurement results
disc degeneration. ANALYSIS: Descriptive statistics were acquired (blinded). To blind the observers each subject was assigned a
using SPSS statistical software. RESULTS: Moderate or severe disc different code number for each session and they were measured
bulging was present in at least one disc in 7.9% of subjects being in a random order, without knowledge of the previous results. During
most common at the two lowest levels. The prevalence of disc the afternoon also an X-ray was made of each subject, showing the
herniations was 0.8%. Moderate or severe disc height narrowing femur heads and the crista iliacii. This standing X-ray was used as a
varied from 2.7% to 9.7% by disc level with 22.4% of subjects having golden standard for validation. ANALYSIS: The data was analyzed
at least one narrowed disc. Four or more wedged vertebrae (5º) using SPSS 12. To estimate intra observer agreement for nominal
were present in 68 subjects and 13 had coexisting Schmorl’s nodes data Cohen’s Kappa was used and for continuous data Pearson’s
meeting a criterion for Scheuermann’s disease. Seven subjects correlation coefficient was calculated. Also, differences between the
(1.3%) met the more stringent criteria with three or more wedged measurements were expressed in mean and standard deviation. To
vertebrae, endplate changes and sclerosis and disc height narrowing. transform the group reliability results to the level of the individual
Age correlated with disc signal intensity (r= 0.31-0.40 depending on patient from the SD’s the Smallest Detectable Difference (SDD) was
the disc level). CONCLUSIONS: The prevalence of disc degeneration calculated. RESULTS: Reliability for all the observers was relatively
is lower in the thoracic spine than has been reported in the cervical low. Cohen’s Kappa’s vary from 0.18 to 0.50 and SDD’s of 5.5 to
and lumbar spines. However, one-fifth of the subjects had markedly 13.0 mm were found. The experienced observer had overall higher
narrowed discs, which have been associated with symptom history intra observer reliability than the inexperienced observer. Kappa’s
in the lumbar region. The symptomatology of these findings still (−0.05–0.17) and correlation coefficients (−0.12–0.39) showed very
remains unclear and therefore should be studied in the future. Age low validity of all methods as compared to X-ray. The reliability as well
is known to be associated with the overall degeneration and in as validity increased to acceptable levels taking in account only the
this study age explained 9.9% to 15.8% of the variance in disc subjects in which a difference of 5 mm or 8 mm was found by the
signal intensity. IMPLICATIONS: Knowledge of the disc degeneration observers. CONCLUSIONS: This study showed that intra observer
in thoracic spine in the general population offers an important reliability and validity of the 4 tested measurement procedures in
reference for clinical observations. KEYWORDS: thoracic spine, disc a healthy population is rather poor. The intra observer reliability
degeneration and MR imaging. FUNDING ACKNOWLEDGEMENTS: and the validity of the methods improve with increasing leg length
The research was supported by grants from the NIH NIAMS discrepancies. IMPLICATIONS: In general measured differences
(R01 AR40857), EURODISC (QLK6-CT-2002-02582), the Finnish less than approximately 0.8 cm should not have any clinical or
Academy, the Alberta Heritage Foundation for Medical Research, the therapeutic consequences. KEYWORDS: measurements, validity,
Alberta Provincial CIHR Training Program in Bone and Joint Health, reliability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
and the Helsingin Sanomat Centennial Foundation. CONTACT: [email protected]
[email protected] ETHICS COMMITTEE: Ethics committee of hospital Medisch
ETHICS COMMITTEE: Ethical Committee of the Department of Spectrum Enschede, The Netherlands
Public Health, University of Helsinki, and the University of Alberta.
A RANDOMISED CONTROLLED TRIAL COMPARING GRADED FUNCTIONAL DEFICITS AFTER SURGICAL HIP DISLOCATION
EXERCISE TREATMENT WITH USUAL PHYSIOTHERAPY FOR Luder G, Rocourt M, Deschner G, Radlinger L; Research
PATIENTS WITH NECK PAIN Physiotherapy, University Hospital Berne, Switzerland
McLean S1,2 , Klaber Moffett J1 , Sharp D1,2 , Gardiner E1 ; 1 Institute PURPOSE: The aim of this study was to characterise the deficits
of Rehabilitation, University of Hull; 2 Hull and East Yorkshire concerning functional aspects of gait, stair climbing and standing
Hospitals NHS Trust balance after surgical hip dislocation (SHD). In addition the pain and
PURPOSE: Neck pain is a prevalent musculoskeletal condition, disability were investigated and compared with functional capacity.
however research into management of neck pain is sparse. There RELEVANCE: After SHD the person walks with reduced weight-
is little good quality evidence to support the use of exercise bearing for 8 weeks. For physiotherapists it is important to know which
programmes as a way of treating neck pain. Additionally there is little functional deficits occur after such a period. The knowledge about
evidence identifying variables which predict outcome of neck pain functional and subjective deficits of persons after surgery will help to
following treatment. The primary aim of this study was to investigate establish an adequate therapy. PARTICIPANTS: This cross-sectional
the effectiveness of a graded neck and upper limb exercise prospective study involved a total of 91 persons: three months after
programme compared with usual physiotherapy. The second aim was SHD (G3, n=29, 28.1±5.8 years, 76.7±17.1 kg), 12 months after
to investigate which patient psychological, sociodemographic and SHD (G12, n=28, 30.1±5.1 years, 80.4±15.7 kg) and a healthy
physical variables were predictive of outcome following intervention. control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg). METHODS:
RELEVANCE: Clinicians are unable to predict which patients are The following measurements have been performed: ground reaction
likely to develop recurrent,persistent or chronic neck pain. They forces (GRF) in gait and stair climbing, time-distance-parameters
also have difficulty directing patients towards the most effective in gait, standing balance, questionnaires for pain, disability and
treatment approaches. This study will help to address these gaps performance (SMFA-D and COPM). ANALYSIS: From the GRF-
in knowledge. PARTICIPANTS: 151 adult neck pain patients were curves force and time parameters were detected. For standing
selected from the waiting list of 4 NHS physiotherapy departments balance the area of centre of pressure (COP) was calculated. From
in the United Kingdom to participate in this randomised controlled the SMFA-D indexes of function and disability were calculated (0 =
trial. Patients were randomised to one of two interventions; 1) best, 100 = worst), as well as COPM performance and satisfaction
graded exercise treatment (GET) or 2) usual physiotherapy (UP). (10 = best, 1 = worst). Descriptive statistics and group differences
Patients were stratified according to treatment centre and neck pain (nonparametric: Kruskal-Wallis-H, post-hoc: Mann-Whitney-U) were
disability score. METHODS: At baseline, patients completed a series computed using SPSS. RESULTS: GRF-parameters on stair in G3
of self administered questionnaires relating to neck pain, upper limb were lower for Fz2 and higher for t2 and thus the loading rate was
disability, psychological, sociodemographic and clinical variables. lower compared to G0 in ascent and descent. For G12 similar values
Following treatment patients were followed up at 6 weeks and 6 as G0 were found except for Fz2 and Fz3 in ascent. Gait velocity was
months using postal questionnaires. The primary outcome measure similar in all groups, while relative stance phase showed a tendency
was the Northwick Park Neck Pain Questionnaire (NPQ). ANALYSIS: to increase for G3 and G12. For standing balance no significant
Repeated measure ANOVAs were used to test for differences on differences were found in the area of the COP. SMFA-D showed a
outcome measure between the graded GET group and UP group function-index for G3 of 19.7, for G12 of 12.3 and for G0 of 2.3 and
at each time point. ANCOVA, using general linear models, was a disability-index for G3 of 14.6, for G12 of 12.5 and for G0 of 1.
used to test the influence of baseline variables on NPQ score at All differences were highly significant. Similar significant differences
6 month follow-up. RESULTS: After 6 months both interventions were found in the COPM, where performance and satisfaction in
reduced neck pain by a clinically significant amount (GET 5%; G3 were 5.9 respectively 5.6 and in G12 7.1 respectively 6.2
UP 7.7%)(p = 0.013). There was no significant difference between compared to G0 with 9.7 respectively 9.6. Furthermore most of all
GET and UP (p = 0.317). After adjusting for baseline NPQ scores and persons after SHD mentioned pain in some daily-life-activities, such
intervention type, general linear modelling identified that regardless as longer walking or standing and stair climbing. CONCLUSIONS:
of intervention, deprivation status (p = 0.002) significantly predicted The functional measurements showed clear differences between the
treatment outcome at 6 months. Baseline fear avoidance beliefs groups only in stair climbing, whereas the other tasks might have
scores and intervention type interacted to predict 6 month outcome been too less demanding to find differences. However both exper-
such that patients with higher than average fear avoidance beliefs imental groups showed in the questionnaires clearly less function,
were predicted to have better outcome following GET intervention. performance and satisfaction and more disability and pain in daily-
Those with lower than average fear avoidance beliefs were predicted life. IMPLICATIONS: Persons after SHD showed clear deficits in the
to have better outcome following the UP intervention (p = 0.011) subjective perception of pain and function, but these findings were not
CONCLUSIONS: This study provides preliminary evidence that confirmed by the functional measurements we performed. Functional
graded neck and upper limb exercise and usual physiotherapy are measurements for assessment in physiotherapy should be more
effective methods of managing neck pain. GET appears to be adapted to daily-life problems, i.e. with higher impacts or physical
particularly beneficial for patients exhibiting higher than average fatigue. KEYWORDS: Immobilisation, Functional deficits, Functional
levels of associated fear avoidance beliefs. UP appears to be assessment. FUNDING ACKNOWLEDGEMENTS: Swiss Associ-
more beneficial for neck pain patients with lower than average ation of Physiotherapy, Switzerland. CONTACT: gere.luder@fisio-
levels of associated fear avoidance beliefs. IMPLICATIONS: Graded burgernziel.ch
neck and upper limb programmes are a viable form of treating ETHICS COMMITTEE: The study was approved by the Ethics
patients with neck pain, particularly if they have high levels of committee of Canton Berne, Switzerland
fear avoidance beliefs. These findings indicate that neck pain
patients should be assessed for the presence of fear avoidance
beliefs. KEYWORDS: neck pain, physiotherapy intervention, predic-
tors. FUNDING ACKNOWLEDGEMENTS: Hull and East Yorkshire
Hospitals NHS Trust, Arthritis Research Campaign. CONTACT:
[email protected]
ETHICS COMMITTEE: Multi-centre research ethics approval from
Hull and East Riding Research and Ethics Committee
CHALLENGES FACED BY CAREGIVERS OF CEREBRAL EFFECTS OF AQUATIC RESISTANCE TRAINING ON KNEE
PALSIED CHILDREN ATTENDING THE DR G MKHARI EXTENSOR-FLEXOR MUSCLE POWER, TORQUE AND
HOSPITAL,GAUTENG PROVINCE-RSA IN PERFORMING A MOBILITY AFTER TOTAL KNEE ARTHROPLASTY
HOME PROGRAM Pöyhönen T1 , Valtonen A1 , Sipilä S2 , Heinonen A2 ; 1 Rehabilitation
Taukobong N, Mwenya J, Mukansoneye M, Sebuyi T; UNIVERSITY and Pain Unit, Central Hospital of Kymenlaakso, Kotka, Finland;
OF LIMPOPO-MEDUNSA CAMPUS,RSA 2 Department of Health Sciences, University of Jyväskylä, Finland
PURPOSE: During follow up vists at the Dr. George Mkhari PURPOSE: This randomised controlled clinical trial was conducted
hospital Cerebral Palsy(CP)clinic, caregivers are ussually requested to investigate the effects of a progressive 12-week aquatic resistance
to demonstrate the child’s home program as part of re-assessment. training on knee extensor and flexor muscle power, torque and mo-
Most of them fail to do so hence the purpose of this study was bility in persons with unilateral total knee arthroplasty. RELEVANCE:
to determine the factors that affect the caregivers retention and Knee replacement reduces pain but also causes knee extensor and
performance of the physiotherapy home program for a child with flexor muscle weakness in the operated leg. This often results in lower
CP. RELEVANCE: Effectiveness of a physiotherapy home program mobility, especially severe difficulties in ascending stairs and standing
depends on the caregivers ability to retain and reproduce a set up from the chair. Aquatic physiotherapy has beneficial effects in
of exercises and handling activities.Failure to perform an effective persons with joint diseases but the effects of aquatic training after
home program lead to unattainable therapy goals and development total knee arthroplasty have been poorly studied. PARTICIPANTS: 51
of complications which could have been prevented. PARTICIPANTS: volunteers (31 women and 20 men, 55-75 years old) with unilateral
A group of 30 caregivers of CP children under the age of 5years, knee replacement 9.5±4.4 months postsurgery were recruited from
who had attended the clinic for at least three consecutive times, the hospital records. They were randomly assigned into aquatic
constituted the sample for the study. All caregivers who did not meet exercise group (N=26) which conducted a 12-weeks progressive
the set criteria were excluded from the study. METHODS: Ethical aquatic training and control group (N=25) METHODS: Maximal knee
clearance was obtained from the university of Limpopo research, extensor and flexor power and torque of the operated and non-
ethics and publications commitee. A permission to conduct the study operated legs were measured isokinetically at constant angular
at the hospital was granted by the superintendent. Consent was velocities of 60 and 180degs-1. In addition, maximal stair ascending
also obtained form participants following a thorough explanation of and repeated sit-to-stand times were measured. ANALYSIS: The
the objectives of the study.Descritive survey was conducted using a effects of the aquatic training were assessed using ANOVA for
structred interview utilizing a self contructed questionnaire. Aspects repeated measures. RESULTS: At 12 weeks, knee extensor and
covered were ability to perform home program in the abscence of flexor power improved significantly in the aquatic exercise group
a physiotherapist, daily routine activities, family support, confidence compared to the control group, the differences being 30% (p < 0.001)
and anxiety level when doing the activities at home. ANALYSIS: and 34% (p < 0.001), respectively. Significant difference in change
Descriptive statistics using frequency distributions was conducted between the aquatic training group and control group was seen for
to analyze the data which was then represented in histograms, 60degs-1 torque of the knee extensors and flexors, 12% (p = .011)
pie-charts and tables for ease of intepretation with the help of and 18% (p = .009), and for 180degs-1 torque 14% (p < 0.001)
a statistician. RESULTS: Only female caregivers participated in and 36% (p < 0.001), respectively. In addition, the exercise group
the study and their age ranged from 15yrs to 45yrs.70% of them improved stair ascending 14% (p = .002) and sit-to- stand test time
were single parents and only 13% were employed.Only 46.7% felt 17.5% (p = .008) compared to controls. CONCLUSIONS: The results
that the home program interferred with thier daily routine.23% felt showed that 12 weeks of progressive aquatic resistance training
confident when performing the activities whilst 60% become very resulted in significant improvement in muscle power and torque
anxious during the performance of a home program. Only 40% of the knee extensors and flexors accompanied with improvement
received support from the other family members during activities.All in mobility. IMPLICATIONS: Progressive aquatic resistance training
partcipants reflected an understanding of the importance of carrying can be recommended after major knee surgery such as total
through the physiotherapy home program. CONCLUSIONS: The knee replacement. KEYWORDS: hydrotherapy, knee replacement,
main challenges faced by caregivers of CP children attending the older. FUNDING ACKNOWLEDGEMENTS: State’s Special Share
CP clinic at the Dr. George Mkhari hospital are increased level Funds of Kymenlaakso Hospital District, Kotka, Finland. CONTACT:
of anxiety when performing the home program and lack of family tapani.poyhonen@kymshp.fi
support. IMPLICATIONS: Caregivers have an extremely tough life ETHICS COMMITTEE: Ethics committee of Kymenlaakso Hospital
dealing with a child diagnosed with CP(Brinchmann:1999)and this District, Kotka, Finland
may lead to increase in their anxiety level which, when not attended
to, will affect the progress of the child’s rehabilitation.Therefore a form
of counselling should be provided for all caregivers attending the CP Research Report Platform Presentation
clinic.Involvement and support of the family is important in guiding 3154 Sunday 3 June 12:05
the caregiver to carry out the home program(Granet et al:2002) and VCEC Meeting Rooms 19-20
visits by more than one member of the family to the clinic should be TRENDS IN LOWER EXTREMITY POWER ACROSS THE
allowed and introduced to encourage family involvement and support LIFESPAN IN WOMEN. A PILOT STUDY
at all times. KEYWORDS: Challenges; Caregivers; home program.
FUNDING ACKNOWLEDGEMENTS: The project was not funded. Newstead A1 , Korff T2 , Jensen J3 ; 1 University of Texas Health
ETHICS COMMITTEE: University of Limpopo Research, Ethics and Science Center at San Antonio; 2 Brunel University, West London,
Publication Commitee(REPC) England; 3 University of Texas at Austin
PURPOSE: Success in basic posture and locomotor tasks is directly
related to muscular power, especially when a rapid response is
required (e.g. increased speed). In this pilot study we used speed
as an independent variable to challenge limits of performance to
describe the trend in lower extremity power across the lifespan.
RELEVANCE: As we age, the lower extremity force and power
losses associated with aging leads to reduction in performance
of functional task skills (e.g. stair climbing), and therefore a to investigate whether thoracic multifidus/rotatores and longissimus
loss of independence, increased disability and reduced quality of thoracis are differentially active during arm movements, and to
life. PARTICIPANTS: Participants were moderately active, healthy, compare muscle activity between thoracic regions(T5, T8, T11).
community dwelling adult women (average of 3-6 METS per day): RELEVANCE: Evidence of differential function between deep and
younger (G1: 29.8±5.7y; n=5), middle-aged (G2: 50.4±3.5y; n=5) superficial muscles in the lumbar and cervical spines have facilitated
and older women (G3: 72.3±2.5y; n=2). METHODS: Lower extremity the development of effective exercise rehabilitation programs for
peak power delivered to the crank during the downstroke (0-1800), people with back and neck pain. Clinical approaches for people with
was determined during repeated bouts of pedaling at incremental thoracic pain are currently based on extrapolation from studies in
cadences between 60 and 120 revolutions per minute (rpm) at those regions. Studies of thoracic muscle function are needed to
15% peak predicted power. While reduction in power production guide treatment. PARTICIPANTS: Ten volunteers (five males, five
is consistently observed in older adults (>65 yrs), the working females) without history of spinal pain, any neurological condition, or
hypothesis was that power production decrements would be evident participation in asymmetric sport at a competitive level participated
earlier in the lifespan. Thus, it was expected that peak power in the study. METHODS: Recordings of electromyographic(EMG)
production during the downstroke would be greatest in G1 compared activity of the right deep (multifidus/rotatores) and superficial
to G2 compared to G3. We anticipated that timed stair climb (TSC) (longissimus thoracis) paraspinal muscles at T5, T8, and T11 were
would be inversely related to power production with increased age. made with fine-wire electrodes. Subjects performed fast bilateral and
ANALYSIS: Descriptive analyses were used to depict participants unilateral flexion and extension of both arms in response to a light.
and power production. A regression analysis was used to compare ANALYSIS: Raw data was displayed randomly to visually identify
the relationship of power for each group to functional timed stair onsets of deltoid EMG. EMG amplitude of the trunk muscles was
climb, and timed stair climb to age. RESULTS: Consistent with calculated during 25 ms intervals for 150 ms before and 400 ms after
our expectation, peak power during the downstroke for 60, 80, and the onset of deltoid EMG. EMG amplitude was normalised to the peak
100 rpm cadences was greatest for G1 (with reduced peak power activity during tasks and was compared between conditions using a
production for G2. Expectedly, G3 produced smaller peak powers repeated measures MANOVA. RESULTS: Multifidus and longissimus
compared to G2. This relationship held up for the 120 rpm condition, had similar responses to bilateral arm flexion movements (two bursts
but the comparison was limited to G1 and G2 (G1 > G2) because of activity, the first burst initiated prior to deltoid EMG onset), and
not all members of G3 could consistently perform at 120 rpm. to bilateral arm extension movements (one burst after deltoid EMG
Specifically, peak total crank power (Pcrank; unitless) delivered to onset). Although similar in these features of the response, the
the pedal during the downstroke (0-1800) was least for G3 (3.55) at muscles were differentially active during unilateral arm movements
60 rpm than both G2 (3.66±0.40) and G1 (4.23±0.60); at 80 rpm depending on the direction of trunk rotation that was induced by
Pcrank was increased for all groups (Gp3=3.75; Gp2=4.55±0.47; the arm movement. Longissimus EMG was greater with left arm
G1=4.55±0.47), as well as at 100 rpm (G3=4.71; G2=4.94±0.72; flexion (induced left trunk rotation) than with right arm flexion (induced
G1=5.93±0.91). At 120 rpm, different results were found, and one right trunk rotation)(p < 0.03). Multifidus showed the opposite pattern
participant could not achieve the 120 target cadence (G3=5.48 (p < 0.04). There were no differences in the response of the muscles
[n=1]; G2=4.48±0.81; G1=5.89±0.85). G3 demonstrated the slowest between thoracic regions (T5, T8, T11)(p = 0.98). CONCLUSIONS:
time to complete the stair climb (22.9±0.8s) compared with both Thoracic multifidus and longissimus are similarly active in response
G2 (15.9±1.7s) and G1 (12.3±1.4s). A linear regression revealed to sagittal plane perturbations of the trunk, but are differentially active
a strong inverse relationship between timed stair climb and age during movements which induce rotation around the vertical axis
(R2=0.80), and a weak relationship between timed stair climb and in addition to the sagittal plane perturbation. These findings are
pedaling power during the downstroke was demonstrated (R2=0.04- consistent with anatomical data suggesting that the muscles control
0.34). CONCLUSIONS: Our preliminary findings support the ex- opposite rotational torques. IMPLICATIONS: These data suggest
pectation of ‘mid-life’ declines in power production limits – despite that specific exercises may be required to differentially train the
the characteristics of moderately active women. IMPLICATIONS: deep and superficial thoracic muscles. In lumbar and cervical spine
Designing intervention programs that include power production pain there are impairments in function of the deep muscles; further
strategies are needed to reverse lower extremity power losses earlier studies in patients with thoracic pain are required to investigate
in life. KEYWORDS: power, stair climb, lifespan, women, cadence. whether changes in function of the deep and/or superficial muscles
FUNDING ACKNOWLEDGEMENTS: * The research was supported occur in this region of the spine. KEYWORDS: thorax, stability,
by the National Science Foundation under Grant No. 9986221. electromyography. FUNDING ACKNOWLEDGEMENTS: Linda-Joy
CONTACT: [email protected] Lee is supported by the Canadian Institutes of Health Research
ETHICS COMMITTEE: University of Texas Health Science Center at (CIHR). Paul Hodges is supported by the National Health and Medical
San Antonio, University of Texas at Austin, Brunel University Research Council of Australia. Michel Coppieters is supported by the
University of Queensland. CONTACT: [email protected]
ETHICS COMMITTEE: Medical Research Ethics Committe of the
Research Report Platform Presentation University of Queensland
PP Crystal Pavilion A
DIFFERENTIAL ACTIVITY OF THE DEEP & SUPERFICIAL
THORACIC PARASPINAL MUSCLES DURING CHALLENGES TO 507 Sunday 3 June 12:45
SPINAL STABILITY & POSTURAL EQUILIBRIUM PP Crystal Pavilion B & C
Lee L, Coppieters M, Hodges P; Division of Physiotherapy, School CROSS-CULTURAL ADAPTATION OF THE DASH
of Health and Rehabilitation Sciences, University of Queensland, QUESTIONNAIRE: PUERTO RICAN VERSION
Brisbane, Australia Mulero A, Colón Santaella C, Cruz C; Department of Graduate
Programs, College of Health Related Professions, Medical Sciences
PURPOSE: The thorax is an important region of load transfer
Campus, University of Puerto Rico
between the upper and lower body. However, little is known about the
strategies used by the nervous system to control mobility and stability PURPOSE: The purpose of this study was to translate into Spanish
of the thorax. Fast voluntary arm movements are an established and culturally adapt for Puerto Rico the Disabilities of the Arm,
method to challenge spinal equilibrium and stability. This study aimed Shoulder and Hand (DASH) questionnaire (McConnel, Beaton and
to determine whether anticipatory activity of the thoracic paraspinal Bombardier, 1999). The questionnaire had already been translated in
muscles is associated with bilateral and unilateral arm movements, Spain. However, a pretest of that version, followed by probing various
health professionals, raised concerns in the meaning and terminology the nerve). Since this elongation may be associated with deleterious
used in some items. Therefore, the need for a cross-cultural strain in the median nerve with the risk of symptom exacerbation and
adaptation was established. The DASH questionnaire is a self- reduced benefits from nerve gliding, we aimed to identify exercises
report measure on physical and social role function. It includes two which are associated with a substantial longitudinal excursion but
additional modules, which measure function at work, in sports, and result in a minimal increase in nerve strain. PARTICIPANTS: Six
performing arts. RELEVANCE: The DASH questionnaire is a self- intact embalmed cadavers were used for this study (5 males, 1
report measure on physical and social role function. It includes two female; age at time of death between 65 and 92 years). METHODS:
additional modules, which measure function at work, in sports, and Longitudinal excursion (digital calliper) and strain (differential variable
performing arts. PARTICIPANTS: The pilot test was performed with a reluctance transducer) were measured in the median nerve at the
nonprobability sample of 32 normal subjects (13 males, 19 females; wrist during six mobilisation techniques involving the wrist and elbow:
age range = 21-75 years). METHODS: The recommendations for (1) a ‘sliding technique’ (simultaneous movement at two joints in
the Cross-Cultural Adaptation of Health Status Measures by the which one movement loaded the peripheral nerve (wrist extension)
American Academy of Orthopaedic Surgeons (Beaton, Bombardier, while the other movement concurrently unloaded the nerve (elbow
Guillemin & Ferraz, 2002) were followed. A translation of the flexion)); (2) a ‘tensioning technique’ (combined movement resulting
questionnaire from the U.S.-English into Puerto Rico-Spanish was in a concurrent increase in length of the median nerve bed at two
made by two independent translators who are native speakers. joints (wrist and elbow extension)); (3-4) wrist extension with the
This was followed by an integration of the two forward translations elbow in flexion and in extension; and (5-6) elbow extension with
into one Spanish version. This Spanish version was back-translated the wrist in neutral and in extension. Techniques were performed in
into English by two independent translators, native U.S.-English random order. ANALYSIS: A one-way repeated-measures analysis
speakers. An expert committee composed of translators, an expert of variance was conducted with Duncan’s tests for post-hoc analysis.
in methodology, a linguist, and health professionals discussed the The level of significance was set at p < 0.05. RESULTS: Although
discrepancies of the four versions (two in Spanish and two in English) all techniques resulted in nerve gliding at the wrist (p 0.006),
and produced a final version to be pilot tested. The expert committe’s there were significant differences in the amount of nerve gliding
goal was to achieve semantic, idiomatic, experiential and conceptual between different techniques (p < 0.00001). The excursion associated
equivalence between the English and Spanish versions. ANALYSIS: with the ‘sliding technique’ (12.4 mm) was at least 30% larger
A pilot study was conducted to evaluate the interpretation of the than the nerve movement in any of the other techniques (2.9-8.9
items on the questionnaire. During the pilot test, the Puerto Rico- mm) (p 0.0002). Strain in the median nerve also differed strongly
Spanish DASH version was administered individually, followed by between techniques (p 0.00001), with the lowest values for the
a structured interview to probe the understanding of each item. ‘sliding technique’. CONCLUSIONS: The findings confirm the clinical
Both the meaning of the items and responses were explored. The assumption that a ‘sliding technique’ results in a large longitudinal
distribution of responses was examined to look for a high proportion excursion and that the increase in nerve strain due to nerve bed
of missing items or single responses. If two or more subjects reported elongation at one joint (e.g., wrist extension) can be counterbalanced
difficulty with understanding an item, that item was revised with the by a simultaneous decrease in the length of the nerve bed at an
expert in linguistics and the research methodologist for reformulation. adjacent joint (e.g., elbow flexion). Substantial differences in the
RESULTS: The final version of the Puerto Rico-Spanish DASH ques- amount of nerve gliding and strain highlighted that different types of
tionnaire was submitted for appraisal and received full approval of nerve gliding techniques should not be regarded as a homogenous
the American Academy of Orthopaedic Surgeons. CONCLUSIONS: group of exercises. IMPLICATIONS: Different types of nerve gliding
The Puerto Rico-Spanish DASH questionnaire is published in exercises have largely different mechanical effects on the median
the official DASH Outcome Measure website, sponsored by the nerve. This may have important implications for the selection of
Institute for Work & Health of Canada and the American Academy effective and safe exercises in the treatment of CTS. A ‘sliding
of Orthopaedic Surgeons (http://www.dash.iwh.on.ca/translate.htm). technique’ may be more biologically plausible in the early stages of
IMPLICATIONS: The availability of a functional evaluation translated rehabilitation than currently advocated exercises which induce nerve
and culturally adapted for the Spanish-speaking population in Puerto gliding by elongation of the nerve bedding. KEYWORDS: carpal
Rico advances patient care, as valid and reliable data can be col- tunnel syndrome; neurodynamics; nerve gliding exercises. FUNDING
lected when examining upper extremity function. KEYWORDS: upper ACKNOWLEDGEMENTS: The study was supported by an Early
extremity function; cross-cultural adaptation; health status measure. Career Research grant from The University of Queensland, St Lucia
FUNDING ACKNOWLEDGEMENTS: NIH NIGMS/MBRS SCORE (Brisbane), Australia. CONTACT: [email protected]
S06 GM008224 support. CONTACT: [email protected] ETHICS COMMITTEE: Anatomy Ethics Committee, School of
ETHICS COMMITTEE: Institutional Review Board, Medical Sciences Biomedical Sciences, The University of Queensland
Campus, University of Puerto Rico
1718 Sunday 3 June 12:45 PP Crystal Pavilion A
VCEC Ballroom A DEVELOPMENT OF A MOBILISATION DYNAMOMETER FOR
LONGITUDINAL EXCURSION AND STRAIN IN THE MEDIAN APPLYING CONTROLLED FORCES IN THE MANUAL THERAPY
NERVE DURING NOVEL NERVE GLIDING EXERCISES FOR CLINICAL SETTING
CARPAL TUNNEL SYNDROME Lau G1 , Waddington G2 , Adams R1 ; 1 School of Physiotherapy,
Coppieters M, Alshami A; Division of Physiotherapy, School of University of Sydney, Sydney, AUSTRALIA; 2 School of Health
Health and Rehabilitation Sciences, The University of Queensland, Sciences, University of Canberra, Canberra, AUSTRALIA
St Lucia (Brisbane), Australia
PURPOSE: To create a clinically suitable mobilising dynamometer
PURPOSE: To measure longitudinal excursion and strain in the (MobDyn) that generates force readouts that give control of applied
median nerve at the wrist during various types of nerve gliding force and enable treatment-to-treatment monitoring of changes in
exercises for carpal tunnel syndrome (CTS). RELEVANCE: Nerve the amount of pressure needed for pain response. Further, an
and tendon gliding exercises are widely recommended in the ergonomic grip on the device may reduce the risk of hand and
conservative and postoperative management of CTS. However, wrist work-related musculoskeletal disorders (WMSD) in the practice
traditionally advocated exercises induce nerve gliding by elongation of manual therapy. RELEVANCE: High volume of manual therapy
of the nerve bed (the tract formed by the structures that surround work stresses the structures of the hands and wrists, and can lead
to WMSD, and possibly to injuries that force therapists to leave results were used to refine a structured questionnaire sent to
their profession. Hence, a mobilising tool with instant force readout, survey participants. The questionnaire included space for comments.
that can reduce hand injury risk and provide a way of gauging Two follow up mail outs were done. ANALYSIS: Focus groups
patient progress between sessions, is needed. PARTICIPANTS: were analysed using an inductive approach allowing patterns and
36 healthy physiotherapy students who had passed courses on categories to emerge. The independent variable for the survey data
spinal mobilisation techniques. All subjects had no history of hand was ‘Use of back related COM’. Nominal data was analysed using the
or back pain three months prior to testing, and were recruited Chi squared test. A factor analysis of a 23 part Likert scale question
via advertisements at University of Sydney, Faculty of Health provided six new variables. These were analysed using independent
Sciences. METHODS: All testing was performed in pairs, where t tests or Mann Whitney U. Finally a multivariate logistic regression
one subject assumed the role of the simulated-therapist whilst analysis was performed. RESULTS: Key themes emerging from the
the other was the simulated-patient. The independent variables focus groups related to methods currently used for assessment and
were spinal segment (T6 and L3), method of force application measurement and perceived barriers to COM. These themes were
(Pisiform grip and MobDyn), and grade of mobilisation (Grades I, incorporated into the questionnaire. The mail survey achieved a 69%
II, and III). Posteroanterior mobilisation forces were standardised response rate and showed NZ physiotherapists use improvements in
by use of a force plinth with force display for feedback. After each individual functional activities as their main outcome measure. Only
combination has been performed, both subjects rated their hand 30% used back related COM in their practice. Statistically significant
and back comfort respectively on a 10 cm visual analogue scale factors determining use of COM in the multivariate analysis were an
(VAS). ANALYSIS: A 2 x 2 x 3 analysis of variance was used to increased level of knowledge of outcome measurement p = 0.001; OR
determine significance and interactions between the independent = 1.75 (95% CI 1.45-2.09) and having a Masters degree p = 0.053;
variables spinal segment, method of force application, and grade OR 2.50 (95% CI 0.98-6.36). Lack of time, frequently mentioned as an
of mobilisation in terms of rated back comfort and hand comfort. excuse did not reach statistical significance p = 0.19, OR 1.11 (95% CI
RESULTS: Back comfort with tool mobilisation was significantly 0.94-1.30). Free text survey responses included concerns that COM
less comfortable than hand mobilisation (p < 0.001, mean = 14 ‘invite recipe orientated practice’. CONCLUSIONS: COM for routine
mm, 95% CI 7.6–20.8 mm on a 100 mm VAS), and back comfort treatment of LBP are not widely used by NZ physiotherapists. Conflict
decreased as the grade of mobilisation increased from Grade I existed between beliefs patients were individuals and treatments
to Grade III (p < 0.001, mean = 27 mm, 95% CI 19.5–34.5 mm) should be patient centred, versus the emphasis on COM and ‘recipe’
regardless of the method of force application. Because the difference approaches to treatment. However logistic regression modelling
between the hands and the tool was approximately half the discomfort explained only 22% of variability in COM use. Further research is
experienced as grade was increased from Grade I to Grade III, needed to identify other factors that may be involved, for example
this difference in comfort was deemed to be acceptable. Hand the degree of acceptance of evidence-based practice and what
comfort, also decreased as grade increased (p < 0.001, mean = role funding bodies play in directing routine use of COM by NZ
20, 95% CI 13.5–27.2 mm), but the method of force application physiotherapists. IMPLICATIONS: Knowledge emerged as the main
was not significant (p = 0.199). CONCLUSIONS: The MobDyn has factor influencing use of COM and this could be addressed by future
been found to be acceptably comfortable at the hands, with education initiatives. The low level of use may indicate that standard
an acceptable level of patient comfort. It can now be used in COM for LBP do not meet the needs of busy clinicians who see
research in physiotherapy clinics. IMPLICATIONS: The mobilising predominately acute presentation LBP patients and are expected to
dynamometer warrants further testing regarding use in manual treat them in a few visits. KEYWORDS: Clinical outcome measures;
therapy for the prevention of hand and wrist WMSD. Further testing Low back pain; Physiotherapy. FUNDING ACKNOWLEDGEMENTS:
is necessary by therapists who are getting hand pain, and with Wellington Branch of New Zealand Society of Physiotherapists Inc. –
patients experiencing back pain. KEYWORDS: Manual therapy, Tool. Searchwell Grant. CONTACT: [email protected]
FUNDING ACKNOWLEDGEMENTS: Neither the candidate nor the ETHICS COMMITTEE: University of Otago Human Ethics Commit-
supervisors on this research project have any financial interest tee, University of Otago, PO Box 56, Dunedin, New Zealand
involved. CONTACT: [email protected]
ETHICS COMMITTEE: Human Research Ethics Committee, Univer-
sity of Sydney Research Report Platform Presentation
VCEC Ballroom A
AN ALTERNATIVE APPROACH TO TREATING LATERAL
645 Sunday 3 June 13:05 EPICONDYLITIS. A RANDOMIZED, PLACEBO-CONTROLLED,
PP Crystal Pavilion B & C DOUBLE BLINDED STUDY
CLINICAL OUTCOME MEASURES INVITE RECIPE ORIENTATED Nourbakhsh M, Fearon F; North Georgia College and State
PRACTICE University
Copeland J, Taylor W, Dean S; Rehabilitation Teaching and
PURPOSE: Lateral Epicondylitis (LE) is a pathology mainly as-
Research Unit, Department of Medicine, Wellington, New Zealand
sociated with repeated and overload wrist and hand movements.
PURPOSE: Clinical outcome measures (COM) are tools for monitor- Symptoms of LE are attributed to degenerative changes and
ing the effectiveness of interventions over time. This study examines inflammatory reactions in the common extensor tendon induced by
factors influencing their use by New Zealand (NZ) physiotherapists microscopic tear in the tissue after repetitive or overload functions
when treating low back pain (LBP). RELEVANCE: Treatment of of the wrist and hand extensor muscles. Conventional treatments,
LBP forms an important component of musculoskeletal physiotherapy provided for reducing soft tissue inflammation, have shown 39 to
practice. However physiotherapists often struggle to convince funders 80% failure rate. An alternative approach suggest that symptoms
their treatment is evidence-based and cost-effective in producing of LE could be due to active tender points developed in the origin
long term sustainable outcomes. PARTICIPANTS: Participants were of hand and wrist extensor muscles after overuse or repetitive
NZ physiotherapists. Purposeful sampling was used for two focus movements. Based on this hypothesis, the purpose of this study
groups, one in a private practice (N=6) and one in a public hospital was to investigate the effect of localized tender point treatments
(N=6). A mail survey was then sent to all private practices listed with Neuroprobe on pain, grip strength and functional abilities of
on a telecommunication database, and public hospital physiotherapy subjects with chronic lateral epicondylitis. RELEVANCE: Clinical
outpatient departments. METHODS: This cross sectional study relevance: Interventions with emphasis on tender point treatments
employed two data methods: focus groups were conducted and could provide an effective alternative treatment for symptoms of
chronic LE. PARTICIPANTS: Eighteen subjects participated in this were provided to subjects during training to apply specific grade
study. A number of subjects had bilateral symptoms, thus a total of mobilization in feedback groups either concurrently or terminally
of 24 cases of chronic lateral epicondylitis were included. Prior via a monitor. The control group received no quantitative feedback
to their participation, all subjects were screened by an orthopedic during the training. Pretest and no-feedback retention tests were
clinical specialist to rule out cervical and other pathologies that could conducted by using the same joint model as was used during
possibly contribute to their lateral elbow pain. Subjects who met training. A novel joint model was also implemented during the
the inclusion criteria were randomized into treatment and placebo retention tests to investigate the effect of transference of learning.
treatment groups by a second (treating) therapist. Subjects and ANALYSIS: Effects of grouping, grade of mobilization and learning
the screening therapist were blinded to the group assignment. on performance (mean normalized error ‘NE’) were assessed by
METHODS: Subjects in the treatment group received six sessions three-way ANOVA with repeated measures for data obtained from
of Neuroprobe treatments. Subjects in the placebo group received the resting position and the end position models. Tukey’s test was
the same treatment with the Neuroprobe, except the intensity of the used for post hoc comparisons. The a value was set at 0.05.
electrical stimulation was kept at zero during the whole placebo- RESULTS: During acquisition and retentions, both feedback groups
treatment session. Jamar Dynamometer, Patient Specific Functional showed smaller NE than did the control group (p < 0.01 for all
Scale (PSFS) and Numeric Rating Scale (NRS) were used to grades of mobilization in all models tested). No difference in NE
measure grip strength, functional status, pain intensity and pain was found between the terminal feedback group and the concurrent
limitation respectively. The screening therapist who was blinded to feedback group during retention. During retention tests significantly
the subjects’ group assignment performed pretest, posttest and six- less NEs was found in the novel models than those of the pretest
months follow up measurements. ANALYSIS: We used Repeated (p < 0.01 for any grade of mobilization in any model) indicating a
Measure analysis for within goup and used Multivariate Analysis of positive transfer of learning in the feedback groups. CONCLUSIONS:
Variance for between group comparisons. RESULTS: Subjects in Less variability, thus more consistency was achieved by using
the treatment group showed both clinically and statistically significant the JTS as a tool for mobilization skill acquisition. Adaptability
improvement in grip strength (P = 0.04), function (P = 0.002), pain or transference of learning was retained immediately and five
intensity (P = 0.001) and pain limitation (P = 0.003) compared days after skill acquisition. However, guidance hypothesis was not
with those in the placebo group. Follow up data showed that supported as the current feedback showed no superior effectiveness
100% of subjects maintained the improved level of function and on improving mobilization skill performance. Learning effects of
83% of the subjects remained pain free for at least six months mobilization can be enhanced either by quantitative concurrent
post treatment. CONCLUSIONS: Symptoms of LE may be due to feedback or by terminal feedback. IMPLICATIONS: The JTS is useful
active tender points that can be effectively treated by Neuroprobe. in learning the perception of mobilization grade forces. KEYWORDS:
IMPLICATIONS: The findings of this study provide strong evidence Physical therapy, Feedback, Learning, Joint mobilization. FUNDING
for an alternative treatment for symptoms of lateral epicondylitis. ACKNOWLEDGEMENTS: This study was supported in part by grant
KEYWORDS: Chronic pain; Lateral epicondylitis; Elbow. FUNDING (NSC 92-2320-B-006-033) from National Science Council, Taiwan.
ACKNOWLEDGEMENTS: This project was not funded. CONTACT: CONTACT: [email protected]
[email protected] ETHICS COMMITTEE: Institutional review board of the National
ETHICS COMMITTEE: IRB committee at Norht Georgia College and Cheng Kung University Hospital
State University
3108 Sunday 3 June 13:25 PP Crystal Pavilion B & C
PP Crystal Pavilion A DEVELOPMENT AND VALIDATION OF THE WHEELCHAIR-
ADAPTABILITY OF LEARNING ON JOINT MOBILIZATION RELATED SELF-EFFICACY SCALE (PORTUGUESE VERSION)
SKILL WITH AUGMENTED FEEDBACK BY USING A JOINT Martins A, Pais Ribeiro J; Faculdade de Psicologia e Ciências
TRANSLATION SIMULATOR da Educação, Universidade do Porto, Portugal
Chang J1 , Chang Chien C2 , Chang G1 , Chung K1 , Hsu A3 ;
1 Institute of Biomedical Engineering, National Cheng Kung PURPOSE: Persons who adjust well to unexpected events, generally
lead healthy, active and happy lives after injury but those with
University, Tainan, Taiwan; 2 Department of Electrical Engineering,
negative acceptance have a harder time accepting their changes
National Cheng Kung University, Tainan, Taiwan; 3 Department of
in appearance and have difficulty in coping. Studies showed that
Physical Therapy, National Cheng Kung University, Tainan, Taiwan
a person’s confidence in being able to perform a behaviour (self-
PURPOSE: Joint mobilization is a complicated task to teach and efficacy) is a good predictor of social participation and is an
learn and is characterized by great inter-subject and inter-session area to target in future physiotherapy contexts. Relationships have
variability. With the use of a joint translation simulator (JTS) been established between self-efficacy and a variety of functional
capable of simulating behavior of joints with varying stiffness, the measures, including those of balance, instrumental activities of
present study was implemented to investigate effects of training daily living, and exercise adherence. As no specifically instrument
with augmented concurrent or terminal feedbacks on enhancing the designed to measure wheelchair users perception of self-efficacy
perception of specific grade of mobilization, more specifically, on the existed, we developed the Wheelchair-Related Self-Efficacy Scale
effect of transference of learning to joint models of different stiffness. and tested its psychometric properties. RELEVANCE: Intervention
RELEVANCE: The JTS simulates 1-D joints with different stiffness programs over few weeks are probably insufficient to achieve
and provides quantitative feedback for learning specific grades significant changes in impairments, activity limitations and restrictions
of joint mobilization. PARTICIPANTS: Thirty-six undergraduate on participation with well-established chronic conditions, but clients
physical therapy students were randomly assigned into control, who are efficacious continue to perform desired behaviours learned
concurrent feedback, and terminal feedback groups. Each subject in treatment after they are discharged. A better understanding of
read and signed an informed consent. The experimental protocol wheelchair users’ self-efficacy beliefs could help physiotherapists
was approved by the institutional review board of the National develop interventions that are effective in altering their clients’
Cheng Kung University Hospital. METHODS: The JTS was designed confidence, reason to choose this personal factor as a primary
and developed to simulate tissue resistance against displacement outcome measure. PARTICIPANTS: Seventy three adults aged 18
based on load-displacement relations derived from material property to 77 years with mobility impairment severe enough to require the
testing of glenohumeral joint specimens. Quantitative feedbacks continuous use of a wheelchair, who attended physiotherapy services
from central regions of Portugal (68.5% from Coimbra district) took limb reaction time, upper limb speed of movement, pain severity
part. METHODS: An extensive literature review was conducted to and global improvement were taken at baseline, then at 3, 6,
identify general and specific self-efficacy outcome measures. The 12, 26 and 52 weeks post-randomisation. ANALYSIS: Outcome
instrument was developed through a process of item generation, measures were estimated using linear mixed models with participant
selection and scaling, according to the process consistent with defined as a random effect and treatment and time as fixed
Bandura’s (1986) recommendations regarding the development of effects (p < 0.01). Significant effects were further assessed using
domain-specific self-efficacy measures, and subjected to wheelchair ANOVAs at the primary endpoints of six and 52 weeks (p < 0.01).
users to the initial validation and reliability tests. Face validity was Linear regression analyses were used to examine the relationship
derived from direct patient input. ANALYSIS: Analyses included between sensorimotor measures and patient characteristics (age,
descriptive statistics, factor analysis and Cronbach’s alpha. Ques- sex, duration of condition, previous elbow symptoms, additional
tionnaires for 73 respondents (46.6% female; mean [SD] age, 39 treatment during follow up, recurrence of condition during follow
[14.5] years; and mean [SD] number of years since adoption of up). Finally, comparison of baseline and 52-week sensorimotor
the wheelchair, 12 [7.5] years) were analyzed. RESULTS: Using measures between the TE cohort and controls were assessed using
factor analysis with varimax rotation, three subscales explained ANOVAs (p < 0.01). RESULTS: Significant deficits in reaction time
58.6% of the variance in our 13-item questionnaire. The domains and speed of movement in the TE group compared to controls were
reflecting three aspects of wheelchair-related self-efficacy: symptoms confirmed at baseline (p = 0.003), with no difference between sides.
management, personal efficacy and coping. Cronbach’s alpha of Although sensorimotor measures significantly improved over time
the entire instrument was 0.81, and for the three individual scales (simple reaction time (SRT) mean change 0-52 weeks: 17.3msec;
scores were 0.80, 0.70 and 0.77, respectively. Interscale correlations 99%CI 11.7 to 22.9), there were no significant differences between
were moderate-to-high. Significant correlations were found between interventions (p = 0.718). At 52 weeks the TE cohort remained
domain and overall scale scores. CONCLUSIONS: The psychometric significantly worse compared to controls (SRT mean difference
properties of the Wheelchair-Related Self-Efficacy Scale seem to be 17.9msec, 99%CI 4.2 to 31.6), despite the majority of participants
highly acceptable. It was easily used by a wide range of persons reporting success (159/190). CONCLUSIONS: It appears that upper
without formal training and has the advantage of being very brief limb reaction time and speed of movement are affected bilaterally
and it should be a useful measure in needs assessment and in unilateral TE. Sensorimotor measures change over time, but
rehabilitation outcomes. Further validation of its use across diferent this change is independent of treatment and not strongly related
cultural settings is required. IMPLICATIONS: It is important that to baseline clinical characteristics. IMPLICATIONS: Sensorimotor
health professionals should have knowledge and understanding of deficits appear to be a part of the aetiological profile of TE,
self-efficacy perception of wheelchair users. Physiotherapy programs however current treatments do not preferentially affect these deficits.
providing skills for physical training, self-management in activities Treatments that specifically address sensorimotor deficits should be
of daily living and social participation, problem-solving strategies incorporated into the overall management of patients with TE. The
and gaining self-confidence depend on and influence self-efficacy. clinical significance of sensorimotor deficits requires further investiga-
KEYWORDS: Wheelchair users, outcome measures, self-efficacy. tion. KEYWORDS: Manual therapy, musculoskeletal, sensorimotor.
FUNDING ACKNOWLEDGEMENTS: This work was unfunded. FUNDING ACKNOWLEDGEMENTS: Financial support from The
CONTACT: [email protected] University of Queensland and National Health & Medical Research
ETHICS COMMITTEE: Faculty ethics committee Council (Primary Care Research), Australia #252710. CONTACT:
l.bisset@griffith.edu.au
ETHICS COMMITTEE: The University of Queensland Medical
Research Ethics Committee
VCEC Ballroom A
SENSORIMOTOR DEFICITS IN TENNIS ELBOW: RESULTS OF
A RANDOMISED CONTROLLED TRIAL 958 Sunday 3 June 14:00
Bisset L1 , Darnell R2 , Vicenzino B2 ; 1 Griffith University, Gold Coast,
Australia; 2 The University of Queensland, Brisbane, Australia SIGNIFICANT DECREASE IN SICK LEAVE USING HIGH
DOSAGE MEDICAL EXERCISE THERAPY IN PATIENTS WITH
PURPOSE: The purpose of this randomised controlled trial was UNILATERAL LONG LASTING SUBACROMIAL PAIN
to evaluate the effect of a physiotherapy programme, corticosteroid
Østerås H1 , Torstensen T, Haugerud L, Østerås B; 1 Sør-Trøndelag
injections or a wait and see approach on sensorimotor performance
University College, Trondheim, Norway
in patients with tennis elbow (TE). RELEVANCE: TE is a chronic
musculoskeletal condition affecting approximately 1-3% of the PURPOSE: Compare two different types of exercise programs in
general population. The poorly understood aetiology of TE is relation to return to work in patients with long lasting subacromial
reflected by the multiple clinical treatments currently in use. Recent shoulder pain. RELEVANCE: There is increasing evidence that
research suggests a neurophysiological component, evidenced by exercise therapy is effective for this patient category, but no evidence
sensorimotor deficits such as upper limb reaction time and speed of regarding what type of exercises and dosage is most effective
movement in the order of 11-32%. However, changes in sensorimotor regarding return to work. PARTICIPANTS: 61 patients with unilateral
deficits in reponse to currently accepted treatments have not been subacromial pain. METHODS: Multi center, randomized controlled
assessed. PARTICIPANTS: 198 participants aged (mean ± SD) trial, where patients were randomly assigned either to a high dosage
47.6 ±7.8 with a clinical diagnosis of unilateral TE were selected HD medical exercise therapy group (n=30) or to a low dosage LD
from the general community. Exclusion criteria included bilateral exercise therapy group (n=31). Patients in the HD group performed
symptoms or any other systemic, neck or upper limb pathologies. a total of 11 exercises consisting of 3 global exercises using a
In addition, a healthy control group of 40 participants (aged 48.4 stationary bike and 8 semiglobal and local exercises doing 3 sets
±7.7) with no history of neck or upper limb pathology were included of 30 repetitions of each exercise. The LD group performed a global
in the baseline data collection. METHODS: TE participants were exercise once for 10 minutes and performed 5 semiglobal and local
randomised into one of three groups: the wait and see group exercises doing 2 sets of 10 repetitions of each exercise. Both
received advice; the corticosteroid injection group received up to groups received 3 treatments a week over 3 months. The difference
two injections and the physiotherapy group received eight treatments between the groups were time performing aerobic global exercises,
which consisted of “Mobilization with Movement” manipulation number of exercises, repetitions and number of sets. The patients
technique and an exercise program. Outcome measures of upper were supervised and the exercises were individually tailored and
graded according to the clinical picture. Patients were assessed at minority of people with limited sitting balance (0-22%) and standing
inclusion, end of treatment, at 6 and 12 months follow up. Data balance (25-50%) recovered independent functional mobility. Most
on sick leave was blinded regarding intervention group and was people who could walk initially recovered independent functional
measured as number of days off work as well as % return to mobility (66%-84%), but 16% suffered a decline in their mobility
work and was registered by the local insurance office. ANALYSIS: and 44% had enduring limitations in everyday mobility activities.
Differences between the groups were analyzed using a one-tailed CONCLUSIONS: Initial balance disability is a strong predictor of
Independent-Sample T-Test. RESULTS: There were no statistical function and recovery after stroke. IMPLICATIONS: The results of
difference between the two groups at baseline. During treatment this study can be used to inform clinical decision making. Balance
5 patients (8%) dropped out, another 8 patients dropped out at disability is strongly associated with function and the recovery
one year follow up. At end of treatment there was no statistical of function so the restoration of balance abilities should be a
difference between the groups, but a tendency for a higher return physiotherapy priority. Few people with an initial loss of sitting
to work in the in the HD group. At 6 and 12 months follow balance can be expected to regain independent mobility and so
up there was a significant difference (p < 0.05) between the two physiotherapy should focus on alternative means of mobility in the
intervention groups in favor of the HD medical exercise therapy first instance. Most people who are able to walk in the acute
group. CONCLUSIONS: In patients with long lasting uncomplicated stages after stroke should be expected to remain independently
subacromial pain, HD medical exercise therapy is an efficient mobile. However a significant minority suffer a deterioration in
treatment approach getting more patients back to work as well as mobility and enduring mobility limitations at three months post-
getting patients faster back to work compared to the LD exercise stroke. Therefore their mobility should be monitored and they should
group. IMPLICATIONS: HD medical exercise therapy is an effective be offered rehabilitation to prevent deterioration and maximise
treatment approach reducing sick leave significantly in patients with their activity. KEYWORDS: Stroke, physiotherapy, balance, recovery.
long lasting subacromial shoulder pain. Patients, health professions FUNDING ACKNOWLEDGEMENTS: Stroke Association, Humphrey
and third party payers should be aware that potential costs due Booth Charities. CONTACT: [email protected]
to long term sick leave are saved using HD medical exercise ETHICS COMMITTEE: SAlford & Trafford Local Research Ethics
therapy. KEYWORDS: Sick leave, shoulder pain, exercise therapy, Committee
randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: [email protected]
ETHICS COMMITTEE: Regional health authorities, Nirway
VCEC Ballroom A
PP Crystal Pavilion B & C EVERYDAY PHYSICAL ACTIVITY IN EARLY RHEUMATOID
ARTHRITIS. A RANDOMIZED CONTROLLED STUDY OF A
THE RELATIONSHIP BETWEEN BALANCE, DISABILITY AND
ONE-YEAR SUPPORT PROGRAM
RECOVERY AFTER STROKE
Brodin N1 , Eurenius E2 , H. Opava C1,3 , PARA study group4 ; 1 Division
Tyson S1 , Selley A2 , Hanley M2 , Chillala J2 , Tallis R2 ; 1 Centre
of Physiotherapy, Department of Neurobiology, Care Sciences and
for Rehabilitation & Human Performance Research, University
Society, Karolinska Institutet, Huddinge, Sweden; 2 Rehabcentrum,
of Salford, Salford UK; 2 University of Manchester, Manchester, UK
Skellefteå Hospital, Skellefteå, Sweden; 3 Department of Medicine,
PURPOSE: To examine the influence of balance on function and the Division of Rheumatology, Karolinska University Hospital – Solna,
recovery of function after stroke using a balance measurement tool Stockholm, Sweden; 4 Marita Algebrandt, Linköping University
that covered a wide range of abilities. RELEVANCE: Physiotherapy Hospital, Ingrid Almin, Örebro University Hospital, Britt Andersson,
is a mainstay of stroke care and in order to set suitable therapeutic Karolinska University Hospital/Solna, Gunhild Bertholds, Skövde
goals, devise effective treatment plans and facilitate discharge Hospital, Catarina Forsberg, Falun Hospital, Emma Haglund,
planning information is needed about the patients’ expected degree Spenshult Rheumatology Hospital, Ann-Marie Holmén-Andersson,
of recovery. The absence of static sitting balance in the acute Sahlgrenska University Hospital, Mölndal, Anna Hultman, Uppsala
stages after stroke is known to be a negative predictor for recovery University Hospital, Claudia Lennartsson, Karolinska University
but this is a relatively crude measure that affects a minority Hospital/Huddinge, and Elin Norman, Danderyd Hospital/Stockholm
of people with stroke. However other measures which involve a
range of balance abilities have rarely been included in predictive PURPOSE: To evaluate the outcome of a one-year support program
models of stroke outcome. PARTICIPANTS: One hundred and for healthy physical activity behaviour in daily life among patients
two people with weakness following 1st-time anterior circulation wirh early rheumatoid arthritis (RA). RELEVANCE: Physical inactivity
stroke, 75 of whom completed follow-up assessment at 3 months threatens public health in the western world. The level of physical
METHODS: A cross-sectional survey design was used to assess activity among people with RA is even lower than that in the general
consecutive admissions to six NHS hospitals (UK) 2-4 weeks population. This might be due to pain and generally poor health,
after stroke. The following parameters were administered in an but also to conceptions on benefits or risks of physical activity.
one-off measurement session: Demographics – age, sex, pre- Physical activity might be even more important in people with RA
morbid disability; Stroke pathology – side of hemiplegia, stroke in order to prevent disability, poor quality of life and the increased
type (infarct or haemorrhage), stroke severity (Oxford Community risk of comorbidity related to this condition. PARTICIPANTS: Two
Stroke Project Classification); Stroke related impairments – balance hundred and twenty-eight patients (74% women, median age 56
(Brunel Balance Assessment), weakness (Motricity Index), Sensation years, disease duration one year) were randomized to an intervention
(Rivermead Assessment of Somoato-sensory Perception), Neglect group (IG, n=94, 72% women, median age 54 years) and a control
(Star Cancellation and Line Bisection tests); function (Barthel Index group (CG, n=134, 75% women, median age 56 years). They
and Rivermead Mobility Index). Recovery was assessed using the were recruited from nine rheumatology clinics in different parts of
Barthel Index and Rivermead Mobility Index at 3 months post- Sweden. METHODS: Effects of a one-year support program for
stroke. ANALYSIS: Univariate and linear regression using the ‘enter’ healthy physical activity (30 minutes, daily, moderately intensive).
method; cross-tabulations RESULTS: Balance was the strongest The program included extra information, frequent tests of body
predictor of function in the acute stages. Weakness was also an functions with written feed-back, problem-solving strategies, goal-
independent predictor. Recovery was independently predicted by setting for physical activity behaviour, activity logs, and a ‘personal
balance, weakness, age and pre-morbid disability. At 3 months, a coach’. The control group received ‘ordinary treatment’, including
general patient information and necessary prescriptions of hospital- reassessed in S2, S3 and S4. In order to estimate the intra- and inter-
based training or home exercise programs with no specific follow- rater reliability, E1 assessed the strength in S2 and E2 in S3. Lastly,
up. Questionnaires on exercise and physical activity and on health- E1 reassessed the muscle torque with the Cybex dynamometer in S4.
related quality of life (Euro-QoL) were filled out and testing of joint ANALYSIS: Descriptive statistics (mean and standard deviations) of
motion (EPM-ROM scale), muscle function (Grippit, Timed stands maximal isometric muscle torque values were calculated. Intraclass
test), and functional balance (walking in a figure of an 8) was correlation coefficients (ICCs) were computed to determine the intra-
performed at the physiotherapy departments within ten days prior and inter-rater reliability as well as the concurrent validity. The amount
to or after physician visits, where data on disease activity, including of measurement error was estimated by calculating the standard
pain and general health perception (VAS), activity limitation (HAQ), error of measurement (SEM). RESULTS: The muscle torque varied
and inflammatory activity (DAS28), were collected. ANALYSIS: Data according to the age and muscle group (p < 0.05). The intra and inter-
were analyzed with the Mann-Whitney U-test and all randomized rater reliability of all tested muscle groups was good to excellent
patients were included in the analyses with ‘Baseline value carried (ICCs: 0.67 to 0.98) except for the plantarflexor muscles (ICC =
forward’. RESULTS: At study start the two groups were comparable 0.48). The concurrent validity of HHD with the Cybex was good to
in all investigated variables except in grip strength and functional excellent (ICCs = 0.69 to 0.94). The SEM was ranging from 0.5 to
balance, where the IG performed better (p = 0.005 and p = 0.007 8.5 Nm according to gender and muscle group. CONCLUSIONS:
respectively). Seventy-seven (82%) patients of the IG and 114 (85%) The results showed that muscle torque assessment with a HHD
of the CG completed the study. After the intervention there was no using the same standardized protocol with children of all ages is
change in self-reported physical activity in either of the two groups. feasible and has good to excellent measurement properties. The
However, the IG significantly improved their timed standing and grip knowledge of the SEM will allow the clinician to accurately identify
strength compared to the CG (p < 0.001 and p = 0.003 respectively). muscle weaknesses and make better conclusions about clinical
Moreover, the IG improved significantly over the CG in health-related changes over time. The development of reference values of maximal
quality of life (p = 0.026). No other changes occurred between the two isometric muscle torque with a valid and reliable HHD protocol is
groups. CONCLUSIONS: It thus seems as if the one-year support essential to characterize the normal changes expected in muscle
program resulted in improved muscle function and health-related strength during childhood and adolescence. IMPLICATIONS: The
quality of life in these patients with early RA. Possible explanations results of this study and our future work will establish reference
for our failure to demonstrate improved exercise behaviour might values. This will help paediatric physiotherapists to determine a well-
be that the self-reporting questionnaires were not enough sensitive aimed treatment plan and evaluate the effects of therapy including
to change or that the patients’ perception of their own physical physiotherapy interventions as well as medication and surgery,
activity did not change. IMPLICATIONS: The present results make especially in children that have bilateral impairments. KEYWORDS:
a case for physical activity as a complement to medical treatment muscle strength, hand-held dynamometer, paediatric rehabilitation.
in patients with early RA. KEYWORDS: Randomised controlled FUNDING ACKNOWLEDGEMENTS: This research was supported
trial, rheumatoid arthritis, physical activity behaviour. FUNDING by a grant from the Rehabilitation Institute of Quebec City.
ACKNOWLEDGEMENTS: The Health Care Science Postgraduate ETHICS COMMITTEE: The Ethic Committee of the Quebec
School of Karolinska Institutet, the Swedish Rheumatism Association, Rehabilitation Institute approved the study protocol
the Swedish Research Council. CONTACT: [email protected]
ETHICS COMMITTEE: The research ethics comittée at the Research Report Platform Presentation
Karolinska Institutet. D nr: 00-010
Research Report Platform Presentation IMPACT OF A CUEING PROGRAM IN THE HOME ON
GAIT RELATED MOBILITY IN PARKINSONS DISEASE: A
RANDOMISED CLINICAL TRIAL
MEASUREMENT OF MUSCLE TORQUE IN CHILDREN BY HAND- Kwakkel G1 , Vanwegen E1 , Nieuwboer A2 , Willems A2 ,
HELD DYNAMOMETRY: A NEW STANDARD IN REHABILITATION Rochester L3 , Jones A3 ; 1 VU University Medical Centre,
Amsterdam, The Netherlands; 2 Katholieke Universiteit, Leuven,
Hebert L1,2 , Lepage C3 , Saulnier J3 , Crete M3 , Perron M4 ; Belgium; 3 Northumbria University, Newcastle, UK
1 National Defense of Canada, CFHS HQ – HS Delivery, Ottawa,
Canada, K1A 0K6; 2 Faculty of Medicine, Department of Radiology, PURPOSE: Gait and gait related mobility problems are common in
Laval University, Quebec City, Canada; 3 Quebec Rehabilitation Parkinson’s disease (PD). This study aimed to investigate a rehabil-
Institute, Quebec city, Canada; 4 Centre de santé Valcartier, itation approach using cueing therapy delivered at home to improve
Valcartier Garrison, Quebec City, Canada gait and gait related activities in people with Parkinson’s disease
as an adjunct to the overall disease management. RELEVANCE:
PURPOSE: To test 1) the feasibility of a standardised protocol Gait and gait related mobility problems are common in Parkinson’s
for isometric muscle torque assessment in a paediatric population disease (PD). PARTICIPANTS: In this multi-centre, single-blind
using a hand-held dynamometer (HHD), 2) its intra- and inter-rater randomised clinical trial with cross-over design, 153 patients with
reliability, and 3) concurrent validity with the Cybex dynamometer. idiopathic Parkinson’s disease (PD) were recruited (65 women and
RELEVANCE: In addition to validating a new HHD protocol to assess 88 men, mean age of 67.1 (±7.54), Hoehn & Yahr score 2.7 (±0.6)
muscle torque in children of all ages, this study is a preliminary and Unified Parkinson Disease Rating Scale part III (UPDRS III) 33.1
step towards the establishment of reference values. PARTICIPANTS: (±11.3)). METHODS: Patients were randomly allocated to receive
A random probabilistic sample was established from a student list an early or late intervention in their home consisting of three 30
of a primary and secondary school. Seventy-four children from 4 minute sessions of cueing therapy per week for 3 weeks given
to 17.5 years of age participated in the study. METHODS: The by trained therapists using a prototype cueing device. Outcome
maximum isometric torque value of 11 muscle groups was measured measures were conducted at baseline, 3, 6, and 12 weeks by an
with a push-pull HHD. For each muscle group, the mean of two independent assessor who was blinded to treatment allocation. The
trials was used for the final analysis. Measurements were taken primary outcome measures were the Posture and Gait Score (PG-
by two independent experienced physiotherapists (E1 and E2) in score), gait speed, step length, step frequency, Functional Reach
four separate sessions (S1, S2, S3, S4). To confirm feasibility, E1 test (FR), Falls Efficacy Scale (FES), Freezing of Gait Questionnaire
assessed the 74 children in S1. To examine the reliability and the (FOGQ), timed tests of tandem and single leg standing. Secondary
concurrent validity, a subgroup of 20 children selected from S1 was outcome measures included Nottingham Extended Activities of Daily
Living Scale, Parkinson’s Disease Questionnaire (PDQ-39), UPDRS cycling at 30 rpm and 60 rpm. Subjects with CP were also tested
III and the Carer Strain Index (CSI). ANALYSIS: Multiple linear while cycling with a shank guide designed to limit joint motion to
regression models (designed to account for repeated measures) were the sagittal plane. ANALYSIS: Non-circular data were analyzed via
used for continuous outcomes, with a trivariate normal distribution mixed model ANOVAs. Circular data were analyzed using circular
for error components. Data were transformed where necessary to t-tests. Accepted p-values were adjusted based on the number of
meet normality assumptions. The intervention effects are reported variables for each measure. RESULTS: Joint kinematics for subjects
as b and standard error (SE) for the linear regression models, odds with CP were different than those of subjects with TD for all motions
ratios and hazard ratios (=exp(b)) with 95% confidence intervals studied based upon crank position. Subjects with CP displayed earlier
for the logistic and Cox regression models, respectively. RESULTS: onsets and later offsets of muscle activity, increased cocontraction of
Seventy-six patients were included in the early and 77 in the late agonist/antagonist muscles, and decreased efficiency as compared
intervention group. Multiple linear regression models for repeated to subjects with TD. There were no differences in perceived
measures showed a significant improvement of cueing therapy on the exertion. Subjects with CP spent a greater percentage of the
PG-score (p = 0.005), gait speed (p = 0.005), step length (p < 0.0001), revolution applying negative force (pulling instead of pushing) than
FES (p = 0.03), balance (timed tandem and single leg stance tests) did subjects with TD. Use of the shank guide for subjects with
(p = 0.003) and UPDRS III (p = 0.03). There was no increase in risk CP primarily affected joint kinematics, with few differences seen
of falling following intervention. Overall, the effects of intervention in muscle activity and no changes seen with efficiency, perceived
were significantly reduced at 12 weeks. CONCLUSIONS: Cueing exertion, or the percentage of the revolution spent applying negative
therapy in the home improves gait and balance and does not force. CONCLUSIONS: Subjects with CP appeared to use different
increase the risk of falling in PD. These effects generalize to strategies to cycle than subjects with TD. The differences in cycling
functional activities but do not affect overall health-related quality. biomechanics seen may be due to decreased strength and motor
IMPLICATIONS: Cueing therapy can be seen as a useful adjunct control in the subjects with CP. Future work should examine
to the overall multidisciplinary management of patients with PD. the outcomes of a cycling intervention for individuals with CP to
KEYWORDS: Parkinson’s disease, rehabilitation, cueing. FUNDING determine its effects on function, cardiovascular fitness, and the
ACKNOWLEDGEMENTS: We gratefully acknowledge the financial musculoskeletal system. IMPLICATIONS: The findings of this study
support from the European Commission Framework V funding; can assist clinicians who use cycling as a therapeutic intervention
QLK6-2001-00120. We would like to acknowledge the contribution for individuals with CP by providing greater knowledge about cycling
of Professor Rowena Plant in gaining funding. Prof. E.C.H. Wolters strategies. KEYWORDS: Cycling, cerebral palsy, biomechanics.
(MD, PhD), Dr. H.W. Berendse (MD, PhD), C.M. Zijlmans (MD, PhD) FUNDING ACKNOWLEDGEMENTS: Shriners Hospitals for Chil-
Prof. R. Dom (MD, PhD), Dr D. Burn (MD) and Dr R. Walker (MD) dren, Grant #8530, Pediatric Section of the American Physical
are acknowledged for referral of patients. We gratefully acknowledge Therapy Association. CONTACT: [email protected]
assistance with data analysis from S. Fieuws and K. Desloovere. ETHICS COMMITTEE: Temple University Institutional Review Board
We particularly want to acknowledge the patients with Parkinson’s
disease and their carers who participated in this study. CONTACT:
[email protected]
ETHICS COMMITTEE: The study was approved by the ethics 962 Sunday 3 June 14:00
committee of each participating University. VCEC Meeting Rooms 19-20
A PROSPECTIVE STUDY ON KNEE PROPRIOCEPTION AFTER
MENISCAL ALLOGRAFT TRANSPLANTATION
980 Sunday 3 June 14:00 Thijs Y1 , Witvrouw E1 , Evens B1 , Coorevits P1 , Almqvist F2 ,
VCEC Meeting Room 17 Verdonk R2 ; 1 Ghent University, Ghent, Belgium; 2 Ghent University
Hospital, Ghent, Belgium
THE BIOMECHANICS OF CYCLING IN ADOLESCENTS WITH
AND WITHOUT CEREBRAL PALSY PURPOSE: The meniscus plays an important role in the proprio-
ceptive ability of the knee joint. The aim of this prospective study
Johnston T1,2 , Barr A2 , Lee S1−3 ; 1 Shriners Hospitals for Children,
was to assess the short term influence of a meniscus replacement
Philadelphia, PA, USA; 2 Temple University, Philadelphia, PA, USA;
3 University of Delaware, Newark, DE, USA on the proprioception of the knee. RELEVANCE: The results of
this study suggest that although no significant improvement of
PURPOSE: The purposes were to compare the biomechanics of pain and functionality of the operated knee occurred at this short
recumbent cycling between 1) adolescents with cerebral palsy (CP) term follow-up period, a meniscal allograft transplantation seems to
and adolescents with typical development (TD), and 2) cycling with have a significant positive effect on the joint position sense of the
and without a shank guide designed to limit motion to the sagittal previously meniscectomised knee. PARTICIPANTS: 14 patients who
plane for adolescents with CP. RELEVANCE: Cycling is a potential had undergone a fresh meniscal allograft transplantation between
intervention for fitness and general strength training in children with May 2001 and June 2003 in the Ghent University Hospital were
CP. However, little is known about the biomechanics of cycling tested preoperatively and six months postoperatively. METHODS:
in CP or which impairments are best addressed through cycling. Disability regarding pain, stiffness and functionality of the affected
PARTICIPANTS: Twenty subjects (15.2 ±1.6 years) participated. Ten knee during daily activities was measured by the WOMAC-scale. The
subjects had TD, and 10 subjects had spastic CP and were classified knee joint position sense was assessed using the Biodex System
as levels III and IV using the Gross Motor Function Classification 3® Isokinetic Dynamometer. ANALYSIS: Independent-Samples T-
System. METHODS: The stationary cycle had adjustable-length tests were used to compare the preoperative proprioception results
crank arms, adjustable pedals, and an attached therapy bench as of the affected knee with those of the unaffected knee. Paired-
the seat. The cycle was adjusted to the individual’s anthropometric Samples T-tests were used to test differences between the pre-and
measurements and resistance provided was based on body weight. postoperative proprioception results within the groups (operated and
Lower extremity joint kinematics and muscle electromyography were contra-lateral knee). Changes in differences of the proprioception
measured during three 10-15 second trials. Crank position was between the affected and unaffected knee were analysed by means
recorded via a rotary encoder, and 3-dimensional piezoelectric of independent-samples T-tests on the change score of both groups.
force transducers measured force exerted on the pedals. Energy The change score of a group was defined as the increase or
expenditure and perceived exertion using the OMNI Scale were decrease made pre to post by that group. One-sample T-tests
collected during a 5-minute cycling test, and efficiency was calculated were performed to determine significant differences between the
(power output/metabolic input). If able, subjects were tested while obtained proprioception results and the reference angles (30º and
70º knee flexion). The results of the WOMAC-index were analysed it was not possible to combine results but in all studies patients
by paired-samples T-tests. RESULTS: The results of the WOMAC- showed an improvement in outcome scores. Exercise programmes
scale showed no significant differences concerning pain, stiffness or were well documented in 5 studies. CONCLUSIONS: No randomised
knee function between the pre- and postoperative condition of the controlled trials met the inclusion criteria and the evaluation has
knee. Assessment of the knee joint position sense at a reference therefore been based on lesser quality case series. The case series
point of 70º of knee flexion revealed a significant improvement of findings suggest that some evidence exits that supports the use of
the proprioception of the operated knee at six months after surgery exercise in the management of rotator cuff tears. IMPLICATIONS:
compared to the preoperative condition. CONCLUSIONS: The There is a definite need for well planned randomized controlled trials
results of this study showed the appearance of a significant deficit investigating the efficacy of exercise in the management of massive
of knee joint proprioception after a total meniscectomy. Following a (inoperable) rotator cuff tears. KEYWORDS: Rotator cuff tears,
meniscal allograft transplantation, a significant improvement of the exercise, systematic review. FUNDING ACKNOWLEDGEMENTS:
knee proprioception was seen at 70º of knee flexion at short term This work was unfunded. CONTACT: [email protected]
(six months) despite the absence of detectable changes in knee
functionality. IMPLICATIONS: The improvement in proprioception
following a meniscus transplantation may have a considerable impact Research Report Platform Presentation
on the knee functionality in long term as the subjective stability 1622 Sunday 3 June 14:20
of the joint becomes more and more important when patients are VCEC Ballroom A
exposing their knee to higher demands in sports- or daily activities.
Therefore the results of this study are the first to suggest that the EXERCISE MAINTENANCE IN RHEUMATOID ARTHRITIS –
long term functional results after a meniscal transplantation may also A QUALITATIVE STUDY AMONG INDIVIDUALS WITH REGULAR
be the consequence of an improved proprioception. KEYWORDS: EXERCISE BEHAVIOR
meniscus; meniscectomy; meniscal transplantation; proprioception; Swärdh E1,2 , Biguet G1 , H. Opava C1,3 ; 1 Karolinska Institutet,
knee joint position sense. FUNDING ACKNOWLEDGEMENTS: This Department of Neurobiology, Care sciences and Society, Division
work was unfunded. of Physiotherapy; 2 Karolinska University Hospital, Department
ETHICS COMMITTEE: Ethics Committee Ghent University Hospital of Physiotherapy; 3 Karolinska University Hospital, Department
of Rheumatology
Research Report Platform Presentation PURPOSE: In chronic diseases such as rheumatoid arthritis (RA),
1512 Sunday 3 June 14:20 the individual often has to make permanent changes in lifestyle and
PP Crystal Pavilion A adopt new patterns of behavior such as exercise, in order to gain and
EXERCISE THERAPY FOR THE MANAGEMENT OF MASSIVE sustain health benefits. Further, it has been suggested that behavioral
(INOPERABLE) TEARS OF THE ROTATOR CUFF: A strategies for exercise maintenance might differ from strategies
SYSTEMATIC REVIEW for adoption. Empirical work that sheds light on the exercise
maintenance in patients with RA is however scarce, and little is known
Ainsworth R1 , Lewis J2,3 ; 1 Torbay Hospital, Torquay, UK; 2 Chelsea about the patients’ perspective. The purpose of this study was to
and Westminster Hospital, London, UK; 3 St George’s Hospital, describe various ways of perceiving and reasoning about exercise
London UK maintenance, in individuals with RA that already have adopted an
PURPOSE: To review the evidence for the effectiveness of exercise behavior in a clinical setting. RELEVANCE: Considering the
therapeutic exercise for the treatment of massive (inoperable) tears emerging self-management paradigm and the economic constraints
of the rotator cuff. RELEVANCE: Although there are many surgical of health care, demands on patients to maintain their exercise
approaches for the management of full thickness rotator cuff tears, behavior outside the clinical context have increased, and this calls
there is little consensus as to the most effective method for repairing for new roles of health professionals including physical therapists.
massive cuff tears. There is a consensus that the outcome of rotator PARTICIPANTS: Fourteen women and four men with RA of at least
cuff tendon surgery in the elderly is generally very poor. As such, two years’ duration were purposefully selected to participate. They
exercise therapy is usually recommended for this patient group. had all performed planned regular exercise with and without support
Although commonly prescribed the evidence to support this approach from a physical therapist. METHODS: Semi-structured interviews
is equivocal. The aim of this study was to conduct a systematic review were performed. ANALYSIS: Information from the interviews was
of the literature to determine the efficacy of exercise therapy for the qualitatively analyzed in accordance with the phenomenographic
management of full thickness rotator cuff tears. PARTICIPANTS: method. RESULTS: Five qualitatively different behavioral categories
Patients with a diagnosis of full thickness rotator cuff tears who relating to exercise maintenance were identified. Expected effects of
are treated with exercise therapy METHODS: A systematic review exercise, the role of the physical therapist, preferable exercise setting
was conducted to synthesise the available research literature on the and personal inner strengths seemed to be the most critical factors
effectiveness of exercise therapy for full thickness tears of the rotator in explaining differences between the categories. The categories
cuff. Data Source: Reports up to and including September 2006 were; external control – monitoring and safety, sticks and carrots –
were located from MEDLINE, the Cumulative Index to Nursing & demands and support, a joint venture - shared responsibility and
Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane confidence, the easy way – incentives and confidence, and on
Database of Systematic Reviews and the Physiotherapy Evidence one’s own terms – autonomy and confidence. CONCLUSIONS:
Database (PEDro) using the terms “rotator cuff” and “tear/s” and The findings revealed a knowledge basis, which increases the
“exercise” or “physiotherapy” or “physical therapy” or “rehabilitation”. understanding of different factors that could affect the way exercise
Study Selection: Studies were included if they related to full behaviors are maintained. The categories found could be a starting
thickness rotator cuff tears and exercise. Data Extraction: Two point when designing individually tailored interventions. However, the
independent reviewers assessed the methodological quality of the findings also raises questions as to whether any of the maintenance
studies. Differences were resolved by consensus. ANALYSIS: Data behaviors are more optimal, and how different coaching approaches
Synthesis: 10 studies met the inclusion criteria. 8 studies were can affect exercise maintenance on the basis of the five categories.
observational case series and 2 were single case studies. There IMPLICATIONS: In order to minimize the risk for relapse into a
were no randomized clinical trials. RESULTS: Only 4 studies were non-exercise behavior, the findings of the present study emphasize
specific to massive rotator cuff tears. 1 study had a subgroup with the importance of broadening individuals’ knowledge, skills and
massive cuff tears and 5 studies were not specific as to the size self-efficacy related to a variety of exercise types and settings.
of the tear. Due to the heterogeneity of outcome measures used, Physical therapists should also be aware of both the positive
and the negative impact he or she may have on patients’ self- Research Report Platform Presentation
management initiatives by providing different support and coaching 1087 Sunday 3 June 14:20
approaches. KEYWORDS: Chronic disease, exercise behavior, VCEC Meeting Rooms 11-12
patient perspective. FUNDING ACKNOWLEDGEMENTS: Center for INFLUENCE OF INCREASED WAIST CIRCUMFERENCE ON
Health Care Sciences at Karolinska Institute, Swedish Associations MEASURES OF HAMSTRINGS FLEXIBILITY
of Registered Physiotherapists, and the Swedish Association of Croft L, Mason J, Davey C, Holland S, Lane J; Queen Margaret
Rheumatism. CONTACT: [email protected] University College, Edinburgh, UK
ETHICS COMMITTEE: Regional Ethical Review Board in Stockholm,
Sweden (Dnr 2005/371-31) PURPOSE: To determine whether increased waist circumference
influences measures of hamstrings flexibility. RELEVANCE: Ham-
strings flexibility is an important aspect of physical fitness. Poor
hamstrings flexibility has been associated with low back pain,
altered gait kinematics and increased risk of falling. Therefore,
increasing hamstrings flexibility is a common physiotherapeutic
1437 Sunday 3 June 14:20 goal. The sit-and-reach test is the most commonly used measure
VCEC Exhibit Hall A of hamstrings flexibility and is shown to have good validity and
TRUNCUS ENDURANCE, HIP AND ANKLE MOBILITY reliability. Clinical observations however suggest that apposition of
AND AEROBIC FITNESS IN 15-YEAR OLD NORWEGIAN the abdominal soft tissues in overweight subjects may affect test
ADOLESCENTS IN 1968 AND 1997 results. The WHO estimates that there are 1 billion overweight
people worldwide. Therefore, it would be useful to clinicians to know
Sjolie A1,2 ; 1 Amot Physiotherapy Clininc, 2450 Rena, Norway;
2 Hedmark University College, 2450 Rena, Norway how measures of hamstring flexibility are affected by increased
waist circumference. PARTICIPANTS: 22 (19 female, 3 male) non-
PURPOSE: There are theories that physical performance in young overweight (waist circumference <88cm) volunteers were recruited
people is declining due to a more passive lifestyle. The purpose of from a student population. METHODS: Queen Margaret University
this study was to explore potential changes in truncus endurance, College approved this study. Exclusion criteria were: a history of low
ankle and hip mobility, and aerobic fitness in Norwegian adolescents back pain and/or recent hamstrings injury. Each subject undertook
over a time interval of one generation. RELEVANCE: There seems 4 tests of hamstring flexibility both with and without a ’fat-suit’
to be an increase in musculo-skeletal diseases and other lifestyle which increased the waist circumference by 60cms, thus placing
disorders also in young people. The frequency of low back pain waist circumference of all subjects into the overweight category
seems also to be on the rise in both young people and adults. (>88 cm for females and >105 cm for males). The tests were: sit-
As health professionals physical therapists should participate in and-reach (SAR), modified sit-and-reach (MSAR), chair sit-and-reach
exploring health factors. PARTICIPANTS: The material included 1329 (CSAR) and the straight leg raise (SLR). The order of all tests was
15-year old Norwegian adolescents in Akershus county in Eastern randomised. Two raters measured each test. ANALYSIS: Intra-class
Norway in 1968, and 1105 15-year old adolescents in the same correlation coefficients (2,1) and standard error of measurement
(SEM) were used to determine inter-rater reliability for each test. An
region in 1997. METHODS: The investigations were supervised by
average of both raters was used to determine differences in each test
the same conductor at both occasions, and used identical physical
with and without the fat-suit, using a paired t-test. The alpha level was
tests. The test battery included tests of dynamic endurance of
set at 0.05. RESULTS: Inter-rater reliability for the three SAR tests
abdominal and low back muscles, hip flexion, ankle dorsiflexion,
without the fat-suit were >0.98 and with the fat-suit were >0.96. ICC’s
and aerobic fitness. ANALYSIS: Mean values for the variables were
for the SLR were slightly lower (without fatsuit = 0.756, with fatsuit =
estimated for girls and boys, and the ratio between abdominal
0.797). The SAR tests without the fatsuit had a SEM of <1.4cm and
and low back endurance was calculated. The statistical differences
those with the fatsuit had a SEM of <1.6cm. The SLR had an SEM of
were analysed by two-groups T-test. The level of significance was 8º without the fatsuit and 4ºwith the suit. Paired t-tests showed that
set to P 0.05. RESULTS: Compared to 1968 low back extension tests with the fat-suit were significantly worse(p < 0.001) than those
endurance in 1997 was almost 10% lower in both genders, the without. CONCLUSIONS: Inter-rater reliability was good for the three
endurance of the abdominal muscles was 4.8% poorer among boys SAR tests and was not influenced by increased waist circumference.
and 8.1% higher among girls. The ratio between abdominal and low Inter-rater reliability of the SLR was acceptable although increased
back extension endurance had increased over time 11.8% among measurement error was observed with the fat-suit. All tests with
boys, and 26.4% among girls. Compared to 1968 hip flexion in 1997 the fatsuit were significantly worse than those without, supporting
was 8.3% higher in girls, while ankle dorsiflexion and aerobic fitness anecdotal evidence that increased waist circumference may affect a
in boys were 15% and 13.4% poorer. Compared to 1968 ankle subjects ability to undertake the tests, placing in doubt the validity of
dorsiflexion and aerobic fitness in girls were 4.9% poorer and 2.5% the tests in those with an increased waist circumference. Although
higher, respectively. CONCLUSIONS: The data indicate a general the study is limited by the fact that increased waist circumference
decline during one generation in physical performance among boys, a was simulated, the fact that each subject acted as their own control
decline in low back endurance, and ankle mobility among girls, and an is a strength and a unique feature of the study. Future work
increase in abdominal endurance among girls. The balance between may consider whether there is a direct relationship between waist
abdominal and low back endurance was changed to a stronger circumference and measures of hamstring flexibility. IMPLICATIONS:
abdominal dominance in both genders. IMPLICATIONS: Though Measures of hamstrings flexibility may not be valid in subjects
diverging, the data indicate a need for more physical activity in young who are overweight. KEYWORDS: hamstrings;flexibility;overweight.
people, in particular activities that may increase low back endurance, FUNDING ACKNOWLEDGEMENTS: No funding was received in
the balance between low back and abdominal muscles, and ankle support of this study. CONTACT: [email protected]
mobility in both genders, as well as activities that increase aerobic ETHICS COMMITTEE: Physiotherapy Subject Area, Queen Margaret
fitness in boys. Physical therapists working in public health may University College.
promote such activities, and add to promote patterns and structures
in the communities that fascilitate such activities. KEYWORDS:
Secular trend, physical performance, truncus balance, low back
endurance, hip mobility, ankle mobility, aerobic fitness. FUNDING
ACKNOWLEDGEMENTS: No funds have received for this study.
INTERNAL CUES IMPROVE GAIT PERFORMANCE IN PATIENTS THE EFFECT OF CONTINUOUS WALKING ON THE LOWER
WITH PARKINSON’S DISEASE LIMB KINEMATICS AND SURFACE EMG OF CHILDREN WITH
Pimentel Piemonte M, Hitori E, Xavier G; Department of Physical SPASTIC DIPLEGIC CEREBRAL PALSY
Therapy of Medical School, University of Sao Paulo Sale T1 , Cramp M2 , Shortland A1 ; 1 One Small Step Gait Laboratory,
PURPOSE: The aim of this study was to verify the efficiency of Guy’s & St. Thomas’ NHS Foundation Trust, London, UK; 2 School
internal cues coupled with motor training in improving-performance of Health and Bioscience, University of East London, London, UK
of gait and daily life activities (DLA) of PD patients. RELEVANCE: PURPOSE: This study was designed to investigate changes in lower
Strategies to minimize the gait disruption typical of patients with limb kinematics, electromyography (EMG) and perceived exertion
Parkinson’s disease (PD patients) have posed a great challenge (PE) during a 6 minute continuous walking task (6MWT) in children
for Physical Therapy Science. External cues have proven efficient with spastic diplegic cerebral palsy (SDCP). We hypothesised that
in improving some aspects of Parkinsonian gait, although further the task would induce measurable fatigue in the lower limb muscles
evidence is needed concerning the efficacy of internal cues. This and a change in the gait pattern. RELEVANCE: Parents of children
type of strategy may therefore yield significant benefits to the daily with SDCP report that fatigue is one of the most significant limitations
lives of patients, who can generate and manage their own cues to their mobility in the community. At present, we do not know
independently. PARTICIPANTS: Sixty patients with idiopathic PD if the fatigue reported is due to central or peripheral factors,
were selected for the present study complaining of gait alterations, and distinguishing these in disabled subjects may provide more
having a mean age of 68.08 years (St.Dev.= 8.24), mean duration of information to guide therapeutic intervention. PARTICIPANTS: Ten
the disease of 6.78 years (St.Dev. = 3.05), comprising 24 women and boys with SDCP, aged 8 to 16 years (10.6±2.91yrs) took part. All
36 men, with 39 at stage 2, and 21 at stage 3 of disease evolution were able to walk independently, and were classified as GMFCS
according to the Hoehn and Yahr classification.All participants level I or II. METHODS: Subjects undertook a 6MWT combined with
signed HCFMUSP institution’s Term of Free and Informed Consent. three dimensional gait analysis. Kinematics, EMG, spatiotemporal
METHODS: The patients were randomly divided into an Experimental data and PE (modified Borg CR-10) were collected on each lap
group (EG), which carried out 8 sessions (twice a week) of motor of a 33 metre circuit. The results recorded closest to each minute
training coupled with internal cues (ICT); and a Control group (CG), were analysed. ANALYSIS: 34 key variables were extracted from
which performed control training (CT) under identical conditions to the time-varying kinematic data (e.g. minimum knee flexion in single
the EG, but without the aid of cues. Internal cues consisted of support; walking speed). The amplitude and the power density
information on the sequence of movements involved in normal gait, spectrum was extracted from Fourier transformed EMG data, and
which were memorized and evoked verbally by patients while walking. the median frequency (MF) derived. Significant differences between
ANALYSIS: The (1) performance in daily-life activities according to variables gathered at different time intervals of each subject’s 6MWT
section II (DLA) of the Unified Parkinson’s Disease Rating Scale were assessed using parametric or non-parametric 2-way analysis
(UPDRS), and (2) gait performance in terms of speed to walk of variance as appropriate, and post hoc tests conducted. Statistical
20 meters, were compared before (BT), 48 hours (AT), and 3 significance was set at p<0.05. RESULTS: Continuous walking
months after the training (3mAT), using the ANOVA variance analysis did not result in any significant changes in kinematics, despite
model for repeated measurements. Those factors yielding category a statistically significant increase in PE (p<0.0001). Reduction in
differences on mean comparison then underwent the Scheffé post- MF was significant in the tibialis anterior (TA) bilaterally (p<0.05),
hoc test to verify level of significance, two by two. RESULTS: The but not in the other muscles tested. A significant reduction in the
results showed a significant improvement of performance in gait EMG amplitude of the medial gastrocnemius (MG) (p<0.005) was
with regard to speed, exclusively for the EG after ICT (ANOVA, observed bilaterally. CONCLUSIONS: The 6MWT induced classic
F=13.181; p < 0.000001), and confirmed by the post-hoc test showing signs of muscular fatigue in the TA only, in spite of a highly
significantly improved in speed prior to, 48 hours and 3 months significant increase in perceived exertion. The reduction in EMG
after end of training, solely for the ICT (BT X AT – p < 0.0000001; amplitude of the MG muscle suggests that this muscle may be
BT X 3mAT – p < 0.0000001), associated with an improvement in working close to its mechanical capacity. IMPLICATIONS: If the
performance of DLA (ANOVA, F=95.78; p < 0.000005), and confirmed MG is working close to capacity in children with SDCP when
by the post-hoc test showing significantly improved average scores walking, muscle strengthening is likely to be beneficial in increasing
prior to, 48 hours and 3 months after end of training, solely for baseline strength and thereby walking endurance. However, the
the ICT (BT X AT – p < 0.0000001; BT X 3mAT – p < 0.0000001). child’s ability to modulate their motor unit activation may limit
This performance improvement in DLA proved to be directly related the impact of a strengthening programme. Further research is
to the improvement in gait performance (r = 0.6531; p < 0.000000). required to develop techniques to quantify the relative contributions
CONCLUSIONS: Motor training coupled with internal cues leads of neurological and mechanical factors in the motor performance of
to significant improvements in gait performance compared with the this group. KEYWORDS: Cerebral palsy; fatigue; gait. FUNDING
same training without cues. IMPLICATIONS: The internal cues can ACKNOWLEDGEMENTS: This work was supported by Guy’s and
be useful in the motor rehabilitation of such patients, constituting St. Thomas’ Charitable Foundation and the Chartered Society of
a straightforward, inexpensive and swift form of training for PD Physiotherapy. CONTACT: [email protected]
patients. KEYWORDS: Parkinson’s Disease, gait, cues. FUNDING ETHICS COMMITTEE: Approved by the Brighton and East Sussex
ACKNOWLEDGEMENTS: HCFMUSP. CONTACT: [email protected] Research Ethics Committee and the University of East London Ethics
Committee.
VCEC Meeting Rooms 19-20 PP Crystal Pavilion A
THE EFFECTIVENESS OF BEHAVIORAL GRADED ACTIVITY DESIGN OF A HIGH DOSAGE MEDICAL EXERCISE THERAPY
IN PATIENTS WITH OSTEOARTHRITIS OF HIP OR KNEE: A PROGRAM FOR PATIENTS WITH UNILATERAL CHRONIC
RANDOMIZED CONTROLLED TRIAL SUBACROMIAL PAIN. A RANDOMIZED CLINICAL TRIAL
Veenhof C1 , Köke A2 , Dekker J3 , Oostendorp R4 , Bijlsma J5 , Torstensen T1 , Østerås H2 , Harms-Ringdahl K3 ; 1 Holten Institute
van Tulder M3 , van den Ende C6 ; 1 Netherlands Institute for AB, Stockholm, Sweden; 2 Sør-Trøndelag University College, Faculty
Health Services Research, Utrecht, The Netherlands; 2 University of Health Education and Social Work, Department of Physical
Hospital Maastricht, Maastricht Hoensbroek Rehabilitation Center, Therapy, N-7004 Trondheim, Norway; 3 Karolinska Institutet,
Hoensbroek, The Netherlands; 3 Institute for Research in Extramural Stockholm, Sweden
Medicine, VU University Medical Center, Amsterdam, The
Netherlands; 4 University Medical Center St. Radboud, Nijmegen, PURPOSE: Designing an effective high dosage (HD) comprehen-
The Netherlands; 5 University Medical Center Utrecht, Utrecht, The sive exercise program for patients with longstanding subacromial
Netherlands; 6 Rheumatology Centre St Maartenskliniek, Nijmegen, pain/impingement RELEVANCE: There is today no agreement what
The Netherlands type of exercises or exercise dosage is most effective for patients
with long lasting subacromial shoulder pain. PARTICIPANTS: Sixty
PURPOSE: To determine the effectiveness of a behavioral graded
one patients with unilateral subacromial pain METHODS: The high
activity program (BGA) compared to usual care (UC, mainly exercise
dosage (H)D medical exercise therapy program consisted of twenty
therapy) according to the Dutch guideline physical therapy in patients
minutes (stationary cycle, step machine), global (G) exercise, then
with osteoarthritis (OA) of hip and/or knee. The BGA intervention
four semiglobal (SG) exercises each of 3 sets og 30 repetitions
consisted of an exercise program with booster sessions, using
performing deloaded exercises specifically for the arm and the
operant treatment principles with the goal to increase activity levels in
shoulder using lateral pulley, single pulleys, incline board, angle
the long term. RELEVANCE: There is strong evidence that exercise
bench and varies sizes of dumbbells and barbells, then another
therapy has a short term benefit for patients with OA. However,
global exercise for 10 minutes, continuing with 3 new (SG) and
beneficial post-treatment effects of exercise therapy in patients with
one local (L) exercise for the arm and the shoulder, and finally
OA seem to decline and finally disappear. To enhance long term
finishing with a 10 minutes (G) cycle exercise. The low dosage (LD)
effects of exercise therapy, integration of exercise therapy with
treatment program consisted of one (G) stationary cycle exercise of
daily performed activities, based on cognitive-behavioral principles
5 to 10 minutes and then the same 5 (SG) and the one (L) exercise.
and additional booster sessions, seems promising. PARTICIPANTS:
Each exercise was performed doing only 2 sets of 10 repetitions.
A total of 200 patients were included in the study. Inclusion
In both groups the physiotherapist was present supervising the
criteria were OA of hip or knee according to the clinical criteria
of the American College of Rheumatology. METHODS: A cluster patients making sure that the exercises were performed coordinated
randomized controlled trial was performed, comparing BGA with UC. and regraded according to clinical changes during the treatment
Primary outcome measures were pain (VAS and WOMAC), physical period. A pain contingent treatment approach was applied by
function (WOMAC) and global patient assessment (GPA), which were the physiotherapist. Both treatment groups were treated 3 days
assessed by blinded research assistants, at week 0, 13, 39 and 65. per week for 3 months. The intensity of the global exercise(s)
Secondary outcome measures were, among others, physical function were similar for both groups. ANALYSIS: Differences between the
(MACTAR), walking time, and exercise adherence. ANALYSIS: Data groups were analyzed using a one-tailed Independent-Sample T-
were analysed according to intention-to-treat principle. Change test. RESULTS: The treatment time for the (HD) group varied from
scores were calculated and were compared for the two intervention 80 to 90 minutes, compared to the (LD) exercise group which
groups using Student’s t-test. In order to adjust for various covariates, varied from 20 to 30 minutes. Number of repetitions specifically
multiple linear regression analyses were performed. Additional aimed at the arm/shoulder complex for the (HD) group were 720
subgroup-analyses were performed. RESULTS: Both treatments repetitions versus 100 repetitions for the (LD) group. Time for global
showed beneficial within-group effects both in the short term and long exercise was 40 minutes for the (HD) group versus 10 minutes
term. The mean differences between the two groups for the primary for the (LD) group. The difference in exercise dosage resulted in
outcome measures pain and functional status were not statistically significant reduction in pain and improved function (p < 0.05). The
significant. Significant differences in favor of BGA were found for compliance was similar in both groups. CONCLUSIONS: A high
the functional scale MACTAR, 5 meter walking test at week 65, and exercise dosage treatment performed three times a week over 3
exercise adherence. Furthermore, significant interaction effects were months with high compliance resulted in significantly better clinical
found for the subgroup of patients according to their baseline-level of outcomes than a low dosage exercise program. IMPLICATIONS: To
physical function on the outcomes pain and physical function. This get optimal dose response effects using exercise as treatment for
means that patients with a low level of physical function at baseline improving function and decreasing pain in patients with long lasting
responded significantly better on BGA-treatment compared to UC. subacromial shoulder pain, health professions should take great care
CONCLUSIONS: Since both interventions resulted in beneficial long designing exercise programs consisting of global, semiglobal and
term effects, the superiority of BGA over UC, in general, could not be local exercises. The physiotherapist must be present in the exercise
demonstrated. However, evidence was found for the particular benefit room motivating and supporting the patient, making sure the patient
of BGA in the subgroup of patients with a low level of physical function understand why the exercise program must have a high dosage.
at baseline. IMPLICATIONS: BGA is recommended for patients with The physiotherapist must continuously help the patient re grading
OA of hip and/or knee with a low level of physical function at the exercises making sure that they are coordinated and performed
start of treatment. KEYWORDS: osteoarthritis, behavioral graded within the patients capability with a high but at all time appropriate
activity, exercise therapy, randomized controlled trial, subgroups. dosage. KEYWORDS: Subacromial pain, high dosage exercise ther-
FUNDING ACKNOWLEDGEMENTS: The study was funded by the apy, randomized trial. FUNDING ACKNOWLEDGEMENTS: none.
Dutch Health Care Insurance Board. CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: Medical Ethical Committee of the VU Medical ETHICS COMMITTEE: Human Review Committee (Trondheim,
Center, Amsterdam, The Netherlands Norway)
PP Crystal Pavilion B & C VCEC Meeting Rooms 11-12
TRAINING SITTING BALANCE EARLY AFTER STROKE: A PHYSICAL ACTIVITY MONITORING IN HEALTHY ADULTS
RANDOMIZED CONTROLLED TRIAL
Moorhead A1 , Liddle D1 , Hurley-Osing D2 , Häger-Ross C3 ,
Dean C, Channon E, Hall J; Physiotherapy, Faculty of Health Sundelin G3 , Baxter D4 , McDonough S1 ; 1 Health and Rehabilitation
Sciences, The University of Sydney Sciences Research Institute, University of Ulster, Newtownabbey,
PURPOSE: The purpose of this randomised placebo-controlled study United Kingdom; 2 Department of Community Medicine and
was to investigate the efficacy of a sitting balance training protocol Rehabilitation, Umeå University, Umeå, Sweden; 3 School of
in individuals who had suffered a stroke less than 3 months ago. Physiotherapy and Performance Science, University College Dublin,
RELEVANCE: Poor sitting balance is a common problem after Dublin, Ireland; 4 School of Physiotherapy, University of Otago,
stroke, yet sitting balance has been found to be a prognostic Dunedin, New Zealand
indicator for walking outcome. Previous work has demonstrated
PURPOSE: Physical activity is beneficial for health and well-
the efficacy of sitting balance training protocol in individuals who
being and is commonly measured using a range of physical
had suffered a stroke 2-17 years previous (Dean and Shepherd
1997). By examining the efficacy of the same protocol early after activity monitors. The aim of this study was to determine the
stroke, this research will not only expand the physiotherapy evidence validity and reliability of the activPAL™ activity monitor to measure
base but also have implications for intervention early after stroke. physical activity in a laboratory-based setting. RELEVANCE: There
PARTICIPANTS: Twelve individuals who had suffered a stroke less is currently no universally accepted benchmarking for measuring
than 3 months ago and were able to sit unsupported were recruited physical activity in patients with chronic conditions such as low back
from a rehabilitation facility. METHODS: Participants were randomly pain. Therefore the use of activity monitors will more accurately
allocated to the experimental or control group. The participants in reflect exercise adherence and patterns of activity in clinical
the experimental group completed a 2 week sitting balance training populations. PARTICIPANTS: Twenty-four healthy participants (12
protocol that involved practicing reaching tasks beyond arm’s length. males; 12 females) were recruited (age 25.5±2.2; BMI 21.8±2.2).
The control group completed a 2 week sham sitting balance training Ethical approval was obtained from the School of Health Sciences
protocol that involved practicing cognitive-manipulative tasks with Filter Committee, University of Ulster, U.K. METHODS: In an
minimal perturbation to balance. Sitting balance was measured experimental laboratory based study, the participants participated on
pre and post training as well as 6 months later by examining the two occasions, one week apart. The participants worn the activPAL™
performance of seated reaching tasks in 3 directions (ipsilateral, on their thigh and conducted a defined and timed (2 minutes) set of
forward and across). Sit-to-stand, walking and cognitive skills were activities. The activities were as follows: sitting at a computer; lying on
also measured. ANALYSIS: The immediate effects of training were a treatment bench; walking/jogging on a treadmill at 3.2, 4.5 (with and
analysed by comparing post training scores between groups using without incline), 8 km/h; cycling on an exercise bike at 45, 60, 75 rpm;
ANCOVA with the pretest score as a covariate. The retention walking at normal pace and controlled speed on flat ground; and stair
effects were analysed by comparing the 6 month scores between walking. The concurrent validity was tested by comparing the time for
groups using ANCOVA with the pretest score as a covariate. each defined activity, e.g. lying/sitting, as recorded by the activPAL™
RESULTS: Immediately after training, subjects in the experimental with those periods of activity measured by an independent observer
group performed significantly better than the control group on the at the time of recording and afterwards via video recording. An
reaching tests (p < 0.05). Experimental participants were able to independent observer recorded the number of steps to compare with
reach further and faster in all directions and were able to load those recorded by the activPAL™. ANALYSIS: Data was analyzed
their affected foot more when required by the task than the control using the Statistical Package for the Social Sciences version 11.0
group. In addition, the experimental group generated significantly (SPSS, Chicago, IL, USA). Descriptive statistics was conducted for
greater force production through their affected foot during sit-to- the demographic data and each of the variables. T-tests were used
stand than control subjects. Only 9 participants (4 Control and 5
to examine the differences between the variables. The reliability
Experimental) were available for 6 month evaluation. The significant
of the activPAL™ was tested using the limits of agreement test.
differences between the groups at 6 months were maintained for
RESULTS: The number of steps for each activity recorded by the
maximum distance reached in the diagonal directions and also
activPAL™, observer and video recording were not significantly
in force production through the affected foot during sit-to-stand.
different expect for jogging on the treadmill at 8.0 km/h (P = 0.000)
CONCLUSIONS: The sitting balance protocol used in this study was
effective immediately in improving sitting balance and sit-to-stand and walking on a treadmill with and without incline at 4.5 km/h
early after stroke. Some of the benefits were maintained 6 months (P = 0.000). The time spent sitting/lying and walking recorded by
after training. IMPLICATIONS: This sitting balance protocol should be the activPAL™ did not differ significantly from the video recording.
implemented early after stroke. KEYWORDS: Stroke rehabilitation, The inter-monitor reliability was excellent for the activPAL™, as
balance, sitting. FUNDING ACKNOWLEDGEMENTS: This project there were no significant differences between the two occasions.
was funded by a grant from the Physiotherapy Research Foundation From the limits of agreement, the activPAL™ records the same
in Australia. CONTACT: [email protected] activity on two separate occasions within the ranges of −5.19 to
ETHICS COMMITTEE: The University of Sydney and Southeastern 5.05, 95% of the time. CONCLUSIONS: The activPAL™ is valid and
Sydney Area Health Service Ethics Committtee reliable in measuring physical activity in healthy participants within
a laboratory-based setting. However, further studies are required to
test this monitor in patients in free-living environments to confirm
the clinical and research utility of this device. IMPLICATIONS: This
study will be used to design studies to test this monitor in low
back pain patients and thus may lead to better management of
low back pain. KEYWORDS: activPAL™ activity monitor; Physical
activity; Exercise. FUNDING ACKNOWLEDGEMENTS: This study
was funded by the Strategic Priority Fund, Department of Education
and Learning. CONTACT: [email protected]
ETHICS COMMITTEE: Ethical approval was obtained from the
School of Health Sciences Filter Committee, University of Ulster.
OUTCOMES OF A PHYSICAL THERAPY-DESIGNED THE RELATIONSHIP BETWEEN POSTURE, MUSCLE TONE AND
COMMUNITY EXERCISE PROGRAM FOR PERSONS WITH UPPER LIMB FUNCTION IN CHILDREN WITH BRAIN DAMAGE
PARKINSON’S DISEASE Rotem M1 , Lewitus H1 , Katz-Leurer M1,2 , Liebermann D2 ; 1 Alyn
Steffen T, Mollinger-Riemann L, Petersen C, Komassa P; Programs Hospital Jerusalem Israel; 2 Physical Therapy Department, Sackler
in Physical Therapy, Concordia University Wisconsin, Usa Faculty of Medicine, University of Tel Aviv, Israel
PURPOSE: To assess the relationship between posture and hand
PURPOSE: To measure the effects of group exercise on physical per- motor performance and muscle activity of the lower limbs in spastic
formance in persons with Parkinson’s Disease (PD). RELEVANCE: children with cerebral palsy (CP) and traumatic brain injury (TBI).
Immobility and falls are frequent complications for persons with PD. RELEVANCE: Hypertonicity in children with CP and TBI often
There is little literature addressing the long-term benefits of exercise interferes with functional activities. The associated increase in muscle
for people with PD. PARTICIPANTS: Forty-six individuals (mean tone affects control of the normal muscle patterns required for
age 70 years) diagnosed with PD were invited to participate in a locomotion and upper extremity functions. In the treatment of such
community fitness class for persons with PD. The class exercises patients, therapists make extensive use of different positions (e.g.
were developed by a P.T. Over the course of 18 months, the subjects weight bearing while standing) to reduce muscle tone since this
naturally formed three groups: 1) those who consistently participated is assumed to enhance motor function. PARTICIPANTS: A group
in the “group-exercise program” (N=15); 2) “independent exercisers,” of 20 children (Patient Group), 10 children with TBI and 10 with
those who did not participate in the program but reported exercising CP (24 male and 16 female; mean age 8+2 years) and a Control
greater than 120 minutes per week (N=15); and 3) those who Group matched for sex and age, group of 20 typically developed
reported minimal or “no exercise” (N=15). Participants reported an children, participated in the study. METHODS: Upper limb motor
functioning was assessed using the Box & Blocks test (maximal
average of 10 years since onset of PD symptoms and 7 years since
number of blocks moved from one side to other side of a box in
diagnosis of PD. METHODS: The group-exercise program included
60 sec) in sitting and standing positions. EMG was recorded (60
trunk and lower extremity stretching/strengthening followed by
sec) bilaterally from the Gastrocnemius (GA) and the Tibialis Anterior
treadmill walking (10 minutes backwards, then 10 minutes forwards). (TA) muscles while subjects were active (B&B task) and passive (no
Data were collected on tests of physical function every 2 months for upper limb action) during sitting or standing. The EMG amplitudes
a year and at 6 months after that: Six Minute Walk Test (6MWT), Gait and frequencies were used to assess changes in muscle activity
Speeds (GSs), Berg Balance Scale (BBS), Timed-Up-and-Go (TUG), ANALYSIS: Posture effect on hand motor performance and muscle
Forward Functional Reach (FFR), Backward Functional Reach (BFR), activity was analyzed using a repeated measure ANOVA model with
Sharpened Romberg (SR) Tests, and Unified Parkinson’s Disease a between subjects factor of group (patients vs. controls), a within
Rating Scale (UPDRS). ANALYSIS: For each outcome measure and subject factor of posture (sitting vs. standing), hand (preferred vs. non
each group, data analysis included descriptive statistics and serial preferred hand for motor performance) and activity (performing or not
graphing of test results with a line of best fit calculated with regression the B&B test). RESULTS: Posture significantly associated with upper
analysis. RESULTS: The line of best fit for people in the group- limb functioning (p < 0.01). Patients and controls showed superior
exercise program suggested improvement in the 6MWT, FFR, and performance with both upper limbs during standing. EMG analyses
BFR, minimal slope changes in fast and comfortable GSs, BBS, did not fully account for such effects. The mean EMG amplitude for
and SR (eyes open), and declines in SR (eyes closed), UPDRS the GA muscle tended to decrease during passive standing. For
the TA muscle, the mean EMG amplitude significantly increased
total score, and TUG performance. People who were independent
during standing (p < 0.01) both in active and passive conditions.
exercisers showed a trend toward improvement on the 6MWT and
Comparisons of the averaged spectrograms of the GA and TA
BBS, minimal changes in other functional tests, and a decline in SR
(expressed as a proportion of the EMG spectrograms obtained for
(eyes closed) and UPDRS total. There was high attrition in people the control group) showed different and complex patterns of muscle
who were categorized as non-exercisers making the interpretation activation in the CP and TBI subgroups. The GA muscle contribution
of the lines of best fit unreliable. CONCLUSIONS: This is the first of fibers firing at>300 Hz was proportionally smaller in CP children as
longitudinal study following a group of individuals with PD who compared to controls during sitting and passive standing, the TA was
exercise. The functional test results of those who exercise on a nearly reversed in sitting conditions but not during standing. In the
regular basis demonstrate not only maintenance of function but also TBI group the GA and the TA muscles presented a lower activation
progression of ambulation endurance (6MWT) and balance (FFR & at all firing frequencies. CONCLUSIONS: Changes in posture affect
BFR). The attrition rate in the non-exercisers group created limitations upper limb performance but the underlying mechanisms cannot
in the analyses. Although 18 months is a long research timeframe, be attributed to a reduction of muscle tone. Different postures
this may not be long enough to describe the effect of exercise resulted in different patterns of muscle activation for TBI and CP
for persons with PD. Inclusion of exercises specific for sit-to-stand patients. IMPLICATIONS: Treating upper limb function can be ranked
to improve TUG scores and balance activities with eyes closed to by using different postures. Although hypertonicity is a common
improve SR (eyes closed) is suggested for future exercise programs. denominator, it should not be treated as a single phenomenon in
IMPLICATIONS: Group exercise designed by physical therapists to these children in spite of similarities in their motor performance.
KEYWORDS: CP, TBI, Spasticity, Posture, Upper Limb Function.
meet individual needs of those with PD may be neuroprotective
FUNDING ACKNOWLEDGEMENTS: Alyn Hospital.
and slow the decline of function, thus reducing long-term medical
ETHICS COMMITTEE: Ministry of health in Israel
costs and improving quality of life. This raises the importance of
physical therapists designing evidence-based wellness programs for
people with disabilities. KEYWORDS: Parkinson’s Disease, Treadmill
Training, Exercise. FUNDING ACKNOWLEDGEMENTS: Greater
Milwaukee Foundation; Kickhaefer Manufacturing Fund and Elsa
Schoeneich Medical Research Fund; and the Wisconsin Parkinson
Association. CONTACT: [email protected]
ETHICS COMMITTEE: Concordia University Wisconsin, USA IRB
Research Report Platform Presentation The study was funded by the Dutch Health Care Insurance Board.
1346 Sunday 3 June 14:40 CONTACT: [email protected]
VCEC Meeting Rooms 19-20 ETHICS COMMITTEE: Medical Ethical Committee of VU University
FACTORS INFLUENCING THE SUCCESS OF BEHAVIORAL Medical Center, Amsterdam, The Netherlands
GRADED ACTIVITY IN PATIENTS WITH OSTEOARTHRITIS OF
HIP OR KNEE: A QUALITATIVE STUDY Research Report Platform Presentation
Veenhof C1 , van Hasselt T1 , Köke A2 , Dekker J3 , Bijlsma J4 , van 2085 Sunday 3 June 15:00
den Ende C5 ; 1 Netherlands Institute for Health Services Research, PP Crystal Pavilion A
Utrecht, The Netherlands; 2 University Hospital Maastricht, HIGH DOSAGE ENDURANCE TRAINING INCREASED MUSCLE
Maastricht Hoensbroek Rehabilitation Center, Hoensbroek, The STRENGTH AND RANGE OF MOTION SIGNIFICANTLY IN
Netherlands; 3 Institute for Research in Extramural Medicine, VU PATIENTS WITH LONG LASTING SUBACROMINAL PAIN
University Medical Center, Amsterdam, The Netherlands; 4 University
Medical Center Utrecht, Utrecht, The Netherlands; 5 Rheumatology Haugerud L1 , Østerås H2 , Østerås B3 , Torstensen T4 ; 1 Moholt
Centre, St. Maartenskliniek, Nijmegen, the Netherlands Physical Institute, Trondheim, Norway; 2 Rosenborg Sport Clinique;
3 Melhus Physical Institute; 4 Holten Institute, Stockholm, Sweden
PURPOSE: To investigate why certain patients treated with Be-
havioral Graded Activity (BGA) successfully integrate activities in PURPOSE: Comparing two different types of exercise programs
their daily lives and others do not. RELEVANCE: Recently, a effects on muscle strength and range of motion in patients with long
randomized controlled trial was conducted on the effectiveness lasting subacromial shoulder pain. RELEVANCE: There is conflicting
of BGA in patients with osteoarthritis (OA) of hip and/or knee, evidence what type of training is best for improving impairments
compared to usual care (UC; exercise and advice, according to like muscle strength and range of motion. PARTICIPANTS: 61
the Dutch guideline for physical therapy). The BGA intervention is patients with unilateral subacromial pain. METHODS: Multi center,
performed by physiotherapists, aims to increase activity in the long randomized controlled trial, where patients were randomly assigned
term and consists of an exercise program with boostersessions, either to a high dosage (HD) endurance training medical exercise
using operant treatment principles. Both interventions had beneficial therapy group (n=30) or to a low dosage (LD) exercise therapy
effects on pain, physical function, and patient global assessment, group (n=31). Patients in the HD group performed a total of 11
both in short and in long term. However, some patients benefitted exercises consisting of 3 global exercises using a stationary bike
more from BGA compared to others. PARTICIPANTS: We invited a and 8 semiglobal and local exercises doing 3 sets of 30 repetitions
sample of participants treated with BGA to participate in this study. of each exercise, a total of 80-90 minutes. The LD group performed
Patients were included in the original trial if they were diagnosed a global exercise once for 10 minutes and performed 5 semiglobal
to have OA of the hip or knee according to the clinical criteria and local exercises doing 2 sets of 10 repetitions of each exercise,
of the American College of Rheumatology. For the present study, a total of 20–30 minutes. Both groups received 3 treatments a
we selected two sub-samples of patients based on their success week over 3 months. Patients were assessed at inclusion, end of
of treatment as assessed on patient global assessment (PGA). treatment and at 6 months follow up where isometric strength in
One group of patients were selected with a low score on PGA flexion, abduction, internal and external rotation was measured using
(ranging from completely recovered to improvement), and one group a using a digital dynamometer (MicroFET2, Westloch, Sweden).
of patients with a high score on PGA (ranging from worsened to vastly Active range of motion was measured using a digital inclinometer
worsened). METHODS: A qualitative study was performed, based (Dualer IQ, JTech Medical, USA. ANALYSIS: Differences between
on open-ended in-depth interviews with 12 patients. A conservation the groups were analyzed using a one-tailed Independent-Sample
developed from the themes ‘aspects related to the content of T-Test. RESULTS: There were no statistical differences between the
the BGA treatment’, ‘aspects related to experiences with physical two groups at baseline. During treatment 5 patients (8%) dropped out,
therapists’, and ‘aspects related to the patient’ and subsequent and another 10 patients dropped out at follow-up. At end of treatment
questions were more specified. Data collection stopped after 12 and at 6 months follow up the group receiving endurance training
interviews; no new relevant data seemed to emerge during the last as HD medical exercise therapy group came out significantly better
interviews. ANALYSIS: The method of data analysis was based (p < 0.05) compared to the LD group with improved isometric strength
on a grounded theory approach. Initially, interview transcripts were of abduction and external rotation and range of motion of flexion and
read to identify conceptual themes in the text which were then abduction. CONCLUSIONS: In patients with long lasting uncompli-
coded. The codes in each interview were then compared and cated subacromial pain, endurance training like HD medical exercise
codes expressing related concepts were grouped together to create therapy resulted in significantly improved muscle strength and range
broader categories that linked codes across interview. RESULTS: of motion. compared with an exercise program using number of
The findings from this study suggest that two factors influenced the repetitions and sets similar to strength training. IMPLICATIONS:
compliance of patients treated with BGA. First, patients’ motivation for Physiotherapists practicing low dosage exercise programs with only
long-term goals seemed to relate to a higher compliance of patients. 2 sets of 10 repetitions should increase their exercise dosages to get
Secondly, an active involvement of patients during the treatment- better clinical effects. However, there is a need for research regarding
process seemed to relate to a higher compliance. CONCLUSIONS: the mechanisms behind these results understanding why patients
Although the involvement of patients in the treatment process is with pain increases both isometric muscle strength and range of
already part of the BGA protocol, it would be beneficial to emphasize motion so significantly to an endurance type exercise program.
the importance of an active involvement of patients right from the KEYWORDS: shoulder pain, muscle strength, range of motion,
start of the treatment. Furthermore, to increase the success of randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
treatment, physical therapists should gain a clear understanding None. CONTACT: [email protected]
of the patients’ motives for treatment and, subsequently, physical ETHICS COMMITTEE: Regional Ethics Committee, Norway
therapists can make use of the knowledge of these motives when
making a choice for a specific intervention. IMPLICATIONS: The
expanded knowledge and information provided from this study can be
useful in the implementation and application of the BGA treatment.
Besides an active involvement of the patients, physical therapists
should consider patients’ preferences/values at the start of treatment.
KEYWORDS: osteoarthritis, behavioral graded activity, qualitative
study, success of treatment. FUNDING ACKNOWLEDGEMENTS:
PP Crystal Pavilion B & C VCEC Exhibit Hall A
CHANGING PATTERNS OF DUAL TASK BALANCE RELATIONSHIPS BETWEEN PHYSICAL ACTIVITY AND SUN
PERFORMANCE AMONG PEOPLE WITH STROKE AT SIX AND PROTECTION IN AN ADULT STUDY POPULATION
12 MONTHS AFTER DISCHARGE FROM HOSPITAL
Wilson C1 , Pandeya N2 , Green A2 ; 1 University of Queensland (UQ)
Hyndman D1 , Ashburn A1 , Yardley L1 , Fitton C1 ; 1 The Stroke Brisbane, Australia; 2 Queensland Institute of Medical Research
Association Rehabilitaton Research Centre, University of (QIMR) Brisbane, Australia
Southampton, Southampton, UK
PURPOSE: The primary aim of this study was to assess the physical
PURPOSE: This prospective experimental study explored the extent activity practices of an adult community with the objectives of: 1. Ex-
and nature of changes in balance performance among people amining associations between skin cancer, sun protection (sunscreen
with stroke when challenged by dual tasks at six and 12 months and hat use in particular) and physical activity. 2. Analysing other
post discharge from hospital. RELEVANCE: Amelioration of balance possible associations with physical activity, including demographic
impairments and fall prevention are important goals of stroke factors, body mass index, fruit and vegetable intake, alcohol and
rehabilitation. Cognitive motor interference has been linked to smoking. RELEVANCE: A lot of physical activity takes place
poor recovery and falls but little is known about the patterns of outdoors. Examining the sun protective patterns of people and other
recovery of dual task balance ability. PARTICIPANTS: This study variables such as body mass index, occupation, education and
was part of a larger project for which consecutively admitted attitudes in relation to physical activity levels is important to build
people with stroke were recruited at discharge from hospital. Fifty- the emerging evidence base on the benefits of physical activity
four participants (38 men, 16 women; mean age 66.6 sd. 11.6) and the dangers of sun exposure, and to drive clinical practice
attended both assessment sessions (at six and 12 months post in terns of appropriate therapeutic exercise prescription in relevant
discharge) at a gait laboratory. Of these, 25 had left and 29 had right settings. PARTICIPANTS: This study was nested within a skin cancer
hemisphere infarctions. Twenty-three participants reported repeated prevention trial in Queensland, a longitudinal study that has been
falls. METHODS: Ethics approval was obtained from Southampton ongoing since 1986. A total of 963 people (99.2% response rate)
and South West Hampshire Local Research Ethics committee.
completed this study. METHODS: This cross sectional descriptive
Participants completed assessments of attention, balance, functional
study used data collected by self-administered questionnaire.
ability and fall history. Postural sway was examined using a Kistler
Additional information on sun protection and socio-demographic
Force plate during quiet standing (under three conditions: preferred
variables was provided from data collected in previous questionnaires
stance, feet together and eyes closed). Tasks were performed
between 1986 and 2002. ANALYSIS: Data analysis was carried
in isolation (multiple baselines) and whilst performing a cognitive
out using the statistical packages SPSS and SAS. Multinomial
task. ANALYSIS: Statistical significance was tested using repeated
logistic regression was used to verify the assocation between
measures ANOVA. RESULTS: Whole sample: Between 6 and
individual variables and the outcome variable(physical activity) whilst
12 months sway reduced for preferred stance (P < 0.05), feet
controlling for other predictor variables.The final multivariate model
together (P < 0.01) but not for the eyes closed condition (P > 0.05).
was then analyses and reported with adjusted odds ratios, confidence
At six months, the competing task influenced sway (P < 0.05)
intervals and significance levels for associations with ‘some’ and
during feet together and sway (P < 0.05) and cognitive performance
‘sufficient’ physical activity. RESULTS: Twenty nine per cent of
(P < 0.01) during the eyes closed condition. At 12 months sway
and cognitive performance were unaffected by the competing task people, consisting of a similar proportion of males and females,
(P > 0.05) under any of the balance conditions. Repeat-fallers: A met the current international health related guideline of ‘sufficient
interaction was noted for the dual task eyes closed condition; time and sessions’ of physical activity. The proportion of people
while sway decreased over time among non-repeat-fallers, sway meeting this guideline increased progressively with age (p = 0.01).
increased among repeat-fallers (F=5.3, P = 0.028). At 12 months, Twenty six per cent (22% men and 28% women, p = 0.05) were
dual task cognitive performance during the eyes closed condition physically inactive or sedentary. These results compare unfavourably
deteriorated among repeat-fallers (F=11.7, P = 0.004); the interaction with what is considered already low rates in the overall Australian
in comparison to non-repeat-fallers just missed significance (F=4.1, population and other industrialised nations. Meeting the health
P = 0.05). CONCLUSIONS: While dual task performance influenced guideline for sufficient physical activty was associated with a highly
sway and cognitive performance during the more demanding balance significant increase in the use of sunscreen and hats (p 0.001).
situations at six months, most participants were able to cope with The association of skin cancer with level of physical activity was
competing tasks by 12 months post discharge from hospital. Repeat- examined after adjusting for age. People who met the guideline
fallers were less able to perform the more demanding dual task for sufficient activity were significantly almost twice as likely to
balance tasks. IMPLICATIONS: Recovery of motor and cognitive have skin cancer compared to sedentary people (AOR = 1.92,
performance should be considered together in rehabilitation to 95% CI =1.21 to 2.75). CONCLUSIONS: This is the first study to
identify clinically significant balance deficits that may be masked explore physical activity practices in a fixed cohort involved in a
under single task conditions. Dual task balance ability should be skin cancer prevention trial, and to examine the associations of sun
considered when assessing fall risk. Further research is needed protection practices and other variables with physical activity levels
to explore whether those prone to instability and falls benefit from in adults. Only 29% of people were sufficiently active, or in other
intervention to improve dual task balance ability in the later stages of words, over 70% of this population were either inactive or not doing
recovery post stroke. KEYWORDS: Stroke, Community, Dual tasks. enough activity to acquire health benefits. IMPLICATIONS: Physical
FUNDING ACKNOWLEDGEMENTS: This project was funded by activity is a cornerstone of chronic disease prevention strategy. The
The Stroke Association. CONTACT: [email protected] need to promote greater participation in physical activty is urgent
ETHICS COMMITTEE: Southampton and South West Hampshire and physiotherapists have a vital role in providing expertise and
Local Research Ethics Committee. leading public health initiatives. KEYWORDS: self -report, physical
activity, guidelines, sun protection, health benefits, health risks.
FUNDING ACKNOWLEDGEMENTS: This study was done in partial
requirement for the award of the Masters of Public Health at the
University of Queensland. No funding was received to carry out the
study. CONTACT: [email protected]
ETHICS COMMITTEE: Queensland Institute of Medical Research
VCEC Meeting Rooms 11-12 VCEC Meeting Rooms 19-20
SHOULDER MUSCLE ACTIVITY DURING MAXIMAL ISOMETRIC PATIENTS’ PERCEPTIONS OF OUTCOME IN A RCT EXAMINING
CONTRACTIONS THE EFFECTS OF HYDROTHERAPY AND SHORT-WAVE
DIATHERMY FOR RELIEF OF OSTEOARTHRITIC SYMPTOMS
Boettcher C1 , Ginn K1 , Cathers I2 ; 1 Faculty of Medicine, The
University of Sydney, Sydney, Australia; 2 Faculty of Health Cusack T1 , McAteer M1 , Daly L2 , McCarthy C3 ; 1 UCD School
Sciences, The University of Sydney, Sydney, Australia of Physiotherapy and Performance Science, Health Sciences
Centre, Belfield, Dublin 4, Ireland; 2 UCD School of Public Health
PURPOSE: 1) To identify a series of tests that could be used to and Population Science, Health Sciences Centre, Belfield, Dublin
produce maximal activation for shoulder muscles during isometric 4, Ireland; 3 Department of Rheumatology, Mater Misercordiae
contractions, and 2) to quantify the relative electromyographic (EMG) University Hospital, Dublin 7, Ireland
activation of these muscles during maximum effort isometric tests.
RELEVANCE: A detailed understanding of shoulder muscle activity PURPOSE: Hydrotherapy and continuous short-wave diathermy
is necessary to assist in developing improved shoulder examination (CSWD) are frequently used by physiotherapists to relieve the
and rehabilitation techniques. Maximal voluntary contractions (MVC) symptoms associated with osteoarthritis (OA) of the knee. The
have frequently been used to normalize recorded data when primary aim of this work was to quantitatively examine the effect of hy-
examining muscle activity of the shoulder with electromyography drotherapy and CSWD, however it was considered equally important
(EMG). Currently there are no standardized techniques for producing to examine patients’ perceptions of their physiotherapy programme
MVCs for shoulder muscles and therefore comparisons of results and the subsequent results of that programme. RELEVANCE: In
from different studies are difficult. PARTICIPANTS: The dominant order to define what patients consider important in terms of treatment
shoulder of 15 normal subjects between the ages of 18 and 50 outcome they must be asked directly. This study examined the
years was examined. METHODS: EMG activity was recorded from effectiveness of the study interventions in terms of patient responses
13 shoulder muscle sites using surface and intramuscular electrodes. gained at study completion. PARTICIPANTS: Patients aged between
Rotator cuff muscles (supraspinatus, infraspinatus, upper and lower 50-70 years, presenting with osteoarthritis of their knees were
subscapularis), scapulothoracic muscles (serratus anterior, upper, identified as potentially suitable for entry to the study from the
physiotherapy department waiting list. Patients were asked to give
lower and middle trapezius), and axio/scapulohumeral muscles
informed written consent and were screened for inclusion prior to
(anterior, middle and posterior deltoid, pectoralis major, latissimus
participation. METHODS: Following a self-management programme
dorsi) were examined. Maximum isometric contractions in 15
of education and exercise, patients were randomised to one of four
shoulder positions were performed in randomized order. Shoulder
groups: combined hydrotherapy and CSWD, hydrotherapy alone,
positions were selected for examination on the basis of their common
CSWD alone and a control group that had neither intervention.
usage and previous research. ANALYSIS: Maxima of rectified and
On completion of the study, structured interviews were undertaken
low pass filtered (8th order, 3Hz) EMG were determined for all
and tape-recorded by an independent observer unknown to the
muscles during all test positions. Repeated measure ANOVAs were
patient. ANALYSIS: The interviews were then transcribed and
used to compare the activity level in all the muscles in all test
analysed according to a grounded theory approach. This involved
positions. Pairwise comparisons of maxima were also undertaken
the identification and coding of recurring themes though out the
using linear regression analysis. RESULTS: Isometric contractions
data. Patients’ perceptions of the interventions which they received,
in four test positions is adequate to reliably generate an MVC from
together with any changes which they identified as occurring as
all 12 muscles examined (p < 0.05). As well, axio/scapulohumeral a result of these interventions, were analysed. RESULTS: Sixty
muscles were most active during positions requiring them to act patients completed the study, n=15 in each group. Twenty-six of the
as torque producers. Scapulothoracic muscles were most active in 30 patients that had hydrotherapy as a component of their treatment
mid shoulder range test positions in which resistance was performed programme indicated that they had benefited from their programme
with a long lever arm. Rotator cuff muscles were most active during in terms of pain reduction and improved mobility, twenty-three of
resisted rotation tests and in mid shoulder range test positions in the patients indicated that hydrotherapy was the most beneficial
which resistance was performed with a long lever arm. As well, component of their programme. Patients acknowledged that they
rotator cuff, scapulothoracic, and axio/scapulohumeral muscles were enjoyed the experience and indicated that they would continue to
found to have highly linear relations in their levels of activation in the exercise in their local swimming pool. Patients that had CSWD as
15 tests performed e.g. supraspinatus and infraspinatus (R2=0.76), a component of their treatment programme were more likely to
supraspinatus and lower trapezius (R2=0.86), and supraspinatus and indicate that they had increased pain and poorer mobility. In all groups
middle deltoid (R2=0.63). CONCLUSIONS: A parsimonious set of patients (n=23) identified that the self-management programme was
standardized tests for generating MVCs for shoulder muscles has beneficial in terms of increasing their awareness and understanding
been identified. As well, results indicate that maximum isometric of OA while improving their mobility and stimulating them to continue
shoulder tests performed in mid-range shoulder positions require to exercise regularly. CONCLUSIONS: Hydrotherapy resulted in a
high levels of activity in the torque producing axio/scapulohumeral greater degree of patient satisfaction in terms of pain relief and
muscles as well as in muscles that stabilize the humerus at the improved mobility than did CSWD, this concurred with the results
shoulder joint and in the muscles that maintain the position of the of the quantitative RCT. The structured self-management programme
scapula. The high correlation of activation levels in shoulder muscles was clearly recognised by patients as valuable and patients indicated
during isometric MVC reinforces the crucial dynamic support function in several instances that they intended to modify their behaviour in
of the rotator cuff and scapulothoracic muscles in normal shoulder the future to include more exercise. IMPLICATIONS: Patients were
function. IMPLICATIONS: A standardized set of test positions for clearly perceptive in terms of recognising the beneficial components
generating MVCs will assist in future research. Results also illustrate of their treatment programme. This is clinically important since
that shoulder muscles need to be trained in dynamic stabilizing as physiotherapists frequently strive to encourage patients to modify
well as torque producing roles when designing improved examination, their behaviour for their long term benefit. It is evident from this
rehabilitation and training programmes. KEYWORDS: shoulder, elec- work that when patients perceive there has been a positive benefit
tromyography, MVC. FUNDING ACKNOWLEDGEMENTS: None. they certainly express intention to modify their behaviour in the
CONTACT: [email protected] future. KEYWORDS: Qualitative; Hydrotherapy; Continuous short-
ETHICS COMMITTEE: The University of Sydney Human Research wave diathermy. FUNDING ACKNOWLEDGEMENTS: This work was
Ethics Committee in part funded by the Coyle Hamilton Bursary presented annually
by the Irish Society of Chartered Physiotherapists. CONTACT: Research Report Platform Presentation
ETHICS COMMITTEE: Research Ethics Committee Mater Misericor- PP Crystal Pavilion B & C
diae Hospital, Eccles Street, Dublin 7 THE RELATIONSHIP BETWEEN FATIGUE, AEROBIC FITNESS,
AND BALANCE PERFORMANCE IN PEOPLE WITH CHRONIC
STROKE. A PILOT STUDY
Research Report Platform Presentation Tseng B, Kluding P; University of Kansas Medical Center, Kansas
2824 Sunday 3 June 15:20 City, Kansas USA
THE INITIAL EFFECTS OF A SHOULDER MOBILIZATION WITH PURPOSE: The purpose of this pilot study was to explore the
MOVEMENT ON PAINFUL SHOULDERS relationship between fatigue, aerobic fitness, and postural control
in subjects with various stroke severities in the lower extremity.
Teys P; The University of Queensland Brisbane Queensland,
RELEVANCE: Fatigue is a common complaint among people
Australia
with chronic stroke. Previous research has suggested that post-
PURPOSE: Mulligan’s mobilizations with movements (MWM) are stroke fatigue can impact negatively on daily functions such as
frequently advocated for the treatment of painful shoulders. The walking ability or balance, which may increase the risk of falling.
objective of this study was to investigate the initial effects of a Falls in people with chronic stroke represents a major public
glenohumeral MWM technique on shoulder range of movement health problem, however, despite the fact that many fall risk
(ROM) and pressure pain threshold (PPT) in patients with anterior factors have been addressed, the relationship between post-stroke
shoulder pain. RELEVANCE: There is a dearth of high-quality trials fatigue, aerobic fitness capacity, and balance deficits has not
that support or refute the use of physiotherapy in shoulder pain. been investigated. PARTICIPANTS: Nine subjects were recruited (2
Mobilisation with movement (MWM) is a class of manual therapy males/7 females, mean age=56.78(±11.20) years; mean post-stroke-
techniques that is widely used in the management of musculoskeletal time=3.96(±4.61) years). Subjects with Fugl-Myer-Lower-Extremity
pain. To date, no studies have investigated the effects of the MWM (FMLE) score between 0-28 were placed in the moderate/severe
in people with shoulder pain and reduced ROM. The aim of this group; 29 and above in the mild group. METHODS: A Six-Minute-
study was to evaluate the effect of a MWM on shoulder ROM Walk(6MW) test was performed to induce fatigue between two trials
and PPT. PARTICIPANTS: Twenty-four participants (11 male and of limits-of-stability(LOS) test without rest. The FMLE score, 6MW
13 female) aged between 20 and 64 years (mean 46.1 years SD distance, change in LOS completion time, and fatigue index(FI) were
+ 9.86) were included in the study. The primary inclusion criterion recorded. The peak oxygen uptake(VO2peak) value was recorded
was the inability to elevate the arm greater than 100º because of on a separate visit. ANALYSIS: Analysis of Variance(ANOVA) was
the presence of pain over the anterior aspect of either shoulder. used to determine the differences in VO2peak, 6MW distance,
The duration of pain had to be greater than one month to ensure and LOS-time-change between the mild and the moderate/severe
that there was an established shoulder condition and less than one group. Pearson Product Correlation Coefficient was used to analyze
year to limit the study population to those whose pain was not likely the correlations between LOS-time-change, fatigue index(FI), and
to a result of such conditions as recalcitrant frozen shoulder. The VO2peak in all subjects. RESULTS: The mean VO2peak was
main exclusion criterion was shoulder pain that was deemed not 12.91(±3.697) ml/kg/min, 6MW distance was 969.44(±562.28) feet,
to be musculoskeletal in origin. METHODS: A repeated measures, the mean change in LOS-time was 4.44(±26.66) seconds, and the
cross-over, double-blinded randomized, placebo controlled trial was mean FI was 5.33(±2.00). Both FI and 6MW distance and showed
conducted to evaluate the initial effects of a shoulder MWM on a strong correlation with LOS-time-change (r = 0.768, r = −0.682,
ROM and pain. The outcome measures (dependent variables)
p = 0.05). VO2peak did not show significant correlation with LOS-
used were range of glenohumeral elevation in the plane of the
time-change (r = −0.416, p = 0.266) but a consistent moderate
scapula and PPT over the anterior shoulder, measured before and
negative correlation was observed. No significant difference was
after the application of MWM, sham and control conditions. Two
found in VO2peak (p = 0.568), 6MW distance (p = 0.424), or LOS-
independent variables were incorporated in the research design;
time-change (p = 0.398) between the two groups with different stroke
treatment condition (MWM, sham, control) and time (pre-, post-
severity. CONCLUSIONS: Our preliminary findings indicate that
application). Prior to analysis, the average of triplicate measures of
postural control can be negatively affected by the degree of fatigue
ROM and PPT were calculated. ANALYSIS: A two-factor analysis of
induced by distance walking in stroke survivors with diminished
variance (ANOVA) and appropriate post-hoc tests of simple effects
were then performed on each of the two dependent variables to aerobic fitness, regardless the stroke severity level. More specifically,
test the hypothesis that MWM produced changes in excess of sham the better the endurance, the more efficient the postural control; while
and control from pre- to post- application. (P < 0.05). RESULTS: the greater the fatigue detected, the less precise the postural control
ROM demonstrated a significant mean improvement of 16º pre- to after a fatigue-inducing activity. In addition, our observations also
post-treatment application compared with 3.9º for sham application suggested that the validity of testing people post-stroke using cycle
and 0.27º for the control condition. PPT demonstrated a significant ergometer may be dependent on subject’s stroke severity in the lower
mean improvement of 62.5 KPa pre- to post-treatment application extremity. Because of the difficulty on cycle ergometer, future studies
compared with 25.9 KPa for the sham application and 20Kpa for should consider using a total-body-recumbent-stepper(TBRS) to
the Control. CONCLUSIONS: The results from this study indicate perform maximal graded exercise test in people with moderate/high
that the shoulder MWM may be a useful manual therapy technique stroke severity. IMPLICATIONS: Improving aerobic fitness may
to apply to patients with a painful limitation of shoulder elevation. It increase the resistance to fatigue or delay the onset of fatigue in
has been demonstrated that an improvement in ROM occurs after people with chronic stroke. Since fatigue is a complex measure with
application of the technique. Further studies need to be performed to multiple components, the relationship between aerobic fitness, onset
investigate the duration of these effects over time. IMPLICATIONS: of fatigue, and postural control in people post-stroke will require
This study indicates that the MWM has positive application in component-specific instruments and standardized fatigue-inducing
the treatment of painful shoulder s KEYWORDS: Musculoskeletal, method in future investigations. KEYWORDS: stroke, fatigue,
manual therapy, shoulder pain. FUNDING ACKNOWLEDGEMENTS: postural control. FUNDING ACKNOWLEDGEMENTS: Unfunded.
None. CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: The University of Queensland’s Medical ETHICS COMMITTEE: Human Subject Committee of University of
Research Ethics Committee Kansas Medical Center.
VCEC Ballroom A VCEC Exhibit Hall A
DEVELOPING COMPREHENSIVE MODELS OF CARE FOR KNOWLEDGE OF STROKE AMONG HYPERTENSIVE PATIENTS
ARTHRITIS: PATIENT PERSPECTIVES IN THE TANGA REGION, TANZANIA
MacKay C, Veinot P, Badley E; Arthritis Community Research Rhoda A, Tesha J; University of the Western Cape, Bellville, South
and Evaluation Unit, Toronto Western Research Institute, Toronto, Africa
Canada
PURPOSE: The need for knowledge relating to the nature of stroke
PURPOSE: The objectives of this study are to explore the impact and risk factors for stroke is still a substantial challenge in the world.
of arthritis on people living with the disease, and their perspectives People with disabilities following stroke are lacking rehabilitation
on health care delivery, including the acceptability of expanded roles services in developing countries due to various reasons which include
of health care providers such as physiotherapists in the provision lack of knowledge about stroke and the provision of rehabilitation
of specialist and community-based care. RELEVANCE: Arthritis is services.The aim of this study is to determine the knowledge of stroke
a serious, disabling chronic condition for which there is no cure. amongst hypertensive patients. This inluded determining knowledge
Pressure on access to services, and the need to manage the of the risk factors, signs and symptoms of stroke. RELEVANCE:
long-term consequences of arthritis, is leading to the development Knowledge of stroke amongst at risk groups is important in the
of alternative models of care and new roles for physiotherapists. prevention of stroke and in decreasing its impact. and Results of
Incorporating the perspectives of people with arthritis is critical to this study revealed that the particpants had a low knowledge of
developing client-centred health care. PARTICIPANTS: Adults 18 stroke. This information could be used by health professionals to
years and older with a diagnosis of arthritis in Ontario were included. implement health prevention and promotion programmes relating
Participants were recruited through a community rehabilitation to stroke and hypertension. Rehabilitation professionals could also
program, postings at rheumatologists’ and primary care physicians’ use it to incorporate health education into their treatment regimes.
offices and consumer groups. METHODS: A qualitative method PARTICIPANTS: The study population comprised of all adult patients
using semi-structured interviews with an interview guide was utilized. with a known diagnosis of hypertension, attending the selected
Interviews were recorded and transcribed verbatim. ANALYSIS: hospitals for treatment and follow-up. Two hundred and fifty six
Data were analyzed using a constant comparative approach to patients with hypertension were conveniently selected to partake
identify common themes. RESULTS: Nineteen people participated in the study. METHODS: A descriptive quantitative design using
in the study. The majority of participants were female (17) and a cross-sectional survey was used to collect data in the present
study. A structured self-administered questionnaire with both close
had various types of arthritis, including rheumatoid arthritis and
and open ended questions was used for data collection. This
osteoarthritis. Participants had limited disability with a mean score of
questionnaire was adapted by the researcher, from the previously
0.7, as measured by the Modified Health Assessment Questionnaire.
used questionnaires by Wellwood et al (1994), Yoon et al (2001)
As well as pain and loss of mobility, the impact of arthritis
and Bogoshi et al (2003) which assesses knowledge and perception
on participants’ lives included loss and change related to their
of stroke as well as knowledge of stroke risk factors. The adapted
independence and sense of identity, in particular in relation to work.
questionnaire was distributed to collegues in the field of stroke to
Leisure activities such as sports and hobbies were often either
ensure content valididty.The participants completed the questionnaire
modified or avoided. Participants often relied on their families for
in the presence of the researcher and trained research assistants.
help with daily activities and emotional support. Participants identified
ANALYSIS: The Statistical Package for Social Scientist (SPSS)
concerns about access including long waits for appointments and
version 13 and the Statistical Analysis System (SAS) version 9.1 were
lack of coordination between the health care system and community employed in the analysis. These statistical tests were used to identify
resources. Participants identified a number of aspects of client- the relationship between the knowledge of stroke and the socio-
centred care important to help them manage their disease. A demographic characteristics. The Kruskal-Wallis test was used to
trusting and supportive relationship with one’s health care provider establish the relationship between and within the knowledge of stroke
was identified as being important in decision-making to be able and the socio-demographic groups. RESULTS: Large numbers of the
to take charge of the disease. Health care provider characteristics particpants had a low level of knowledge of the risk factors (n=47.2%),
such as empathy, knowledge and expertise in arthritis were also the signs (n=43.4%) as well as the symptoms (n=42.2%)of stroke
identified. Education, emotional support, continuity of care, and A statistical significance was found between the knowledge of the
coordination of services were identified as important components risk factors of stroke and age, level of education and employment
of health care delivery. The majority of participants were open to status (p < 0.05). CONCLUSIONS: Patients with hypertention in the
receiving more of their care from health care providers, such as Tanga region of Tanzania have low levels of knowledge of risk
physiotherapists working in expanded roles. CONCLUSIONS: The factors, signs and symptoms of stroke. Health education programmes
physical and emotional strains of living with a chronic condition and need to be implemented to increase these patients’ knowledge of
challenges in accessing the needed services are important threats stroke. This could decrease the occurance and consequesnces of
to well-being for patients with arthritis. Participants were receptive to stroke in this population. IMPLICATIONS: Physiotherapists need
emerging roles of health care providers, such as physiotherapists, in to implement health education programmes to improve the level
arthritis care. IMPLICATIONS: With the growing burden of arthritis, of knowledge of stroke in at risk groups. KEYWORDS: Stroke,
physiotherapists can play a key role in promoting wellness and knowledge, education. FUNDING ACKNOWLEDGEMENTS: None.
disease management. Physiotherapists should be aware of patients’ CONTACT: [email protected]
experiences of living with chronic disease and their perspectives on ETHICS COMMITTEE: University of the Western Cape, Senate
optimal care delivery. There is opportunity for the development of research grants and study leave committee
advanced practice roles for physiotherapists to improve delivery of
services for people with arthritis. KEYWORDS: Qualitative methods,
Arthritis, Models of Care. FUNDING ACKNOWLEDGEMENTS: This
Project was funded by the Ontario Ministry of Health and Long-Term
Care. Views expressed in this presentation are not the views of the
Government of Ontario. CONTACT: [email protected]
ETHICS COMMITTEE: University Health Network Research Ethics
Board, Toronto, Canada
PERCEIVED EXERTION DURING ARM CRANK EXERCISE IN EVALUATING THE BENEFITS OF GROUP EXERCISE
PARAPLEGIC AND ABLE-BODIED MEN AND GROUP EXERCISE & EDUCATION PROGRAMS FOR
Hedlund M1 , Sojka P2,3 , Karp K3 ; 1 Department of Community INDIVIDUALS WITH PARKINSON’S DISEASE (PD)
Medicine and Rehabilitation (Physiotherapy), Umeå University, Klassen L1 , Dal Bello-Haas V1 , Sheppard M2 , Metcalfe A3 ; 1 School
S-901 85 Umeå, Sweden; 2 Department of Community Medicine and of Physcial Therapy, University of Saskatchewan, Saskatoon,
Rehabilitation (Rehabilitation Medicine), Umeå University, S-901 Canada; 2 School of Physical Therapy, University of Saskatchewan,
85 Umeå, Sweden; 3 Department of Surgery and Peri-Operative Saskatoon, Canada; 3 Saskatoon Health Region, Royal University
Science (Clinical Physiology), Umeå University Hospital, Umeå Hospital, Saskatoon, Canada; 4 Department of Community Health
University, S-901 85 Umeå, Sweden and Epidemiology, University of Saskatchewan, Saskatoon, Canada
PURPOSE: To elucidate similarities and differences in ratings of PURPOSE: To evaluate the benefits of a group exercise program
perceived exertion (RPE) and physiological responses in paraplegic and a group exercise & education program for community-dwelling
and able-bodied individuals during an exercise test. RELEVANCE: adults with early and mid stage PD. RELEVANCE: Individuals with
Regulating exercise intensity using Borg’s RPE scale has been PD may benefit from community programs promoting self-efficacy
extensively studied in able-bodied healthy people during various in the management of this chronic condition. There is currently
types of exercises. As a result, the RPE scale is considered to be a limited evidence of the benefits of combined exercise and education
reliable tool for regulating exercise intensity for training prescriptions programs for this population. PARTICIPANTS: Twenty-two (16 male)
for able-bodied subjects. Studies on perceived exertion in spinal cord individuals who completed a University of Saskatchewan Bio-
injured individuals are scarce and it has not yet been clearified medical Research Ethics Board approved consent form participated.
if RPE scale could be used in subjects with spinal cord injuries. Participants were 63.86 + 7.9 years of age, had been diagnosed
PARTICIPANTS: Six men with paraplegia (PARA) and six able- 4.64 + 4.5 years prior to admission to the study, and presented
bodied (AB) men were matched with respect to age, length and with Hoehn and Yahr Classification of Disability stage one (12),
body mass. METHODS: The subjects performed a discontinued, stage two (6) and stage three (4). METHODS: A single blind,
progressive, maximal test on an arm crank ergometer. During the randomized, pre and post test design, with a control group, an
test, the paricipants rated their perceived exertion according to Borg’s exercise group and an exercise & education group, was used. For
RPE scale. In addition, oxygen uptake, heart rate and blood lactate 12 weeks, exercise and exercise & education groups exercised
levels were measured. ANALYSIS: The data on RPE were plotted twice per week. The exercise & education group also attended an
for each subject against work load, oxygen uptake, heart rate and education session once per week. The exercise program included
lactate values. Comparison between groups was calculated with the flexibility, strengthening, posture, balance, aerobic, and functional
Mann-Whitney U test. RESULTS: RPE increased in a similar way with task training. The education program emphasized active learning
increasing relative work intensity in both groups. However, mean RPE methods and action plan development. Participants were tested
was found to be around 1.5–2.5 steps lower for PARA during arm at baseline and post-intervention using the Parkinson’s Disease
exercise at working loads between 50-90% of VO2 peak (maximum Questionnaire-Short Form (PDQ – 8), the Stanford Self-Efficacy for
oxygen uptake). The difference was statistically significant (p < 0.05) Managing Chronic Disease 6-Item Scale (SSE), the Northwestern
at 50% of VO2 peak. VO2 peak was statistically significantly (p < 0.01) University Disability Scale (NUDS), the Schwab & England ADL Scale
lower in PARA (1.8 + 0.2 l/min) than in AB (2.75 + 0.47 l/min) during (SE), the Activities-specific Balance Confidence (ABC) Scale, and
arm exercise. Blood lactate concentration of 4.0mM corresponded the Timed Up and Go Test (TUG). ANALYSIS: Kruskall-Wallis and
to a higher percentage of VO2 peak in PARA (about 80% of VO2 post-hoc trend analyses were used to compare the three groups.
peak) than in AB (about 50% of VO2 peak) during arm cranking. RESULTS: There were no significant differences in scores among
CONCLUSIONS: During arm crank exercise, a similar RPE rating groups at either pre-intervention or post-intervention evaluations.
was reported at a slightly higher percentage of V02 peak by PARA Group differences in ABC scores approached significance at post-
than by AB. A lower increase in blood lactate level with increasing intervention evaluation (.08). Post hoc analyses demonstrated: (1) a
work intensity in PARA may be an explanation to their lower RPE trend toward greater improvement in PDQ-8 scores in the exercise
ratings, according to the hypothesis that blood lactate is a major group, than in the exercise & education and control groups; (2) a
contributor to the perception of effort. I has been suggested that trend toward slight improvement in SES scores in the exercise &
lower lactate levels in paraplegic persons during exercise is caused education and education groups, and toward slight deterioration in
by peripheral adaptations resulting from regular upper body training. the control group; (3) a trend toward slight deterioration in NUDS
IMPLICATIONS: Borg,s RPE scale seems to be a usable tool, also for scores for all groups, with greatest deterioration in the exercise group;
people with paraplegia, in order to monitor exercise intensity during (4) a trend toward improvement in SE scores for all groups; (5) and a
arm crank exercise KEYWORDS: Spinal cord injury, oxygen uptake, trend toward greater improvement in ABC and TUG scores in the
perceived exertion, exercise. FUNDING ACKNOWLEDGEMENTS: exercise & education group than in exercise and control groups.
No fundings. CONTACT: [email protected] CONCLUSIONS: Participant numbers were small, and group mean
ETHICS COMMITTEE: The study was approved by the ethical scores were at, or above, the 80th percentile (ceiling effects) at
comimitte, Umeå University baseline for the PDQ-8, SES, NUDS, SE and ABC. Despite these
limitations, study results suggest trends toward greater improvement,
or less deterioration, in exercise and/or exercise & education groups
than in the control group for four of six outcome measures.
IMPLICATIONS: To avoid ceiling effects when studying populations
with early PD, ADL and self-efficacy outcome measures need to
contain items that are sufficiently challenging. Community programs
intended to improve self-efficacy for those with PD should consider
including both exercise and education components. KEYWORDS:
Parkinson’s disease, group exercise, group education. FUNDING
ACKNOWLEDGEMENTS: Study funded by the Royal University Research Report Platform Presentation
Hospital Foundation, Saskatoon, Saskatchewan, Canada. 2358 Sunday 3 June 15:20
ETHICS COMMITTEE: University of Saskatchewan Bio-medical VCEC Meeting Rooms 19-20
Research Ethics Board. DEVELOPMENT OF PATIENT EDUCATION PROGRAMME FOR
WOMEN WITH KNEE OSTEOARTHRITIS IN SAUDI ARABIA
Al-Sobayel H1,2 , Holder-Powell H3 , Kitchen S1 ; 1 King’s College
London, London, UK; 2 King Saud University, Riyadh, Saudi Arabia;
3 London South Bank University, London, UK
Research Report Platform Presentation PURPOSE: Patient education is recommended as a first line man-
2206 Sunday 3 June 15:20 agement strategy for knee osteoarthritis (OA). For any programme to
VCEC Meeting Room 17 be effective it should be tailored to the needs of the target population.
THE PREVALENCE, DISTRIBUTION, AND IMPACT OF Most of the validated programmes are generic and designed for
PAIN AMONG ADOLESCENTS WITH CEREBRAL PALSY: western populations and may not be suited or acceptable to those
IMPLICATIONS FOR PREVENTION in different cultures. The aim of this project was therefore to
Bartlett D, Doralp S; School of Physical Therapy, The University develop and conduct an exploratory testing of a patient education
of Western Ontario, London, Canada programme (PEP) for women with knee OA in Saudi Arabia.
RELEVANCE: The patient education programme was delivered in
PURPOSE: 1) to describe the prevalence of pain in adolescents with the native language of the target population (Arabic) as part of
cerebral palsy (CP) by Gross Motor Function Classification System physical therapy services within the study health care facility. It was
(GMFCS) level; 2) to describe painful body regions; 3) to describe the first step to develop and promote self-management and client-
pain intensity; and 4) to determine the relationship between pain centred care for this population in Saudi Arabia. PARTICIPANTS:
intensity and effect on daily activities. RELEVANCE: Knowledge The consented participants included (i) women with knee OA (age
of prevalence and characteristics of pain among children with CP between 40 and 65 years) (n=25); (ii) family members (n=21) and
is critical for prevention and health promotion. PARTICIPANTS: A (iii) Health care professionals (n=14). The programme content was
representative sample of 104 girls and 126 boys, mean ages 14.7 also reviewed by a group of judges; women with knee OA (n=10),
(sd = 1.7) and 14.8 (sd = 1.7) years, were recruited from 18 of family members (n=5), health care professionals (n=5). An additional
19 children’s rehabilitation centres in Ontario, Canada. METHODS: sample of Saudi women (n=35) with knee OA took part in the
Participants completed a survey asking “have you experienced pilot testing. METHODS: The programme development consisted of
physical pain in the past month?”. Those responding “yes” indicated four stages; (i) Need’s assessment to study the educational needs
the body regions in which they experienced pain, the intensity of pain of the target population as perceived by women with knee OA
(n=25), family members (21), and health care professionals (n=14);
(from 1 = very little pain to 10 = extremely painful) and the extent to
(ii) Programme development based on the needs’ assessment and
which pain interfered with daily activities (from 1 = not at all to 10 =
literature (iii) Programme content review by a group of judges (n=20);
unable to carry out activities). ANALYSIS: Frequency distributions
(iv) Pilot testing of the programme with a sample of Saudi women
described prevalence of pain and its presence in various body
with knee osteoarthritis (n=35). Semi-structured interviews were
regions; chi-square analysis determined differences in frequency of
conducted in stages (i) and (iii). One-group-pre-post-intervention
pain; median and ranges of pain intensity were determined; and
repeated measure design was applied in the fourth stage. Due to
Spearman’s rho determined the relationship between intensity of pain
a lack of OA knowledge test in Arabic, a study was also conducted
and effect on daily activities. All analyses were done separately for
to develop and validate a knee OA knowledge questionnaire. This
girls and boys across GMFCS levels. RESULTS: 1) 63.7% of girls
was used in combination with other validated tools (the Saudi
and 50.4% of boys reported pain in the past month (NS effects
Knee Function Scale and Physical Performance Tests) and semi-
of gender and GMFCS levels). 2) Pain was most frequent in the
structured interviews to explore the acceptability and effectiveness
feet & ankles, knees, and lower backs of girls and boys at levels of the developed programme. ANALYSIS: The qualitative data were
I, 2, 3 & 4. Participants at level IV also reported frequent pain analysed using a thematic framework approach while the quantitative
in the shoulders, hips, and thighs. Foot & ankle and knee pain data were analysed using frequency tables and non-parametric
were also frequent at level V, but upper back and neck pain were statistical measures to evaluate the variance and correlations.
more common than low back pain. 3) Median values for intensity RESULTS: This initial work suggested that this group of Saudi
of pain ranged from 3 to 5 for both genders, across GMFCS women with knee OA have limited knowledge about their condition
levels. 4) The correlation (rs) between intensity of pain and effect and its management, limited understanding of ‘self-management’,
on daily activities was 0.75 (p < 0.01) and 0.82 (p < 0.01) for girls and no experience of educational programmes. Their perceived
and boys, respectively. CONCLUSIONS: More than half of the benefits from the pilot study of this PEP were considerable, and
participants in this population-based sample, regardless of gender matched by improved knowledge. There were slight improvement
and GMFCS level, reported pain experiences across many body in other aspects such as physical function, exercise behaviour, or
regions at intensities sufficiently high to effect daily activities. Data joint protection. CONCLUSIONS: In conclusion, this initial work
from some respondents with cognitive impairments were gathered suggests that a PEP that promotes self-management based on
by proxy, which could under-estimate the prevalence and impact of client’s educational needs is acceptable in this population in Saudi
their pain experiences. IMPLICATIONS: This information contributes Arabia. IMPLICATIONS: This research was the first step towards
to management of children and adolescents with CP by describing introducing patient education for rheumatic conditions in physical
the high prevalence of pain suggesting a greater focus on prevention. therapy services in Saudi Arabia, which promotes self-management
Future work should focus on understanding factors that contribute to and client-centred care. KEYWORDS: Patient education – knee
or alleviate pain in these children. KEYWORDS: cerebral palsy, pain, osteoarthritis – Saudi Arabia. FUNDING ACKNOWLEDGEMENTS:
prevention. FUNDING ACKNOWLEDGEMENTS: This study was This research was part of the PhD project of the first author, who
funded by the Canadian Institutes of Health Research. CONTACT: was sponsored by King Saud University in Riyadh, Saudi Arabia.
[email protected] ETHICS COMMITTEE: Research Ethics Committee at King’s College
ETHICS COMMITTEE: The ethics committee at McMaster University, London (UK) and the Research Ethics Committee at King Khalid
Hamilton, Ontario, Canada. University Hospital (Saudi Arabia)
CAN TAPING REDUCE ACROMIOCLAVICULAR JOINT RELATIONSHIP BETWEEN STANDING BALANCE AND
SEPARATIONS? A RADIOGRAPHIC EFFICACY STUDY IN HEALTH-RELATED QUALITY OF LIFE AFTER MILD OR
PATIENTS WITH ACUTE SPRAIN MODERATELY-SEVERE STROKE
Forwell L; Fowler Kennedy Sport Medicine Clinic and The University Garland J1,2 , Ivanova T1 , Mochizuki G3,4 ; 1 School of Physical
of Western Ontario, London, Canada Therapy, University of Western Ontario, London Canada;
2 Department of Physiology & Pharmacology, University of Western
PURPOSE: ACJ sprains are a common musculoskeletal injury
world-wide. There are over 70 different operative and non-operative Ontario, London, Canada; 3 Centre for Stroke Recovery, Sunnybrook
methods of treatment. Grade I and II injuries are not considered Health Sciences Centre, Toronto, Canada; 4 Toronto Rehabilitation
for surgical repair but become symptomatic with residual problems Institute, Toronto, Canada
occurring in 70, 75, and 100% with grade I, II and III injuries
PURPOSE: The purpose of this study was to examine the
respectively. A taping technique has been proposed as a simple,
relationship between standing balance and health-related quality
inexpensive, method of directly reducing the ACJ following injury.
The efficacy of taping for ACJ sprains has not been evaluated. of life in individuals following mild and moderately-severe stroke.
The present study evaluates the radiographic effects of taping RELEVANCE: Although it is often assumed that improvements in
on ACJ separation. RELEVANCE: Physiotherapists world-wide are functional balance and mobility will enhance an individual’s quality of
faced with the acute and chronic management of ACJ injury. An life, the relationship between balance and quality of life has yet to
effective and available taping technique will facilitate care and be established in individuals post-stroke. PARTICIPANTS: Twenty-
enhance the effects of rehabilitation. PARTICIPANTS: Subjects were four volunteers, who had sustained a stroke one month previously,
part of a larger ongoing randomized controlled trial evaluating the participated in the study. Subjects were categorized into mild (n=13)
effect of taping on long term functional outcomes. Subjects, age and moderately-severe (n=11) groups. METHODS: This inception
18-65, sustained an ACJ sprain, as diagnosed by a physician, cohort study had evaluations of functional and physiological balance
within the previous 10 days. Subjects had to complete functional at 1 month and 3 months following stroke. Functional balance and
outcome questionnaires in English and had no previous or associated mobility were assessed using the Clinical Outcome Variables Scale
injuries to the shoulder, neck or thoracic spine or an allergy to (COVS). Physiological standing balance was evaluated by having
adhesives. METHODS: Ten patients were randomly allocated to subjects stand quietly with each foot on a separate force platform
either a taping or sham-taping group. Standard xray views of and perform a rapid unilateral arm raise perturbation with the non-
the shoulder and ACJ were taken without weights before, then paretic arm. The SF-36 was administered to evaluate health-related
after, application of the assigned taping technique. Four pieces of quality of life. Age- and sex-matched normative Canadian data for
leucospore tape were laid across the ACJ using different directions the SF-36 were used for comparison with subjects following stroke.
of pull. With the taped group, cranio-caudal pressure was applied ANALYSIS: The area of the 95% confidence ellipse for the center
for reduction of the joint. In the sham group, no pressure or pull of pressure (CP) position quantifies the postural sway. The CP
was exerted. Ethics approval was obtained from the Institution’s ellipse area was the outcome measure for physiological balance.
Research Ethics Board for Health Sciences Research. ANALYSIS: The SF-36 has two summary scores: physical component summary
Clavicle-to-acromion distances with and without tape were compared (PCS) and mental component summary (MCS). Two-way repeated
in both the sham tape and true tape groups using paired t-tests. measures ANOVA (factors; time, group) were used for the COVS,
RESULTS: Four patients were randomized to the sham tape group. PCS, and MCS. Three-way repeated measures ANOVAs (factors;
Six patients were randomized to the true tape group. Mean +/− time, group, side) were performed on the CP ellipse area. One-
standard deviations were 4.63 mm +/− 2.29 mm without tape and way ANOVAs were used to compare PCS and MCS scores at
4.58 mm +/− 1.59 mm with tape, and 6.0 mm +/− 1.55 mm without 1 month and 3 months post-stroke with matched normative data,
tape and 7.50 mm +/− 3.15 with tape, for the sham and true
for each group separately. Associations between quality of life and
tape groups, respectively. Changes were not statistically significant
balance were determined for all subjects combined with Pearson
(p = 0.96 and 0.14 for sham and true tape groups, respectively).
correlations. RESULTS: Subjects in both groups had significant
Mean changes with tape were 0.05 mm decrease (95% CI: −2.92,
improvements in the COVS, CP ellipse area, and PCS, between
3.01) and 1.5 mm increase (95% CI: −3.68., 0.68) for the sham and
one and three months post-stroke. The PCS was significantly lower
true tape groups, respectively. CONCLUSIONS: Based on current
numbers, taping does not appear to reduce acute AC joint separation. than normative values in both groups at both one and three months.
Owing to the wide confidence intervals, further data collection No difference in the MCS scores between normative data and
is required. IMPLICATIONS: Health care professionals world-wide individuals following stroke was found in either group or at either
are still searching for evidence-based, effective management for time. There were moderate significant correlations between the
ACJ sprains. Future work involving more subjects is required, and PCS scores and COVS (r = 0.53) and CP ellipse area (r = −0.40)
might include: potential proprioceptive effects of taping, longterm at one month post-stroke but only between the PCS and COVS
outcomes, different taping protocols, compliance and assessing the at three months (r = 0.56). There was no correlation between MCS
effectiveness of family/friend application. KEYWORDS: acromioclav- scores and balance measures at either time. CONCLUSIONS: In this
icular, RCT, taping. FUNDING ACKNOWLEDGEMENTS: Hip Hip study, the PCS but not MCS was negatively affected by stroke and
Hooray, Canadian Orthopaedic Foundation; Lawson Health Research remained lower than normative values at three months post-stroke.
Institute. CONTACT: [email protected] The significant correlation between PCS and balance measures at
ETHICS COMMITTEE: University of Western Ontario Research one-month may indicate that the influence of impaired physiological
Ethics Board for Health Sciences Research Involving Human balance on quality of life is strongest in the acute phase post-
Subjects (HSREB) stroke. IMPLICATIONS: Individuals who have sustained a mild stroke
receive limited rehabilitation, yet this study demonstrates limitations
in balance that are associated with lower quality of life when
compared with normative data. These data suggest that rehabilitative
interventions may be warranted following mild stroke. KEYWORDS:
stroke; balance; quality of life. FUNDING ACKNOWLEDGEMENTS:
This work was supported by the Canadian Stroke Network and the
Heart and Stroke Foundation of Ontario grants NA4838 and T5131. Research Report Platform Presentation
CONTACT: [email protected] 2896 Sunday 3 June 15:40
ETHICS COMMITTEE: Research Ethics Board for Health Sciences VCEC Exhibit Hall A
Research Involving Human Subjects, University of Western Ontario PERCEIVED BENEFITS FROM A REHABILITATION PROGRAM –
A STUDY ON PATIENTS WITH BURNOUT
Research Report Platform Presentation Ahlgren C1 , Stenlund T2,3 , Steinholtz K3 , Slunga-Birgander L3 ,
2439 Sunday 3 June 15:40 Fjellman-Wiklund A1 ; 1 Dep Community Medicine and Rehabilitation,
VCEC Ballroom A Physiotherapy, Umeå University, Umeå, Sweden; 2 Dep Public
THE IMPACT OF A 4 WEEK MULTIDISCIPLINARY EDUCATION Health and Clinical Medicine, Occupational Medicine, Umeå
PROGRAMME IN AN OUTPATIENT RHEUMATOLOGY SERVICE University, Umeå, Sweden; 3 Center for Occupational and
Nolan M, O Gorman A, Doyle C; St James’s Hospital, Dublin 8, Behavioural Medicine, University Hospial, Umeå, Sweden
Ireland PURPOSE: One hundred and thirty-nine persons with burnout had
PURPOSE: Considerable evidence suggests that patient education, participated in a rehabilitation study for one-year. They had been
especially that based on self-efficacy theory, leads to significant and randomized to a program with 30 sessions of a cognitive group
sustained improvements in the health status of patients with rheuma- treatment and Qigong once a week (REST A) or to a program
toid arthritis (RA). The multi-disciplinary team (physiotherapist, with Qigong alone once a week (REST B). The aim of the present
occupational therapist, clinical nurse specialist) piloted this education study was to evaluate the programs with respect to the participant’s
programme in a hospital setting with the following aims; increasing subjectively perceived benefits. RELEVANCE: It is important that
self-efficacy, improving health status, influencing joint protection rehabilitation programs are based on measures relevant for the
behaviours, providing a group support network and promoting patient group in focus. In order to assure that, it is important to include
compliance with therapy recommendations and self management participant’s subjective experiences from the program in parallell with
behaviours. RELEVANCE: Due to the chronic unpredictable nature objective measures. PARTICIPANTS: 18 persons with burnout, 5
of RA, it has been found that health professionals need to assign women and 4 men from each of the programs REST A and REST
much importance to patient education as the majority of the B were included. Mean age 45.6±7.4 years. METHODS: Thematic
treatment must be undertaken in the home. Currently there does interviews were conducted with each person. The interviews were
not appear to be any formal multidisciplinary education programme taped and transcribed verbatim. ANALYSIS: The transcripts from
for patients with RA in operation in the Republic of Ireland, a forum the interviews were analyzed using a qualitative analyze method,
which has been shown to be of significant benefit to this patient Grounded Theory. In the analysis core concepts and subcathegories
population. PARTICIPANTS: 17 subjects, all female, aged between were defined as well as the relation between cathegories. RESULTS:
33 and 73 years (mean age 51.88 years), disease duration varied The overall theme in all interviews regardless of rehabilitation
from 18 months to 35 years (mean duration 15.15 years) were program was that rehabilitation is an ongoing process with ups
recruited from the rheumatology, physiotherapy and occupational and downs. Persons in the two programs had both similar and
therapy clinics. Purposeful sampling was used. METHODS: 4 program-specific experiences of benefits from the programs. Core
education groups were completed, each group was of 4 weeks concepts emerging in the analyses were Recognition and Hope.
duration, with 2 and 1/2 hours of education once per week. The The concepts were constructed from slightly different experiences
programme included education regarding the condition, medication depending on program attendance. Recognition in REST A was
management and joint protection. The physiotherapy component constructed from shared experiences with other participants and
specifically looked at the role of exercise, exercise prescription, theoretical explanations given in the cognitive treatment group, while
pacing principles, action planning and goal setting. Pre and post Recognition in REST B was based on shared experiences with
outcome measures were used to evaluate the programme. These other participants and bodily reactions during Qigong sessions. The
included the Arthritis Self – Efficacy Scale, the Health Assessment concept Hope was in both groups constituted of attitude and guidance
Questionnaire, AIMS II short form, EuroQol, the Joint Protection from the rehabilitation staff. This, together with program-specific self-
Knowledge Questionnaire, grip strength and pain verbal report scale. help tools learnt during the rehabilitation, was perceived to give hope
A patient satisfaction survey was also utilized to gather relevant for the future. CONCLUSIONS: Rehabilitation programs for persons
qualitative data. ANALYSIS: Paired t-tests were used to compare with burnout was perceived as empowering by the participants and
pre and post measurements. SPSS (v12) was used for statistical gave them hope for the future. IMPLICATIONS: The use of qualitative
analysis. RESULTS: All subjects completed the study. Improvements methods in systematic evaluations of treatment programs can give
in the Arthritis Self-Efficacy Scale (p < 0.001) and Joint Protection new and unexpected knowledge. This knowledge can be valuable
Knowledge Questionnaire (p < 0.059) and the affect component of the in the development of new programs. KEYWORDS: Burnout,
AIMS II (p < 0.059) were statistically significant. The improvements Qualitative method, Interview. FUNDING ACKNOWLEDGEMENTS:
in the VRS (p < 0.078) and EuroQol (p < 0.098) approached but did The study was funded by the Swedish Council for Working Life and
not reach statistical significance. CONCLUSIONS: The initial results Social Research. CONTACT: [email protected]
suggest that this education programme is of benefit to patients with ETHICS COMMITTEE: The Research Ethics Committee of Umeå
RA, in terms of increasing self-efficacy, joint protection knowledge University approved of the study. (Um dnr 02-311)
and providing a group support network. IMPLICATIONS: Research
has already established a link between increased self efficacy with
decreased pain, decreased functional disability, improved coping Research Report Platform Presentation
abilities and decreased health care utilisation. Incorporating an 2849 Sunday 3 June 15:40
education programme, that is a proven forum to increase a VCEC Meeting Rooms 11-12
participants self efficacy, into standard physiotherapy care, needs STEPPING OUT: AN INVESTIGATION INTO THE LEVEL OF
to be considered. Continued positive results from arthritis patient AGREEMENT BETWEEN THREE MEASURES OF STEP COUNT
education programmes cannot be ignored and need to be taken
Baer G1 , O’Loughlin H; 1 Dept of Physiotherapy, Queen Margaret
into consideration when developing physiotherapy standards of care
University College, Edinburgh, Scotland, UK
for this patient population. KEYWORDS: RA, education, multi-
disciplinary. FUNDING ACKNOWLEDGEMENTS: Arthritis Ireland. PURPOSE: This study aimed to investigate the levels of agreement
CONTACT: [email protected] between three clinical methods of measuring step count. The tools
ETHICS COMMITTEE: SJH/AMNCH Research Ethics Committee, under investigation were a pedometer (Yamax Digiwalker SW-200),
Tallaght Hospital, Tallaght, Dublin, Ireland a new physical activity monitor (ActivPalTM) and video observation
(used as the criterion standard). RELEVANCE: Regular physical of daily living (ADL) and psychosocial function. Because random
activity is associated with improved physical and mental health. performance fluctuations are common in people with PD, reliable
Measures of step count are commonly used to infer levels of measures are necessary to adequately assess physical and psy-
physical activity. One commonly cited recommendation to ensuring chosocial function in clinical and research settings. PARTICIPANTS:
an appropriate level of physical activity is taking 10,000 steps per Six female and 17 male community-dwelling, ambulatory adults
day (Hatano et al 1993), however valid and practical methods of with PD who completed a University of Saskatchewan Biomedical
measuring physical activity can be problematic. The step count Research Ethics Board approved consent form participated. Subjects
measurement methods require to be accurate and robust for were 64.13±7.81 years of age, had Mini-Mental State Examination
routine clinical use over prolonged periods and for diverse activities. Scores of 27.43±2.52, had had PD for 4.57±4.41 years, and were
PARTICIPANTS: Twenty healthy subjects were recruited (4 male, 16 in Stages 1 (n = 13), 2 (n = 6), or 3 (n = 4) of the Hohn & Yahr
female, mean age 24.8 + 2.6 years). Ethical approval was received Classification of Disability. METHODS: Subjects completed a self-
from Queen Margaret University College, Edinburgh. METHODS: report demographic and health questionnaire and were evaluated
Pilot work was undertaken to determine the study protocol and twice (number of days between Time 1 and Time 2 = 12.92±5.08)
exact location of pedometers and activPal. Subjects wore two by the same evaluator and at approximately the same time of the
pedometers (one on each leg) and an activPal on the dominant day on the following measures: (1) PD Questionnaire-Short Form
(Dom) leg for one free-living day. During the day each subject (PDQ-8), an 8-item questionnaire that asks about health status;
participated in a 30 minute trial of treadmill walking at 2.5 kilometres (2) The Northwestern University Disability Scale (NUDS), a 5-item
per hour(km/h), 5 km/h and jogging at 7.5 km/h. The treadmill trial scale that asks about walking, dressing, eating, washing and speech
was video recorded to provide a criterion measure of step count. abilities; (3) the Schwab & England ADL Scale (SE), a scale that
ANALYSIS: Data were checked for normality of distribution using asks the person to rate overall independence in activities from
Shapiro-Wilkes test. Levels of agreement between methods were 0% to 100%; (4) The Activities-specific Balance Confidence (ABC)
assessed using the Bland & Altman method (Bland & Altman 1986), Scale, a 16-item scale that examines how confident an individual
calculated as the difference in step-count between two methods feels in doing various activities without losing balance or becoming
plotted against the mean of both. Percentage errors in step count unsteady; (5) the Timed Up and Go Test (TUG), a timed test that
were also calculated for pedometer and activPal against criterion asks the individual to rise from a chair, walk 3 meters, turn, return
video observation. RESULTS: The pedometers demonstrated poor to the chair and sit down; and (6) the Stanford Self-Efficacy for
levels of agreement with observation and large error in step count at Managing Chronic Disease 6-Item Scale (SSE), a scale that asks the
2.5 km/h (mean error (ME) −21% non-dominant (non-Dom) leg, and person about how well he/she thinks different aspects of a disease
ME −33 Dom). Pedometers showed very good levels of agreement can be managed. ANALYSIS: Descriptive statistics were calculated.
with observation at both 5 km/h (ME +0.8% non-Dom, and ME Test-retest reliability coefficients were determined using intraclass
+0.18% Dom) and at 7.5 km/h (ME = +0.03% non-Dom and ME correlation (ICC (3,1)) for the TUG. Spearman rho was used to
−0.05% Dom). ActivPal had very good levels of agreement with determine test-retest reliability for the remaining categorical scales.
observation at 2.5 km/h (ME −0.42%) and 5 km/h (ME −0.15%) but Cronbach’s alpha was used to examine internal consistency reliability
showed poor agreement with observation at the higher velocity of of the PDQ-8, NUDS, ABC and SSE. RESULTS: ICC coefficient for
7.5 km/h (ME +18.2%). CONCLUSIONS: Results indicated that the test-retest reliability of the TUG was 0.70, p = 0.00, 95% CI [0.40,
Yamax SW-200Pedometer is a suitable tool for measuring step count 0.86]. Spearman rho correlations for test-retest reliability of the PDQ-
in populations that ambulate at >5 km/h or whose activities include 8, NUDS, SE, ABC, SSE were 0.75, 0.75, 0.68, 0.74, and 0.64,
regular jogging at 7.5 km/h. At velocities of 2.5 km/h and 5 km/h respectively (p = 0.00). Cronbach’s alpha for the PDQ-8, NUDS, ABC,
activPal appears a more appropriate means of measuring step count. SSE was 0.78, 0.77, 0.88 and 0.96, respectively. CONCLUSIONS:
Data obtained with the Yamax pedometer at a velocity equivalent Internal consistency of the PDQ-8, NUDS, ABC, and SSE was
to 2.5km/h and the activPal at velocity of 7.5km/h should however good to excellent. Test-retest reliability of the PDQ-8 and NUDS
be viewed with extreme caution. IMPLICATIONS: When measuring was good, while TUG, SE, ABC, and SSE test-retest reliability
step count as an indication of physical activity, therapists need to was moderate. IMPLICATIONS: The high variability of performance
take into account likely walking speed and select the appropriate within and between persons who have PD makes assessing
measurement tool for the population under investigation. Reference: physical and psychosocial function a challenge. The PDQ-8, NUDS,
Hatano et al 1993 International Council for Health, Physical Education ABC, SE TUG and SSE are easy to administer and exhibited
and Recreation 294-328 KEYWORDS: Pedometer; activity monitor; moderate to good reliability in our sample. KEYWORDS: Parkinson’s
levels of agreement. FUNDING ACKNOWLEDGEMENTS: This work Disease, reliability,. FUNDING ACKNOWLEDGEMENTS: The Royal
was unfunded. CONTACT: [email protected] University Hospital Foundation, Saskatoon, SK, Canada. CONTACT:
ETHICS COMMITTEE: Queen Margaret University College, Edin- [email protected]
burgh, UK ETHICS COMMITTEE: University of Saskatchewan Biomedical
Ethics Board
VCEC Meeting Room 16 824 Sunday 3 June 16:15
RELIABILITY OF FUNCTION, BALANCE, SELF-EFFICACY PP Crystal Pavilion A
AND QUALITY OF LIFE MEASURES IN INDIVIDUALS WITH A TASK-ORIENTED BALANCE PROGRAM FOR OLDER
PARKINSON’S DISEASE INDIVIDUALS AND THOSE AGING WITH CHRONIC
DalBello-Haas V1 , Klassen L1 , Sheppard M2 , Metcalfe A3 ; 1 School DISABILITIES REDUCES FEAR OF FALLING
of Physical Therapy, University of Saskatchewan, Saskatoon, SK Perez C1,2 , Lamontagne A1−3 ; 1 Jewish Rehabilitation Hospital,
CANADA; 2 Saskatoon Health Region, Royal University Hospital, Laval, Quebec, Canada; 2 Centre de recherche interdisciplinaire en
Saskatoon, SK, CANADA; 3 Department of Community Health and réadaptation du Montréal métropolitain (CRIR), Montreal, Canada;
3 McGill University, Montreal, Canada
Epidemiology, University of Saskatchewan, Saskatoon, SK, CANADA
PURPOSE: To determine the reliability of commonly used measures PURPOSE: To study the effects of a ten week exercise program on
in people with Parkinson’s Disease (PD). RELEVANCE: PD, a balance, mobility, fear of falling and general well being. RELEVANCE:
neurodegenerative disorder of the basal ganglia, causes gait Balance problems in the elderly and individuals with chronic
disturbances, postural instability, and interference with activities neuromuscular conditions such as stroke often lead to decreased
autonomy and falls. Fear of falling can further limit their activities upright’ and ‘lumbo-pelvic upright’) and slump sitting. RELEVANCE:
which contributes to greater functional decline. Evidence shows that Clinical observations suggest that both upright and slump sitting
individually-tailored, task-oriented interventions are most effective in postures can exacerbate low back pain. There has been substantial
treating balance problems and reducing fall risk yet few hospital- research on the effects of slump sitting on trunk muscle activation.
based programs exist. This study examined the effects of an out- There has been little research however, investigating the effects of
patient balance program, Programme d’Exercices de la Rééducation different upright sitting postures on trunk muscle activation, with
de l’Équilibre (P.E.R.E.), specifically designed for older individuals some confusion over whether upright sitting results in increased
aging with chronic disabilities. PARTICIPANTS: 14 subjects (mean muscle activation. PARTICIPANTS: 22 healthy adults (13M, 9F)
age 70.8) participated in this study. Subjects were either directly with no history of low back pain were recruited from the Perth
referred to the P.E.R.E. program or screened from an existing metropolitan region for this study. Their mean age was 32 years
physiotherapy waiting list for treatment of problems of balance or (SD ±13 years), mean height 172 cm (SD ±10cm) and mean
mobility. METHODS: Treatment was provided bi-weekly for 10 weeks. weight 71kg (SD ±11 kg). METHODS: A normative within-subjects
This consisted of an individual session which targeted modifiable single-group study. Spinal-pelvic curvature (Fastrak™) and surface
factor(s) involved in balance control and a small group class which electromyography (Bortec™) of six trunk muscles were measured
trained task-specific skills with focus on sensory challenges. The bilaterally in two ‘upright’ (thoracic and lumbo-pelvic) sitting postures
Berg Balance Scale (BBS), Timed “up & go” (TUG), comfortable and and slump sitting. Trunk muscle activation was normalised to
fast gait speeds, Falls Efficacy Scale (FES) reflecting fear of falling, maximum voluntary isometric contraction. ANALYSIS: One-way
and the SF-36 Health-Related Quality of Life Questionnaire were ANOVA’s with repeated measures were used to detect differences
administered pre and post intervention. At a 3 month follow-up the between the three sitting postures (thoracic upright, lumbo-pelvic
BBS, TUG and gait speed were assessed. ANALYSIS: Descriptive upright and slump sitting) in terms of spinal-pelvic curvature, pelvic
statistics were used to explore main demographic characteristics. angle and trunk muscle activation. Within-subject contrasts were
One-way repeated measures ANOVA for BBS, TUG, and gait speeds used to detect further differences. RESULTS: Thoracic upright,
and paired Student t tests for FES and the cumulative SF-36 compared to lumbo-pelvic upright, sitting showed significantly greater
physical (PCS) and mental(MCS) scores were performed. Statistical thoracic extension (p < 0.001), with significantly less lumbar extension
significance was set at alpha (a) 0.05. RESULTS: Comparisons of (p < 0.001) and anterior pelvic tilt (p = 0.03). Further, there was
post versus pre scores revealed significant improvements in BBS, significantly less superficial lumbar multifidus (p < 0.001) and internal
TUG, fast gait speed and FES. The average gains ranged from 9% oblique (p = 0.03) activity, with significantly greater thoracic erector
to 56% with the lowest change in Berg and the highest in FES. No spinae (p < 0.001) and external oblique (p = 0.04) activity in thoracic
significant differences between post-treatment and follow-up were upright sitting. Interestingly, there was no significant difference in
found. Results for the SF-36 revealed a significant positive change superficial lumbar multifidus activity between thoracic upright and
in the MCS. Subject age, gender and baseline measures were not slump sitting. CONCLUSIONS: Different upright sitting postures
associated with the magnitude of improvements. CONCLUSIONS: resulted in altered trunk muscle activation patterns. Thoracic upright,
Aging individuals with chronic disabilities significantly benefit from when compared to lumbo-pelvic upright, sitting involved less co-
a structured balance program. The gains made in balance and activation of the local spinal stabilising muscles, such as lumbar
walking abilities were maintained for at least 3 months. The dramatic multifidus and internal oblique. IMPLICATIONS: This study helps
reduction in fear of falling is of particular interest as it is a known explain why ‘thoracic upright’ sitting may be associated with reduced
risk factor for falls. Additionally, the program led to a significant boost activation of local spinal stabilising muscles. These results highlight
in the mental well-being of our patients, which may be related to the need for clinicians to be highly specific when teaching upright
this decreased level of fear. Providing effective balance treatment sitting posture in subjects with low back pain if the aim of the
and reducing unhealthy fear is essential to the physical and mental intervention is to facilitate the local spinal stabilising muscles. Further
well-being of older people. IMPLICATIONS: People with balance research is needed to study the responses to these sitting postures
problems often develop fear of falling which intensifies with aging. in subjects with low back pain. KEYWORDS: Electromyography,
This leads to enormous functional and emotional consequences. Lumbar spine, Sitting posture. FUNDING ACKNOWLEDGEMENTS:
Clinicians must consider assessing this fear more regularly and None. CONTACT: [email protected]
incorporating self-efficacy techniques along side appropriate balance ETHICS COMMITTEE: Ethical approval was obtained from the
training. Further research is needed to increase our understanding of Curtin University Human Research Ethics committee, Perth, Western
how to enhance balance confidence in patients as well as to study the Australia.
impact this improvement may have on falls incidence. KEYWORDS:
Balance, Aging, Fear of falling. FUNDING ACKNOWLEDGEMENTS:
Jewish Rehabilitation Hospital Clinician’s Salary Award. CONTACT: Research Report Platform Presentation
ETHICS COMMITTEE: Jewish Rehabilitation Hospital Ethics Com- VCEC Ballroom A
mittee and Centre de recherche des institutions de rééadaptation EXERCISE THERAPY IN THE MANAGEMENT OF HIP
#CRIR-178-0905 OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Research Report Platform Presentation Simmonds M, Boocock M, McNair P, Larmer P, Steel L; Physical
Rehabilitation Research Centre, AUT University, Auckland, New
Zealand
THE EFFECT DIFFERENT ‘UPRIGHT’ SITTING POSTURES HAVE PURPOSE: The benefits of strength training programmes in
ON TRUNK MUSCLE ACTIVATION IN PAIN-FREE SUBJECTS patients with osteoarthritic knees have been well established in the
literature. This support has been extrapolated to the management
O’ Sullivan P1 , Dankaerts W1,2 , Burnett A1 , Farrell G1 , Jefford E1 , of osteoarthritis of the hip, with little documented evidence. The
Naylor C1 , O Sullivan K1,3 ; 1 School of Physiotherapy, Curtin purpose of this study was to critically review literature evaluating
University of Technology, Perth, Western Australia; 2 Department
the effectiveness of exercise therapy in the management of
of Rehabilitation Sciences and Physiotherapy, Ghent University,
hip osteoarthritis. RELEVANCE: Osteoarthritis is fast becoming
Ghent, Belgium; 3 Department of Physiotherapy, University of
a significant problem within modern society due to the ageing
Limerick, Ireland
population and increasing longevity. Second to the knee, the hip
PURPOSE: To compare trunk muscle activation in three different is the most common large joint affected by osteoarthritis. Within
sitting postures: Two different ‘upright’ sitting postures (‘thoracic western populations, estimates place prevalence rates at between
3 and 11%. The consequences of this condition are significant, used in the search were: scale, critical appraisal, critical appraisal
with sufferers often afflicted by considerable pain, loss of function, review, appraisal of methodology, research design review, quality
disability and impaired quality of life. Unless effective strategies assessment, randomized controlled trial, and RCT ANALYSIS:
for the management of osteoarthritis can be identified, there will Five independent reviewers screened the publications for inclusion
inevitably be an increased burden placed on the health care criteria and extracted data regarding content, construction, special
system. PARTICIPANTS: not applicable METHODS: An extensive features and psychometric properties for each scale. All reviewers
standardised keyword list was developed and used in a systematic critically analyzed and discussed the information provided by the
literature search of fifteen electronic databases. The search identified scales. RESULTS: Twenty nine relevant studies were identified.
interventional studies as well as previous systematic or critical These studies accounted for 10 scales (Jadad scale, Cho & Bero
reviews. The quality of each article was critically appraised according Scale, Reisch’s Scale, Consort Scale, Maastrich Scale, Chalmers’s
to the Generic Appraisal Tool for Epidemiology and then graded Scale, Andrew’s Scale, Pedro Scale, Detsky’s Scale, and OxforPain
according to a modified version of the Cochrane Scoring System. Validity Scale (OPVS)) and their adapted scales. Most of the
ANALYSIS: To allow an appreciation of the overall level of evidence to analyzed scales have not been rigorously developed following the
support specific exercise-based interventions, a ‘pattern of evidence’ methodological standards and have not been tested for validity,
approach was used. The overall level of evidence assigned to an responsiveness, and reliability in the areas to which they have
exercise intervention was based upon the number of studies, study been applied. The most used scales in the physiotherapy area are
design and the quality rating ascribed to each study. RESULTS: More Jadad and PEDro scales. However, these scales do not provide
than 4000 articles were identified, of which 338 were considered the most comprehensive measure of methodological quality for
suitable for abstract review. Following abstract review, 39 studies physical therapy trials. CONCLUSIONS: Based on the findings of
were considered suitable for full text review. Only six intervention this systematic review, there are many scales used to evaluate
studies met the inclusion criteria. No review papers met the the methodological quality of RCTs in health research. However,
selection criteria as hip data was not analysed independently of there are few original scales that have been developed with that
other conditions. CONCLUSIONS: There was a distinct lack of objective. The readers should carefully choose a scale based on
well-designed studies specifically targeted at the exercise therapy its psychometric properties and its area of development when
management. However, some evidence was found to suggest that ex- assessing methodological quality. IMPLICATIONS: The quality and
ercise therapy can be an effective short-term management approach development of the scales to assess the methodological quality
for reducing pain levels and improving hip function. Furthermore, of RCT needs to be improved. More standardized and practical
there is some evidence to support the use of manual therapy, quality assessments tools closely related to the physical therapy
inclusive of joint stretches, manual traction and traction manipulation. practice are needed. KEYWORDS: Randomized controlled trials,
IMPLICATIONS: Traditional exercise approaches, such as strength methodological quality assessment, Physical Therapy. FUNDING
training, appear to offer benefits for the short-term management of ACKNOWLEDGEMENTS: This study was supported by Alberta
osteoarthritis of the hip. However future consideration should be Provincial CIHR Strategic Training Program in Bone and Joint Health,
given to establishing the optimal exercises and levels of exposure Izaak Walton Killan scholarship from the University of Alberta,
necessary for achieving long term gains, as well as the cost Physiotherapy Foundation of Canada and MECESUP Government
effectiveness of this type of therapy. KEYWORDS: Hip osteoarthritis, of Chile Scholarship. CONTACT: [email protected]
exercise therapy, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
Nil. CONTACT: [email protected]
Research Report Platform Presentation VCEC Meeting Rooms 11-12
1459 Sunday 3 June 16:15 ELECTROPHYSICAL AGENTS IN PHYSIOTHERAPY PRACTICE
VCEC Ballroom B & C AND EDUCATION: STILL A GOOD IDEA AFTER ALL THESE
SCALES TO ASSESS THE METHODOLOGICAL QUALITY OF YEARS?
RANDOMIZED CONTROLLED TRIALS – A SYSTEMATIC REVIEW Chipchase L1 , Williams M1 , Robertson V2 ; 1 School of Health
Armijo Olivo S1 , Macedo L1,2 , Gadotti I1 , Fuentes J1 , Liddle N1 , Sciences, University of South Australia, Adelaide, SA 5000,
Magee D1 ; 1 Faculty of rehabilitation Medicine, University of Alberta, Australia; 2 University of Newcastle, Teaching and Research Unit,
Edmonton, Canada; 2 University of Sydney, Sydney, Australia Gosford, NSW 2250, Australia
PURPOSE: Methodological quality assessment is a topic of great PURPOSE: To ascertain the views of registered Australian phys-
debate in clinical research and medicine based evidence. The quality iotherapists on the role of electrophysical agents (EPAs) in
assessment of Randomized Controlled Trials (RCTs) is important physiotherapy practice and entry-level education. RELEVANCE:
in order to accurately identify the effectiveness of therapeutic EPAs are a fundamental clinical physiotherapy management tool
treatments. There are numerous scales that have been used to and have long been included in entry-level education programs.
evaluate methodological quality in different health areas. However, Changes in the global health-care environment including shifts to
the most appropriate scale to evaluate methodological quality in evidence-based practice, the emphasis on health promotion and the
RCTs in the physical therapy area is still under discussion. The emergence of the generic health worker, have led many authors
purpose of this systematic review was to summarize the content, to question the place of EPAs within contemporary physiotherapy
construction, development, and psychometric properties of scales practice. Changes to professional education with the rapid growth
used to evaluate the quality of RCTs in health research and identify a in scientific knowledge and clinical techniques being used place
good scale for physical therapy practice. RELEVANCE: Good quality strains on ever-expanding entry-level curricula. In relation to EPAs,
assessment tools closely related to the physical therapy scope are the profession appears to be at a cross-road. Should EPAs
needed in order to identify more accurately the efficacy of physical remain mainly in the province of physiotherapy practice? Does the
therapy interventions PARTICIPANTS: Non Applicable METHODS: profession want to remove or maintain knowledge of EPAs as a
Extensive electronic databases searches along with a manual search core foundational skill? PARTICIPANTS: All registered, practicing
were performed. The electronic search included studies from 1965 up physiotherapists, whose names were on a state registration board
to November 8, 2005 including Medline, Embase, Cinahl, ISI Web of in Australia were invited to participate. Physiotherapists who were
Science, EMB Reviews-Cochrane Central register of controlled Trials retired, working overseas or not practicing physiotherapy were
and Cochrane Library and Best Evidence, CDSR, ACP journal Club, excluded. METHODS: An observational cross-sectional methodology
DARE, CCTR, Global health, and HealthSTAR databases. Key words was used to survey registered physiotherapists in Australia (a total
of 12893 physiotherapists). The survey was piloted for reliability ways. Phenomenography studies the variation of those different
and validity. The questionnaire included open and closed-ended ways. ANALYSIS: The interviews were recorderd and transcribed
questions. The three page double-sided survey was designed to elicit verbatim for continued analysis which contained: 1) Familiarisation,
information on EPA usage and practice as well as perceptions of its 2) Condensation, 3) Compararison,4) Categorisation, 5) Articulation,
relevance in current entry-level education. The survey was mailed 6) Assignment of titles, 7) Contrasting. RESULTS: All the informants
to Australian physiotherapists between November 2005 and March stated that they used their paretic hand more in every day life
2006. ANALYSIS: Continuous, categorical and nominal data were after the intervention and were positive to group training. All of
analysed using standard descriptive statistics. Open ended questions them also expressed that the exercises were hard and intense,
were analysed using thematic content analysis. RESULTS: 3538 and it was mostly a positive experience. Three qualitively different
completed questionnaires were returned (27.4% response rate). The categories of perceptions of CIMT could be formed: 1) Confrontation
average age of respondents was 39.4 (SD 10.6) years. Approximately with ambivalence to CIMT, 2) The possibility to accept and adjust
three quarters of respondents (78.1%) indicated that EPAs should to reality, and 3) The possibility to obtain new personal insights,
remain a treatment tool administered primarily by physiotherapists leading to the individual taking responsibility for continued training,
whereas 21.1% indicated that other professions should be able to self-efficacy in goal-setting and the ability to look forward. Most
use EPAs. Close to the total sample (98.1%) agreed that EPAs informants were found in this last category. CONCLUSIONS: The
should remain in the entry-level physiotherapy curriculum. Analysis study showed that a short and intense training period in a group
of the open-ended question seeking reasons behind this belief could be a source of acceptance and motivation and facilitate
produced several common themes: EPAs usefulness as a treatment responsibility for continued training. This could contribute to the cost-
adjunct; common use in clinical practice; perception of efficacy; effectiveness of CIMT in the long run. IMPLICATIONS: A better
community expectation; maintenance of professional boundaries; understanding of different ways of responding to CIMT during, as well
safety/medicolegal issues and the belief that knowledge of EPAs as after, the intervention period could be a practical help for adjusting
is integral to entry-level physiotherapy education. However, many exercise and coaching individually. KEYWORDS: Stroke, Training,
respondents indicated that the breadth of EPAs taught should be Interview. FUNDING ACKNOWLEDGEMENTS: The Foundation for
reduced and focused on those known to provide clear therapeutic Stroke Research (Sweden). CONTACT: [email protected]
benefits or commonly used in clinical practice. CONCLUSIONS: ETHICS COMMITTEE: Karolinska Institutet, The Research Commit-
This sample of Australian physiotherapists expressed a strong tee; Dnr 198/03
belief that EPAs should remain a treatment tool used primarily
by physiotherapists and as core foundational knowledge taught
in entry-level education. IMPLICATIONS: The results provide a
clear view of the perceptions of physiotherapists who believe that 1144 Sunday 3 June 16:15
EPAs should remain a physiotherapy specific tool and that the VCEC Meeting Room 17
teaching should remain within the entry-level curriculum. The results USE OF THE COMMUNITY BALANCE AND MOBILITY SCALE
should be useful to educators and curriculum planners. The results AS AN OUTCOME MEASURE WITH PEDIATRIC ACQUIRED
need to be viewed in light of the response rate which, despite BRAIN INJURY
efforts to maximize, remained low. KEYWORDS: Electrophysical Brewer K1,3 , Wright V1−3 , Wannamaker E1 ; 1 Bloorview Kids Rehab;
agents, physiotherapy practice, entry-level curriculum. FUNDING 2 Bloorview Research Institute; 3 Department of Physical Therapy,
ACKNOWLEDGEMENTS: No funding was received for this study. University of Toronto
ETHICS COMMITTEE: Ethical approval for this study was obtained PURPOSE: This study evaluated the use of the Community Balance
from the University of South Australia’s Human Research Ethics and Mobility Scale (CB&M) to assess balance in high-functioning
Committee (15/02/2005) school-aged children and adolescents who were receiving rehabili-
tation post-acquired brain injury (ABI). We compared change scores
on the CB&M with motor change noted on the Gross Motor Function
Research Report Platform Presentation Measure (GMFM), a validated outcome measure typically used with
1359 Sunday 3 June 16:15 these clients. RELEVANCE: Balance impairments are prevalent
VCEC Meeting Room 16 following ABI, and can impact an individual’s ability to access their
CONCEPTIONS ABOUT PARTICIPATING IN A CONSTRAINT community. There are few outcome measures in pediatrics that
INDUCED MOVEMENT THERAPY GROUP IN SUBJECTS WITH address high level balance issues. The CB&M was designed to:
STROKE, AN INTERVIEW STUDY assess the balance of higher functioning adults with ABI; evaluate
the effectiveness of interventions; and identify individuals with limited
Kusoffsky A, Biguet G; Karolinska Institutet, Department of
community integration due to balance and mobility issues. It is a 13-
Neurobiology, Caring Sciences and Society, Division of Physiotherapy
item observational measure, scored on a 6-point scale. Although the
PURPOSE: Constraint Induced Movement Therapy (CIMT) has CB&M was designed as an adult measure, we wanted to look at its
showed promising training effects regarding the spontaneous use of applicability to pediatrics. From a content perspective, the items of the
the paretic arm and hand in subjects with stroke in some controlled CB&M appear suitable for use in pediatrics. PARTICIPANTS: Thirty-
studies. One difficulty in assessing CIMT lies in identifying which seven children and teens (mean age = 14.7 years) with ABI who were
components are the active or essential elements. Another issue enrolled in an in-patient pediatric rehabilitation program had CB&M
is that little attention has been given to the patients’ reactions to evaluations by physiotherapists at baseline and discharge. Seventeen
this intervention. The purpose of the study was to explore and clients also had baseline and discharge GMFM’s. The other 20
describe how subjects with stroke perceive and respond to CIMT children scored 100% on their GMFM at baseline and thus were
in a group. RELEVANCE: Although research has reported good not retested on it. METHODS: CB&M and GMFM admission and
rates of compliance, the participants’response to CIMT has not discharge scores were collected over a 3-4 year period. ANALYSIS:
been studied deeply. PARTICIPANTS: Eleven subjects with stroke, Inferential (paired t-tests) and regression analyses were performed
who participated in a two week CIMT intervention session, were with CB&M and GMFM scores. RESULTS: CB&M mean change for
interviewed. METHODS: The method used was phenomenography. the entire sample was 17.0% points (SD = 12.2) (mean score = 75.4%
The focus on the phenomenographic method is to describe different at baseline and 92.4% at discharge) (P < 0.0001). For the 17 clients
ways of understanding a phenomenon, in this case the phenomenon with both CB&M and GMFM scores, CB&M mean change was 23.8
“to participate in CIMT”. It is seen that a phenomenon can points (baseline mean score = 65.1%) while GMFM mean change
be conceived of, understood or given a meening in different was 6.8% points (baseline mean score = 92.8%). CB&M and GMFM
baseline and change score correlations were weak (r = 0.34 and 0.14 Research Report Platform Presentation
respectively). CB&M baseline score was a strong predictor of CB&M 2082 Sunday 3 June 16:35
change (R2 = 70.2, P < 0.0001). CONCLUSIONS: The CB&M identi- PP Crystal Pavilion B & C
fied high-level balance issues, and was more sensitive to change in PEROMETRY MEASUREMENT OF LOWER LIMB VOLUME: AN
gross motor abilities than the GMFM. As seen by the high baseline INVESTIGATION OF CRITERION VALIDITY
mean scores for the GMFM (92.8%) and comparatively lower CB&M Bulley C, Coutts F, Grainger A; Queen Margaret University College,
baseline scores (62.8%), it is evident that the GMFM failed to detect Edinburgh, Scotland
balance issues that were present. This is not unexpected since
the GMFM was not designed as a specific measure of balance or PURPOSE: This study aimed to develop a measurement protocol
of quality of movement. In contrast, components of performance for the Perometer (400T) and compare it with the tape measure
quality (e.g., alignment, speed of movement, and co-ordination) are method for the calculation of lower limb volume in healthy individuals.
evaluated in the CB&M’s response scales. IMPLICATIONS: In times RELEVANCE: A variety of musculoskeletal, vascular and neurolog-
of limited resources, it is critical that we use the most appropriate ical conditions impact on limb volume, therefore its measurement
tools to measure meaningful outcomes and change in our clients. is important in their management. It is frequently measured using
The CB&M has proven to be a useful tool for identifying high level geometric calculations from limb circumferences using a tape
balance issues and indicating change with the school-aged and measure (TM). The Perometer (P) optoelectronic imaging device
adolescent ABI population. Further work is warranted in evaluating its demonstrates potential to become a gold standard of measurement.
psychometric properties in this population. KEYWORDS: Pediatric, However, there is a lack of standardised protocol and research into its
Community, Balance. FUNDING ACKNOWLEDGEMENTS: This was validity in the lower limb. PARTICIPANTS: Thirty healthy volunteers
an unfunded project. CONTACT: [email protected] participated in the study (22 women, 8 men; mean age 26.0; mean
height 67.2 cm; mean weight 171.0 kg). Individuals were excluded
if they had relevant specified past medical history. The study was
Research Report Platform Presentation approved by an ethics committee at Queen Margaret University
1534 Sunday 3 June 16:35 College. METHODS: Pilot work was undertaken to establish a
PP Crystal Pavilion A standardised limb position, lower limb landmarks and a percentage
THE OTAGO EXERCISE PROGRAMME (OEP): THE of limb length for measurement. Participants were requested to
EFFECTIVENESS OF NATIONAL IMPLEMENTATION avoid vigorous exercise and alcohol consumption 24 hours prior to
testing, and food/fluid intake one hour before. After a 15-minute rest
Binns E, Taylor D; Physical Rehabilitation Research Centre, AUT
period with the limb elevated to 90 degrees, standardised reference
University, New Zealand
marks were placed to indicate the start and end of TM and P
PURPOSE: The Otago Exercise Programme (OEP) is a year volume calculations. The dominant limb was placed within the P
long, home based, individually prescribed muscle strengthening and frame in a standardised position. Three P measurements were taken,
balance retraining falls prevention programme, developed from four followed by TM measurements at three-centimetre intervals. Volumes
randomised controlled trials. A meta-analysis of these trials demon- in ml were calculated between the two reference marks using the
strated that the OEP reduced falls by a third in older adults. The OEP P computer software and using the TM Disc model method (Man
has now been implemented throughout New Zealand. AUT University et al, 2004: Clinical Physiology and Functional Imaging. 24: 352-
is evaluating this national programme to assess whether the 358). ANALYSIS: Statistical analysis involved testing for normality of
reduction in falls observed in a research setting occur in an ordinary distribution before using parametric inferential statistics: an ICC (3,1)
context. RELEVANCE: Falls are the most common form of injury and was used to assess the correlation, and limits of agreement were
major cause of hospitalisation in older adults. Globally the proportion calculated to assess the degree of agreement, between P and TM
of older adults in the population is growing. Therefore the prevalence limb volume estimates. RESULTS: Limb volume calculations (mean
of falls is likely to increase resulting in a growing public health problem of 3 readings) were 8560 ml (P) and 8717 ml (TM), with a difference
that is costly on public health resources and on individuals’ functional of 157 ml. Data were normally distributed (Shapiro-Wilk: p = 0.268 P;
independence and quality of life. DESCRIPTION: Older adults are 0.602 TM). While the ICC (3,1) indicated good associations between
referred to the OEP by general practitioners, specialists or other the two measures (r = 0.952), limits of agreement analysis indicated
health professionals. There is regional variation as to the inclusion that 95% of the time P limb volume estimates will be between 519
criteria for the OEP but the programme is designed for community ml greater, and 834 ml less than TM estimates, indicating 15.67%
dwelling older adults with a falls risk. EVALUATION: Therapists and variation, and poor agreement. CONCLUSIONS: Results indicated
nurses who deliver the OEP return copies of the assessment forms poor agreement and therefore measurement methods are not
to AUT where they are collated into a national database. There is interchangeable. However, results cannot determine the respective
data received to date for 2154 people, 1680 women and 466 men accuracy of each method. IMPLICATIONS: This was the first study
(no gender available for 8 people) with a mean age of 86 years and to calculate limits of agreement between estimates of lower limb
ranging between 60 and 102 years. Fifty eight percent of participants volume using the TM method and upright 400T model of Perometer.
had fallen in the 6 months prior to commencing the OEP. In the Further work is needed in relation to different aspects of validity and
first 6 months of the OEP 20% of participants had fallen at least reliability to determine which method is more accurate and should
once and 8% more than once. In the last 6 months of the OEP therefore be used as a gold standard. KEYWORDS: Perometer; limb;
26% had fallen once and 4% more than once. CONCLUSIONS: volume; measurement. FUNDING ACKNOWLEDGEMENTS: Queen
Participation in the OEP reduces falls in older adults by a third. More Margaret University College. CONTACT: [email protected]
work is needed to address the barriers to implementing community ETHICS COMMITTEE: Queen Margaret University College research
based falls prevention programmes. IMPLICATIONS: Falls should ethics committee
not be an accepted consequence of ageing and as such the New
Zealand Government have identified falls as a major health issue
for older adults. The Government is actively addressing this issue
by funding the delivery of the OEP and other falls prevention
programmes, creating an opportunity for physiotherapists to be at
the forefront of prevention. KEYWORDS: Falls prevention, older
adult, community dwelling. FUNDING ACKNOWLEDGEMENTS:
AUT University, Accident Compensation Corporation, Ministry of
Health. CONTACT: [email protected]
EQUATIONS FOR PREDICTING MAXIMAL STRENGTH AFTER THE VIEWS OF PHYSIOTHERAPISTS: EDUCATION AND NEW
INJURY TO ANKLE PLANTAR-FLEXORS GRADUATE PREPAREDNESS IN ELECTROPHYSICAL AGENTS
McNair P, Lovelace C, Reid D; Physical Rehabilitation Research Chipchase L1 , Williams M1 , Robertson V2 ; 1 School of Health
Centre Sciences, University of South Australia, Adelaide, SA 5000,
PURPOSE: To compare the accuracy of eight 1RM prediction AUSTRALIA; 2 University of Newcastle, Teaching and Research
equations in persons with an injury to the plantar-flexor muscles of the Unit, Gosofrd, NSW 2250, AUSTRALIA
ankle joint. RELEVANCE: It is important that physiotherapists have
an accurate method for the assessment of plantar flexor strength PURPOSE: This study aimed to determine which electrophysical
in order to appropriately set an individual’s rehabilitation program. agents (EPAs) physiotherapists believed should be included in entry-
While the 1-repetition maximum (1RM) technique is frequently used level training and, to establish new graduate physiotherapists’ beliefs
in athletic training, a major limitation in clinical situations is the regarding their preparedness to use particular electrophysical agents.
chance of re-injury when maximally loading previously injured tissue. RELEVANCE: EPAs remain a core component of many entry-
Equations for estimating 1RM from repetitions completed at sub- level physiotherapy education programs. Successive surveys of EPA
maximal loads have been developed. Unfortunately, no research has usage, however, show professional practice patterns have changed
been conducted on these prediction equations in persons following over the past two decades. This study investigated the views of
injury. If these prediction methods are an accurate measure of physiotherapists as to which EPAs should be included in entry-
1RM in persons following injury, they would provide a useful tool level curricula and, the perceptions of new graduates as to their
for the prescription of muscle strengthening programs following preparedness in using EPAs in the clinical context. PARTICIPANTS:
injury. PARTICIPANTS: Twenty previously injured subjects with a All registered, practicing physiotherapists in Australia whose names
background in recreational sports participated. Fifteen of these were listed on state registration boards were invited to participate
subjects had sustained a full or partial tear of the Achilles tendon. in the study. Physiotherapists who were retired, working overseas
Nine of these Achilles tendon injuries were surgically repaired. Five or not practicing physiotherapy were not included. METHODS:
subjects had sustained a major strain injury to the plantar-flexor In this observational cross-sectional study, a purpose designed
muscles which was diagnosed by ultrasound imaging. METHODS:
questionnaire was mailed to registered Australian physiotherapists
Each subject attended a rehabilitation gym on three occasions; a
(November 2005 and March 2006; to a total 12893 physiotherapists).
familiarisation session, then after randomisation, a session where
Reliability and content validity of the questionnaire were confirmed
the actual or ‘true’ 1RM of the plantar-flexors was established using
prior to the study. All participants were asked to rate how important
a calf raise machine, and a session where the subjects performed
with a load at which they could lift approximately 10 repetitions they believed 23 different EPAs were within entry level curricula (four
before fatiguing. The data from this latter session was used in eight point Likert scale: 1 =”not important” and 4 = “very important”).
prediction equations to calculate 1RM strength. Subsequently, these New graduate physiotherapists, those who had completed their
data were compared to the actual 1RM data. ANALYSIS: A paired training in the last two years, were also asked to indicate how
t-test was used to compare the difference scores (predicted 1RM – well prepared they were to use those 23 EPAs (four point Likert
actual 1RM) across the injured and control limbs. Data were plotted scale: 1 = “not prepared” to 4 = “very prepared”). ANALYSIS:
using Bland and Altman graphs, enabling an appreciation of the Results were analysed with SPSS (v 14) using standard descriptive
distribution of error between the 1RM and that predicted by each statistics. RESULTS: 3538 completed questionnaires were returned
equation. Intraclass correlation coefficients (ICCs) between actual (27.4% response rate), 349 (9.9%) of which were new graduates.
1RM and the respective 1RM prediction methods were calculated. Over 75% of all the respondents indicated that learning about
Typical errors were calculated using the standard deviation of the cryotherapy, EMG and pressure biofeedback, hot packs, ultrasound,
difference scores (predicted 1RM – actual 1RM). Significance levels sensory electrical stimulation and interferential current was “very
were set at 0.05. RESULTS: There was a significant deficit in strength important” or “important” in entry-level curricula. Over 75% also
in the injured plantar-flexor muscles compared to the uninjured limb. indicated that shortwave diathermy, ultraviolet light, infrared light
There were no significant differences between the predicted 1RM and microwave were “not important” or only “somewhat important”
and actual 1RM values for both control and injured limbs. Bland for inclusion in entry-level curricula. Most new graduates (80%)
and Altman graphs for all equations showed a low level of bias reported that they were “prepared” or “well prepared” to clinically
and random scatter across the range of data. All ICCs were high use ultrasound, hot packs, cryotherapy and sensory electrical
(range: 0.95-0.99). However, there were differences in the lower stimulation. They reported lower levels of preparedness in using
confidence interval (range: 0.783-0.972). Typical error ranged from
interferential current, biofeedback and electrical current for motor
1.7-3.0 percent across the predicted 1RMs. CONCLUSIONS: These
stimulation. CONCLUSIONS: New graduates indicated that they
findings show that in patients who have sustained a significant
felt well prepared to use only four of the six EPAs selected by
injury to their plantar-flexor muscles, the accuracy of equations
for predicting 1RM strength is high. IMPLICATIONS: When tissues physiotherapists as the most important for inclusion within entry-
cannot be loaded maximally for fear of causing re-injury, prediction level curricula. There is a mismatch between the EPAs selected as
equations are a useful tool for assessment and prescription of important and new graduates perceived level of preparedness for
ongoing muscle strengthening exercises in subjects with plantar- clinical practice in using them. IMPLICATIONS: New graduates must
flexor injuries. KEYWORDS: Strength, plantar flexors, rehabilitation, be fully prepared to be safe and effective in a range of EPAs that the
prediction. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT: profession considers important for contemporary practice. The results
[email protected] of this study will provide useful information to educators and curricu-
ETHICS COMMITTEE: This work was approved by the Auckland lum planners of entry-level physiotherapy programs. KEYWORDS:
University of Technology Ethics Committee, Auckland, New Zealand. Electrophysical agents, new graduate preparedness, entry-level
curriculum. FUNDING ACKNOWLEDGEMENTS: No funding was
received for this study. CONTACT: [email protected]
ETHICS COMMITTEE: Ethical approval for this study was obtained
from the University of South Australia’s Human Research Ethics
Committee (15/02/2005)
Research Report Platform Presentation Graduate Training in Physiotherapy. Clinical Services, University
1611 Sunday 3 June 16:35 Hospital of Trondheim, Norway. CONTACT: [email protected]
VCEC Meeting Room 16 ETHICS COMMITTEE: The Regional Committees for Medical
BENEFITS OF CONSTRAINT-INDUCED MOVEMENT THERAPY Research Ethics, Norway
FOR UPPER EXTREMITY AFTER STROKE- A RANDOMIZED
CONTROLLED TRIAL IN NORWAY
Dahl A1,2 , Askim T3,2 , Stock R4 , Langørgen E4 , Indredavik B1,5 ; 1714 Sunday 3 June 16:35
1 The Stroke Unit, University Hospital of Trondheim, Norway; 2 Clinical
Services, University Hospital of Trondheim, Norway; 3 Department
PSYCHOMETRIC PROPERTIES OF THE MUSCULAR
of Community Medicine and General Practice, Norwegian University
DYSTROPHY FUNCTIONAL RATING SCALE
of Science and Technology, Trondheim, Norway; 4 Department
of Physical Medicine and Rehabilitation, University Hospital of Lue Y1,2 , Su C2,3 , Yang R4 , Su W2,3 , Lu Y5 , Chen S6 ; 1 Faculty
Trondheim, Norway; 5 Department of Neuroscience, Norwegian of Physical Therapy, College of Health Science, Kaohsiung Medical
University of Science and Technology, Trondheim, Norway University, Kaohsiung, Taiwan; 2 Department of Rehabilitation,
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
PURPOSE: Constraint- Induced Movement Therapy (CIMT) is a 3 Faculty of Occupational Therapy, College of Health Science,
family of therapies that purportedly increase the quality of movement
Kaohsiung Medical University, Kaohsiung, Taiwan; 4 Faculty
and amount of use of the hemiparetic upper extremity after stroke.
of Sport Medicine, College of Medical Science, Kaohsiung Medical
The benefits of CIMT and the use of valid and reliable outcome
University, Kaohsiung, Taiwan; 5 Department of Orthopaedic
measures are discussed in previous studies. The aim of this study
Surgery, Kaohsiung Medical University Hospital, Kaohsiung,
was to determine the short term and long term effects of CIMT,
Taiwan; 6 Department of Neurology, Kaohsiung Chang Gung
and compare its efficacy to traditional rehabilitation in patients
Memorial Hospital, Kaohsiung County, Taiwan
with chronic and sub-acute stroke. RELEVANCE: Patients with
upper limb hemiparesis following stroke often do not integrate their PURPOSE: The purpose of this study was to examine the
affected hand in ADL, although they have the potential to do so. reliability, validity and responsiveness of a new disease-specific
This might reduce independence and increase burden of care. measure – the Muscular Dystrophy Functional Rating Scale (MD-
PARTICIPANTS: The patients were recruited from the Stroke Unit FRS). RELEVANCE: The goals of physical therapy in dystrophic
at the University Hospital of Trondheim and hospitals in central patients are to maximize functional capacities, improve or maintain
Norway. 30 patients with upper limb hemiparesis participated; 23 capability for independence and self-care, reduce or prevent
with chronic stroke (more than 26 weeks post-stroke) and seven significant deformity, and promote quality of life, a comprehensive
with sub-acute stroke (2-26 weeks post-stroke), who fulfilled the evaluation of the varied clinical problems associated with muscular
inclusion criteria. METHODS: The patients were randomly allocated dystrophy is of paramount importance to quantify accurately patient’s
to a experimental group or a control group. The experimental group functional status and to serve as basis for evidence-based disease
consisted of 18 patients who received intensive motor training of management. PARTICIPANTS: A total of 121 patients age over
the affected hand for 6 hours daily for the chronic participants and 6 years and a definite diagnosis of muscular dystrophy confirmed
4 hours daily for the sub-acute participants, for 10 consecutive by two neurologists on the basis of clinical, EMG and muscle
weekdays. The unaffected arm was restricted with a mitten during biopsy criteria were recruited into this study. Over half of our pilot
90% of waking hours. 12 patients were allocated to a control group sample was diagnosed with Duchenne muscular dystrophy, followed
receiving standard rehabilitation. Assessments were performed by by limb-girdle muscular dystrophy, Becker muscular dystrophy, and
blinded assessors at pre-treatment, post-treatment and 6 months facioscapulohumeral muscular dystrophy. METHODS: The internal
after intervention. Wolf Motor Function Test (WMFT) (performance consistency of both total and dimension scores of the scale
time and functional ability) was the primary outcome. Secondary was examined. Test-retest reliability and inter-rater reliability were
outcomes, measuring “real world arm use”, were Motor Activity Log evaluated by administering the test to a group of 51 patients
(MAL) (amount of use and quality of movement) and Functional randomly selected from the total sample. The validity of the
Independence Measure (FIM). ANALYSIS: Differences in change final scale with the Barthel index, the Brooke scale, the Vignos
between groups were analyzed with independent samples t-test and scale, muscle strength, contracture severity and pulmonary function
with ANCOVA using the pre-treatment test of dependent variable was assessed in the same sample for reliability analyses. The
and time since stroke as covariates. RESULTS: All participants responsiveness of the MDFRS was also examined. ANALYSIS: The
completed all assessments. The CIMT group showed a statistically internal consistency was examined using Cronbach’s a coefficient.
significant greater improvement on both WMFT performance time Intraclass correlation coefficients were used to measure inter-rater
(p = 0.047) and WMFT functional ability (p = 0.045), from the pre- and test-retest reliabilities. Validity was measured by examining the
treatment to the post-treatment assessment. There was a trend relationships the Barthel index, Brooke scale, Vignos scale, muscle
towards statistically significant greater improvements in the CIMT strength, contracture severity, and pulmonary function. In order to
group on both MAL amount of use (p = 0.125) and MAL quality verify the factor structure of the MDFRS, a confirmatory factor
of movement (p = 0.138), but no such differences on FIM during analysis was performed. Standardized response mean was used to
the same period. At 6 months follow-up there were no significant measure responsiveness. RESULTS: Internal consistency reliability
difference between the groups according to any outcome measure. was excellent for all domains of the final 33-item scale, with values
CONCLUSIONS: CIMT seems to be an effective method to improve of Cronbach’s alpha ranging from 0.84 to 0.97. Intraclass correlation
motor function of the hemiparetic hand in the short term, but it does coefficients for test-retest and inter-rater reliability were 0.99 for all
not seem to have a long term effect. It is yet unclear to what extent domains of the MDFRS. The MDFRS showed moderate to high
this functional improvement transfer into activities of daily living. correlations with a range of functional rating scales measuring similar
IMPLICATIONS: People with stroke and upper extremity impairments aspects and impairment parameters (Spearman’s rho = 0.65-0.91;
may benefit from intermittent maintenance sessions of CIMT, in p < 0.001, each). Confirmatory factor analysis supported a unitary
order to keep their improved motor function and to regain further construct of the four-dimensional MDFRS. Sensitivity to change
ADL function. KEYWORDS: Stroke, Rehabilitation, Hemiparesis. was confirmed by a large standardized response mean for the
FUNDING ACKNOWLEDGEMENTS: The Norwegian Fund for Post- MDFRS total score. CONCLUSIONS: The MDFRS is a reliable
and valid disease specific measure of functional status for patients
with muscular dystrophy. IMPLICATIONS: The MDFRS combines
both impairment and disability in a single measure that reflects the
patient’s status in the following areas: mobility, basic activites of daily Fall-related injuries, emergency department, elderly. FUNDING
living, arm function and impairment. KEYWORDS: MDFRS, muscular ACKNOWLEDGEMENTS: No funding was received for this study.
dystrophy, functional status. FUNDING ACKNOWLEDGEMENTS: ETHICS COMMITTEE: Research Ethics Board, University of Toronto;
This work was supported by grants from the National Science Council Research Ethics Board, St. Joseph’s Health Centre
(NSC) (project NSC89-2614-B-035-005-M47, NSC90-2614-B-037-
004-M47, NSC91-2614-B-037-009-M47). We are most grateful to
study participants for their contribution to this study. CONTACT:
ETHICS COMMITTEE: Kaohwiung Medical University, Chung-Ho VCEC Ballroom A
Memorial Hospital ANEMIA IMPEDES FUNCTIONAL MOBILITY AFTER HIP
FRACTURE SURGERY
Kristensen M1 , Foss N2 , Kehlet H3 ; 1 Department of Physiotherapy,
Research Report Platform Presentation Hvidovre University Hospital, Copenhagen DK-2650, Denmark;
1543 Sunday 3 June 16:55 2 Department of Anaesthesiology and Orthopedic Surgery,Hvidovre
PP Crystal Pavilion A University Hospital, Copenhagen DK-2650, Denmark; 3 Section of
MANAGEMENT OF ELDERLY PERSONS WITH FALL-RELATED Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet,
INJURIES PRESENTING TO THE EMERGENCY DEPARTMENT Copenhagen DK-2100, Denmark
OF A COMMUNITY-BASED TEACHING HOSPITAL PURPOSE: The impact of anaemia after hip fracture surgery is
Wightman E1 , Miller E1 , Rumbolt K1 , McConnell S2 , Devereaux M2 , controversial. Moderate anaemia has not been demonstrated to
Berg K1 , Campbell F; 1 University of Toronto, Toronto, Canada; increase mortality in patients with a hip fracture, but anaemia
2 St. Joseph’s Health Centre, Toronto, Canada will potentially decrease physical performance and thereby impede
postoperative rehabilitation. We therefore conducted a prospective
PURPOSE: This study describes the management of elderly persons study to establish whether anaemia affected functional mobility in
with fall-related injuries presenting to the Emergency Department the early postoperative phase. RELEVANCE: If anaemia affects
(ED) of a community-based teaching hospital. It examined the functional mobility for a person with a hip fracture during early
demographics and fall characteristics of presenting patients and how postoperative rehabilitation its essential for the physiotherapists to
these patients were screened, assessed, treated and discharged. take this into consideration when searching for reasons that impede
RELEVANCE: Fall management strategies that identify and address mobilization. PARTICIPANTS: 487 consecutive patients, median
multiple fall risk factors have been shown to reduce recurrent falls age 82 admitted to a specialized orthopedic hip fracture unit.
in the elderly. However, it does not appear that such practices are METHODS: All patients were treated according to a well defined
routinely occurring in the ED. This creates a potential role for physical multimodal rehabilitation programme with surgery within 24 hours,
therapists in the ED aimed at falls prevention. PARTICIPANTS: epidural anaesthesia and epidural analgesia, optimized nutrition,
Charts of patients 65 years of age or older who had presented to supplemental oxygen, a liberal transfusion threshold and an intensive
the ED of the participating hospital with a fall-related injury between physiotherapy programme initiated on the day of operation. Hb was
June 2004 and May 2005 (n=300). METHODS: Following approval measured on each of the first three postoperative days; anaemia was
from the Research Ethics Boards from the University of Toronto and defined as Hb < 100 g/l while functional mobility was measured during
the participating hospital, a retrospective longitudinal chart review the daily physiotherapy sessions with the Cumulated Ambulation
was conducted. A data collection tool was developed and pre- Score, which allows day to day measurements of functional mobility in
tested for reliability. ANALYSIS: A univariate analysis was performed the early postoperative phase. In addition the pre-fracture functional
on each variable and bivariate comparisons were conducted for level, medical conditions, type of surgery, complications, length of
patients admitted to hospital and patients discharged directly home stay and 30-day mortality were recorded. ANALYSIS: Correlations
from the ED. The statistical analysis was performed using SPSS were tested with Spearman’s rho. Tests for significant differences
software, version 13.0. RESULTS: Of the 300 patients, 81.3% between categorical data were performed with the Chi-square
(n=245) were discharged directly from the ED. Of these individuals, test, for ordinal and continuous data the Mann-Whitney test was
62.0% (n=152) did not receive a referral for follow-up health care used. Multivariate logistic regression analysis was done to identify
services. Patients discharged directly from the ED were less likely independent factors associated with independent walking. The level
to have fall-related risk factors assessed than patients who were of significance was set at p < 0.05. All data analysis was performed
admitted to hospital. For example, walking ability (10.2%, n=25), with SPSS version 10.1. RESULTS: 170, 132 and 116 patients were
balance (4.1%, n=10), lower extremity strength (2.0%, n=5) and anaemic on the first, second an third postoperative days respectively.
ability to perform activities of daily living (7.3%, n=18) were rarely A significant association between anaemia and the ability to walk
documented in the charts of patients discharged directly from the independently, requiring human assistance or not being able to walk
ED. In the 6 months following the index fall, 8.3% (n=25) of patients was present on each of the three days separately (p < 0.05). A
returned to the ED of the same hospital due to a subsequent fall and multivariate analysis showed anaemia to be an independent risk
17.7% (n=53) returned for a reason other than a fall CONCLUSIONS: factor for not being able to walk on the third postoperative day (OR
In the ED, functional abilities and fall-related risk factors were not 0.41 (0.14-0.73) p = 0.002). 358 patients (74%) were anaemic at
consistently documented and few patients received multidisciplinary some point and this was associated with increased 30-day mortality
management. Access to health care professionals such as physical of 12.6% vs. 6.3% (p = 0.049) and increased length of stay: 13
and occupational therapists should be paired with the piloting days vs. 8 days (p < 0.001). CONCLUSIONS: Anaemia impedes
of a screening tool to identify modifiable risk factors and guide functional mobility in the early postoperative phase after hip fracture
appropriate follow-up health care services. Further investigation is surgery and is an independent risk factor for patients not being able
needed to develop and explore the use of this tool. IMPLICATIONS: to walk postoperatively, but this study does not allow us to make
Assessing the risk factors associated with falls is currently within conclusions as to the question of whether transfusion in the anaemic
the scope of practice of both physical and occupational therapists. patient will improve her physical and functional capacity, which
Incorporating the staffing of these healthcare professionals within the requires randomized studies within similar well-defined perioperative
ED environment could help to prevent recurrent falls in the elderly care programmes. IMPLICATIONS: The present data supports the
population presenting to the ED with injuries. Prevention of recurrent concept that all available measures should be taken to prevent a
falls in our study population alone would have potentially resulted person with a hip fracture in becoming anaemic as a consequence
in over $1 million savings to the hospital system. KEYWORDS: of the surgical intervention. KEYWORDS: Anaemia impedes mobility.
FUNDING ACKNOWLEDGEMENTS: IMK Fonden (Copenhagen, Research Report Platform Presentation

Denmark). CONTACT: [email protected] 1721 Sunday 3 June 16:55
ETHICS COMMITTEE: The study is part of Hvidovre University VCEC Meeting Rooms 11-12
Hospitals Hip Fracture Project, which was approved by the local EFFECTIVENESS OF INTERFERENTIAL CURRENT THERAPY
ethical committee. IN THE MANAGEMENT OF MUSCULOSKELETAL PAIN- A
SYSTEMATIC REVIEW
Research Report Platform Presentation Fuentes J, Reiko O, David M; University of Alberta. Department
2266 Sunday 3 June 16:55 of Physical Therapy
VCEC Ballroom B & C
PURPOSE: Successful management of musculoskeletal pain is
DOES IT MATTER WHICH PLACEBO CONTROL TO USE IN
one of the major challenges in clinical practice. One of the
PHYSIOTHERAPY TRIALS?
electrotherapeutic techniques used for treating musculoskeletal pain
Machado L, Maher C, Kamper S, Herbert R, McAuley J; Back Pain is interferential current therapy (IFT). Even though its widespread use
Research Group, School of Physiotherapy, University of Sydney, by physical therapists, there is little and controversial documentation
Australia regarding the scientific evidence supporting the analgesic effects
PURPOSE: To perform a systematic review describing how placebo of IFT. The objective of this study was to evaluate the available
controls have been implemented in trials investigating physiotherapy literature regarding the effectiveness of IFT applied alone or as
interventions for low back pain (LBP). RELEVANCE: Inappropriate co-intervention for relieving musculoskeletal pain. RELEVANCE: A
placebo choices may introduce bias in randomised controlled trials critical analysis of IFT literature regarding its analgesic effectiveness
(RCTs). Designing a placebo control for a drug trial is usually will help to guide clinicians in their decision making concerning IFT
straightforward but for physiotherapy interventions this task is more in musculoskeletal pain conditions and identify potential areas for
complex. PARTICIPANTS: Not applicable. METHODS: Studies were further clinical research based on physical therapy evidence-practice.
eligible for inclusion if they were randomised, placebo-controlled PARTICIPANTS: Not applicable METHODS: Relevant studies of
trials of physiotherapy interventions for non-specific LBP or sciatica. IFT in musculoskeletal pain were searched from 1970 up to
MEDLINE, EMBASE, CINAHL and PsychInfo databases were and including April 28, 2006. Studies were obtained through an
searched for relevant trials using a search strategy recommended extensive search of electronic databases including Medline, Embase,
by the Cochrane Back Review Group. A combination of terms CINAHL, PubMed, Scopus, Cochrane Library, ISI Web of Science,
to limit search results to trials including a placebo control was and PEDro Physiotherapy Evidence Database. The following key
also used. Two independent reviewers extracted data on the types
words and their combinations were used in the search: interferential
of placebo controls. Trial methodological quality was assessed by
therapy, interferential current, musculoskeletal pain, electrotherapy,
the PEDro scale. ANALYSIS: The adequacy of placebo controls
electroanalgesia, muscle pain, and joint pain. This systematic review
identified by the structured search was accessed according to 5
focused only in randomized controlled trials (RCT) using ITF in
criteria believed to be critical to the design of control groups in RCTs:
(1) indistinguishability/structural equivalence between the placebo musculoskeletal pain conditions such as knee osteoarthritis, jaw
and the experimental group; (2) credibility of placebo intervention; pain, low back pain, and shoulder pain. The main outcome was
(3) exclusion of patients with previous experience with the therapy pain measurement determined by the use of visual analogue
mimicked in the placebo group; and (4) use of a real treatment scale, verbal rating scale, pain rating index, numeric rating score,
in the placebo group. RESULTS: Forty-seven RCTs reporting on and McGill pain questionnaire. Disability/function outcomes were
exercises, manual therapy, electrotherapy, acupuncture, heatwrap also considered. ANALYSIS: Two independent reviewers screened
therapy, education, neuroreflexotherapy, traction and biofeedback the abstracts and analyzed all papers initially selected by the
were retrieved. Most trials were of moderate methodological quality. abstract or title for the inclusion/exclusion criteria. Each criterion
The included trials showed an astonishing variety of placebo controls was graded on a yes/no basis. To evaluate the paper at the next
which were mostly suboptimal when judged against the adequacy level, the critical appraisal, the paper had to meet all the inclusion
criteria. In only 23.4% of trials were the interventions used in the criteria. The methodological quality of the final selected studies
placebo and in the experimental groups indistinguishable, whereas was analyzed with a methodological scale. This scale considered
in 76.5% of trials the interventions used were at least structurally nine important methodological issues. RESULTS: A total of 588
equivalent. Credibility of the placebo intervention was assessed by articles were found in the database search. Of the 588 articles,
different procedures in 25.5% of trials. The same proportion of trials 78 were selected as potential studies of interest based on their
excluded patients with previous experience with the therapy mimicked abstracts. Only 17 studies actually fulfilled the initial criteria. The
in the placebo group. Finally, 27.6% of trials used placebos which are kappa agreement between the reviewers in selecting articles after
contemporary treatments. Potential reasons for inappropriate choices applying the inclusion and exclusion criteria was k= 1.0. At the
of placebo controls may be the disagreements about which compo- end of the critical appraisal stage, there was an agreement of k =
nents of the intervention are specific or represent a placebo and the 0.895. After applying the methodological scale, none article reached
difficulty in designing placebos which are indistinguishable from the
a high methodological quality, just one was of moderate, and 16
experimental intervention. CONCLUSIONS: Placebo controls used in
were of weak methodological quality. CONCLUSIONS: No definite
physiotherapy trials for LBP often fail to meet the basic criteria for the
conclusions could be drawn about the effectiveness of IFT in reducing
use of this type of control in RCTs. Trial protocols must pay special
pain in musculoskeletal conditions alone or as a co-intervention,
attention with choices of placebo interventions which are not inert
and which do not provide a good match for placebo effects in the ex- due to the poor quality of the selected studies. IMPLICATIONS:
perimental group. IMPLICATIONS: RCTs with inappropriate choices With further evidence from high-quality RCTs, it may be possible
of placebo groups may overestimate or underestimate the effects to accept the application of IFT in musculoskeletal pain disorders. It
of physiotherapy interventions. The development of guidelines with is evident that a need exist for carefully designed and conducted
recommendations on how to design placebo controls in physiotherapy RCTs in this area with sufficient power to identify clinically
trials is of high priority. This will allow more interpretable results in significant effects besides more control of internal and external
future studies and it will also facilitate the comparison of results validity. KEYWORDS: IFT, musculoskeletal pain, systematic review.
between trials. KEYWORDS: Systematic review, physiotherapy, FUNDING ACKNOWLEDGEMENTS: This study was supported by
placebo effect, blinding. FUNDING ACKNOWLEDGEMENTS: Not MECESUP scholarship (government of Chile) and Catholic University
applicable. CONTACT: [email protected] of Maule, Chile. CONTACT: [email protected]
Research Report Platform Presentation Innovation. Carol L. Richards holds a Canada Research Chair in
1893 Sunday 3 June 16:55 Rehabilitation. CONTACT: [email protected]
VCEC Meeting Room 16 ETHICS COMMITTEE: Ethics Committee of the Institut de
A VIRTUAL REALITY-BASED LOCOMOTOR TRAINING PRO- réadaptation en déficience physique de Québec (IRDPQ)
GRAM TO PROMOTE WALKING COMPETENCY AFTER STROKE
Richards C1,2 , Malouin F1,2 , McFadyen B1,2 , Dumas F1,2 ,
Comeau F1,2 , Robitaille N2 , Fung J3 , Lamontagne A3 ; 1 Department Research Report Platform Presentation
of Rehabilitation, Laval University, Quebec City, QC., Canada; 2091 Sunday 3 June 16:55
2 Centre for Interdisciplinary Research in Rehabilitation and Social VCEC Meeting Room 17
Integration (CIRRIS); 3 School of Physical and Occupational Therapy, FEASIBILITY AND RELIABILITY OF KNEE MUSCLE STRENGTH
McGill University and CRIR Research Center, Montreal, QC., Canada TESTING AND ULTRASOUND IMAGING OF VASTUS LATERALIS
IN 6-12 YEAR OLD CHILDREN
PURPOSE: Progressively intense task-oriented practice under
varied environmental and cognitive demands, although known to Old S1,2 , Drechsler W1 , Stephensen D1 ; 1 University of East London,
promote locomotor recovery after stroke, is often lacking in current Stratford, London, UK; 2 Northwick Park Hospital, Harrow, UK
rehabilitation programs. Virtual reality (VR) technology offers new PURPOSE: Muscle strength is well established in adults but there
and safe ways to vary practice of walking tasks with cognitive is little evidence in the literature regarding muscle strength in
demands, under conditions that motivate and empower a person to children. Children need to be considered seperately due to different
re-acquire locomotor skills. The purpose of this study is to report the physiological characteristics, including skeletal growth and muscle
feasibility of applying a VR-training program in persons with chronic force. A normative database is required and reliability and feasibility
stroke. RELEVANCE: A VR-based approach should lead to improved of muscle strength tests in children needs to be established. Studies
walking competency in the community by targeting specific practice in adults have determined that muscle architecture is an important
of gait speed, changing terrains, endurance, obstacle avoidance feature of muscle strength. Using ultrasound, anatomical cross-
and decision making. PARTICIPANTS: Five persons (4 men and sectional area (ACSA), muscle thickness, pennation angle and fibre
1 woman) with chronic stroke (34-87 months post stroke) and a length has been investigated in adults. In children, limited data has
stable cardiorespiratory condition aged 51-76 years, who walked been published investigating the use of ultrasound to determine
at free speeds ranging from 49-92 cm/s overground, completed muscle architecture and no studies report reliability in children.
9 training sessions over 3 weeks. METHODS: Subjects walked, Thus, this study aimed to determine the feasibility and reliability of
while using a sliding handrail and a safety harness, on a self- isometric and isokinetic muscle strength testing of the hamstring
paced treadmill mounted on a 6-degree-of-freedom motion platform and quadriceps muscle and the feasibility and reliability of using
in virtual environments (VEs). Platform movements were computer ultrasound to measure ACSA, muscle thickness, fibre length and
controlled to mimic changes in terrain encountered in the VEs. In pennation angle in the vastus lateralis (VL) muscle in children.
the first 3 VEs (Street Crossing, Corridor Walking, Park Stroll) the RELEVANCE: The feasibility and reliability of these measures in
person walked 40m with increasing difficulty (3 levels) related to children needs to be established to develop a normative database
time, terrain changes and obstacle avoidance. Animation provided and to allow clinicians to gain accurate objective measures when
feedback on successes or failures in timing (all levels) or avoiding treating children with a variety of conditions such as cerebral palsy,
collisions (level 3). Once the first 3 VEs were mastered, the subject arthritis and obesity. PARTICIPANTS: 12 children aged 6-12 years
graduated to 2 more complex VEs (Catching a Train, Beach Walking) old with parental consent volunteered from a local primary school
that increased the distance walked (90m; 100m) and included time, and met the inclusion and exclusion criteria. METHODS: Subjects
multiple terrain and obstacle avoidance constraints. Heart rate and were tested twice within a session to determine reliability. Isometric
blood pressure were monitored throughout the program. Pre-and strength measurements at 60 degrees knee flexion and isokinetic
post-training outcomes included: free and fast 5m walking speeds, strength measurements at 180 and 60 degrees/second of the knee
6-minute walk, Balance Scale, Activities-specific Balance Confidence flexors and extensors were recorded. Ultrasound images of VL in the
(ABC) Scale and subjective reports. ANALYSIS: Descriptive statistics transverse and longitudinal plane were recorded to determine ACSA,
are used to report changes in outcomes. RESULTS: All subjects muscle thickness, pennation angle and fibre length. ANALYSIS:
adapted to the self-paced treadmill in about 15 minutes and Mean scores for both tests were determined and a one way ANOVA
reported being able to interact meaningfully within the VEs (total was calculated to determine CV and ICC (1,1; 1,2). Pearson cor-
practice time = 110-125 min.). In the VEs they walked 13-43% relation coefficients were applied to examine possible relationships
(n=5) faster than in the habituation period without VEs, as well between parameters. RESULTS: Good reliability was determined for
as 14-114% and 3-64%, respectively, faster than their free (n=5) all muscle strength tests. Maximal voluntary isometic contraction
and fast (4/5) pre-overground speeds. In addition, with practice, for the knee extensors (MVICE) was the most reliable measure
they were able to meet time constraints or to modulate their (ICC 1,2 = 0.98). Good intrarater reliability (ICC 1,1) was determined
speed to adapt to terrain changes and to avoid collisions. Post- for the following ultrasound measures; muscle thickness both in the
training, the % increase in outcomes was: free walking speed: longitudinal and transverse plane (0.99 and 0.97 respectively) ACSA
2-35% (4/5), fast walking speed: 1-19 (n=5), 6-minute walk: 9- (0.94) and pennation angle (0.72) of VL. Significant relationships
19% (4/5), Balance Scale: 4-6% (3/5), ABC Scale: 7-14% (3/5). (p < 0.05)existed between MVICE and muscle thickness (longitudinal
Subjects reported improvements in walking competency such as: plane); MVICE and ACSA; MVICE and pennation angle; ACSA
improved control on slopes, including in a darkened movie theatre, and pennation angle; ACSA and muscle thickness (longitudinal
improved confidence in street-crossing and in avoiding collisions with and transverse planes); pennation angle and muscle thickness
persons or wheelchairs. CONCLUSIONS: These preliminary results (longitudinal and transverse plane). CONCLUSIONS: Isometric and
demonstrate the feasibility and empowerment potential of this VR- isokinetic strength measurements of the quadriceps and hamstrings
based locomotor training system to promote walking competency were reliable in children age 6-12 years old and ultrasound
in the community. IMPLICATIONS: Before it can be recommended, images of VL could be reliably taken in these children. Additionally
however, its efficacy must be demonstrated in the randomized correlations were found to exist between the various parameters.
controlled pilot trial currently underway. KEYWORDS: stroke, IMPLICATIONS: This research suggests that ultrasound may be
virtual reality, locomotor training, walking competency. FUNDING used as a low cost tool to indirectly measure muscle strength in the
ACKNOWLEDGEMENTS: This work was supported by the Canadian clinical setting. KEYWORDS: muscle strength, ultrasound imaging,
Stroke Network for Excellence and the Canada Foundation for children. FUNDING ACKNOWLEDGEMENTS: Paediatric Therapy
Department, North West London Hospitals Trust, UK. for funding MSc FUNDING ACKNOWLEDGEMENTS: Royal Brisbane and Women’s
in Physiotherapy. CONTACT: [email protected] Hospital Foundation, Australasian Menopause Society. CONTACT:
ETHICS COMMITTEE: Ethics approval was gained from University [email protected]
of East London, School of Health and Bioscience Ethics Committee ETHICS COMMITTEE: Medical Research Ethics Committe at the
university of Queensland and the Royal Brisbane and Women’s
Research Report Platform Presentation Hospital Research Ethics Committee.
EVIDENCE FROM DEMOGRAPHICS, FUNCTIONAL TASKS,
STRENGTH MEASURES AND SENSORY FUNCTION SUPPORT
SCREENING FOR BALANCE LOSS IN ‘HEALTHY’ COMMUNITY Research Report Platform Presentation
AMBULANT WOMEN 2972 Sunday 3 June 17:15
LowChoy N, Brauer S, Nitz J; The University of Queensland
MUSCLE ACTIVITY ONSET IN ABDOMINAL MUSCLES
PURPOSE: The purpose of the research is to inform new initiatives RECORDED SIMULTANEOUSLY BY INTRAMUSCULAR
and strategies towards healthier ageing. This study investigated ELECTROMYOGRAPHY AND HIGH FRAME-RATE
differences in demographics, functional measures, strength and ULTRASOUND IMAGING
sensory system function of stable, unsteady and unstable categories
Vasseljen O1 , Fladmark A1,2 , Westad C1 , Nygaard Ø1,2 , Torp H1 ;
of women identified after completion of postural stability tasks. 1 Faculty of Medicine, Norwegain University of Science and
RELEVANCE: Given the continuing prevalence of falls in the older
Technology, Trondheim, Norway; 2 St Olav University Hospital,
person and the escalating costs associated with falls and related
Trondheim, Norway
injuries of an ageing Australia and other international countries,
it is important to inform new initiatives and strategies towards PURPOSE: The purpose of this study was to investigate whether
healthier ageing. One option is to identify early those vulnerable
high frame-rate ultrasound imaging would yield comparable results
to an increased fall’s risk with age to enable prioritized referral for
as compared to intramuscular EMG for muscle activity onset in the
education and prevention intervention. PARTICIPANTS: 254 ‘healthy’
abdominal muscles (transversus abdominus, internal and external
women aged between 40 and 80 years. METHODS: Demographics
obliques; TrA, OI and OE). RELEVANCE: Delayed anticipatory
(age, height, weight, medication use, co-morbidities, fall history and
activity level), clinical balance tests of function, lower limb strength muscle activity response in deep abdominal and back muscles
(quadriceps, hip abductor and adductor muscles), somatosensation has been observed in patients with low back pain, indicative of a
(vibration sensitivity, joint re-positioning error, tactile acuity), gaze pathological condition. Muscle activity onset is traditionally recorded
stability and visual acuity were recorded. Women were categorized as by intramuscular electromyography (EMG), but there is a need for
stable (able to complete all trials), unsteady (failed one or two trials) a non-invasive and less cumbersome recording method in large
or unstable (failed all trials) using performances of three 10-second clinical studies. PARTICIPANTS: Six young to middle-aged healthy
trials of bilateral stance, foam surface, eyes closed (BS_ foam EC) male and females volunteered to the study. METHODS: Muscle
and one-legged stance eyes open (OLS_EO). ANALYSIS: ANOVAs activity onset was recorded simultaneously by ultrasound m-mode
were used to identify differences between categories of women and intramuscular EMG during rapid arm flexions in response to the
for recorded measures. RESULTS: Both balance tasks identified flash of a light signal. Ultrasound m-mode with a temporal resolution
a similar proportion of women from the 50s as unstable (8-9%) of 500 frames per second was used to record rapid movements
although more women were categorized as unsteady after trials caused by muscle deformations in TrA, OI and OE. Alternative
of BS_foam EC (18%) than OLS_EO (12%). The unsteady and ultrasound techniques based on tissue velocity imaging was included
unstable categories were older, reported more medications and co- to explore regional onset variations (strain rate imaging). The latter is
morbidities and less activity. More falls were reported by the unstable under analyses and will be presented at the congress. ANALYSIS:
category who failed OLS_EO. Heavier women failed OLS_EO but Latency time between the light signal and muscle activation onset
not BS_EC. Performances of the unsteady and unstable categories was calculated separately for the EMG (volt) and US recordings
of women for the step test and the TUG test were inferior to (deformation) by visual inspection of time-amplitude displays. Mean
the stable women (p < 0.001). The unstable group was significantly latency differences between the methods were calculated for all three
weaker (p < 0.01); recorded higher vibration thresholds (p < 0.01) muscles. RESULTS: High frame-rate ultrasound and intramuscular
and greater joint re-positioning error during a weight bearing task EMG recorded muscle onset in TrA and OI with an average
(p < 0.01); and lower scores for edge contrast sensitivity and low- difference between the two methods of less than 10 ms. In OE
contrast visual acuity (p < 0.001). Gaze instability was more evident muscle onset was on average recorded 42 ms later by EMG than
for unsteady / unstable categories of women. CONCLUSIONS:
ultrasound. True activation within the muscle at loci distant to the
These data provide evidence that simple screening tools could be
site of initial onset, as recorded by EMG, is likely obscured in the
used to prioritize referral for early prevention intervention for women
m-mode image by passive tissue deformations. CONCLUSIONS:
from the 40s to minimize falls risk as women age. IMPLICATIONS:
Ultrasound m-mode imaging at high time resolution can detect onset
• Simple balance tasks (bilateral stance, foam – eyes closed and
one-legged stance – eyes open) could be used in community of muscle activity comparably accurate to intramuscular EMG. As
based settings to screen women from the 40s for balance loss as applied, the US m-mode method is not suited to detect regional
a low cost initiative towards healthier ageing. • Women who fail onset variations within the muscle occurring after the initial starting
balance tasks (8-9%) should be referred for education and targeted point. Alternative ultrasound applications will be explored in an
prevention intervention. Other women identified as ‘unsteady’ need attempt to resolve this shortcoming. IMPLICATIONS: The study gives
to be monitored (up to 15%) and referred for prevention intervention evidence for an alternative and non-invasive method to intramuscular
if further reduction in balance occurs. • Physiotherapists and EMG for muscle activity onset recordings. KEYWORDS: Muscle
others engaged in exercise prescription could use the evidence to onset, Ultrasound imaging, Electromyography, Low back. FUNDING
address the reduction in strength, visual acuity, gaze stability and ACKNOWLEDGEMENTS: The project received financial support
somato-sensory function during the delivery of targeted prevention from The Norwegian Fund for Postgraduate Training in Physiotherapy.
intervention programs to maximize the functional ability of women ETHICS COMMITTEE: National committee for research ethics in
with ageing. KEYWORDS: Women, balance loss, screening, ageing. Norway (REK IV)
Research Report Platform Presentation NMES, fracture. FUNDING ACKNOWLEDGEMENTS: The study was
2651 Sunday 3 June 17:15 partly funded by The Danish Rheumatism Association. CONTACT:
VCEC Ballroom A [email protected]
A PERI-OPERATIVE PHYSICAL THERAPY PROGRAM ETHICS COMMITTEE: The regional research ethics committees of
INCLUDING STRENGTH TRAINING AND ELECTRICAL Copenhagen and Frederiksberg
STIMULATION MAY HELP COUNTERACT FUNCTIONAL
DECLINE AFTER HIP FRACTURE
Beyer N1 , Albertsen B2 , Bährentz G2 , Rasmussen M2 , Suetta C3 ; 2198 Sunday 3 June 17:15
1 Institute of Sports Medicine – Copenhagen & Dept. Physical
Therapy, Copenhagen University Hospital Bispebjerg, Copenhagen,
LONG TERM EFFECTS OF REPETITIVE KNEE EXTENSION
Denmark; 2 Dept. Physical Therapy, Copenhagen University Hospital
INDUCED BY NEUROMUSCULAR ELECTRICAL STIMULATION
Bispebjerg, Copenhagen, Denmark; 3 Institute of Sports Medicine –
(R-NMES) ON MOTOR CORTICAL EXCITABILITY
Copenhagen, Copenhagen University Hospital Bispebjerg, Denmark
Tremblay L, Arbour C, Franche M, Major K, Ouellette S; School
PURPOSE: It has been shown that functional muscle performance
of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
increased as a result of postoperative resistance training and
electrical stimulation following hip replacement. Moreover, resistance PURPOSE: It has been well established that neuromuscular electrical
training markedly reduced length of stay in these patients. The stimulation (rNMES) enhances the performance of innervated
question is whether peri-operative physical therapy combined with muscles for patients with musculoskeletal and neurological disorders.
resistance training and neuromuscular electrical stimulation can help However, the effects of rNMES on brain excitability is not yet known.
counteract functional decline in hip fracture patients. RELEVANCE: This project investigated the modulation of cortico motor excitability
Optimising physical therapy programs to counteract functional decline using modern technology such as transcranial magnetic stimulation
in hip fracture patients may potentially improve functional ability in (TMS) during and after prolonged application (30 mins/day X 7 days)
a group of patients where many never recover their pre-fracture of repetitive NMES inducing knee extension. RELEVANCE: In the re-
physical function. PARTICIPANTS: 103 patients, aged 60 years education of motor control it is important to know the effects of NMES
and older, admitted to the Department of Orthopaedics with a on the sensorimotor cortex area of the brain. PARTICIPANTS: 10
primary hip fracture between October 2004 and June 2006. Pre healthy male volunteers (median= 21.9±1.4 yrs) from the Faculty of
fracture all patients were home-dwelling and had independent Health Sciences participated in this project. METHODS: Repetitive
walking function. METHODS: Patients who fulfilled the inclusion knee extension was induced (90º to full extension without fatigue,
criteria were invited to participate in the randomised controlled (non- with 10% of maximal voluntary contraction) with rNMES (Response
blinded) study. On inclusion the patients were randomly allocated Select©, 300 msec, biphasic simetrical wave, 15 Hz, duty 8/8 sec,
to a standard physical therapy program (SR) consisting mainly I at 2.0 X motor threshold) over the femoral nerve with a pair of
of functional training as part of an accelerated hospital stay or rubber carbon silicone electrodes (5X8 cm). Corticospinal excitability
standard physical therapy combined with resistance training (3/wk) was measured using a TMS stimulator (magstim 200©) connected
and neuromuscular electrical stimulation (daily) of the operated to a double cone coil at 10% over motor threshold. Motor evoked
side (RTES). The rehabilitation programmes were commenced the potentials (MEPs) induced by the TMS were recorded (EMG) via
day after surgery. All patients were tested with the New Mobility surface electrodes placed over motor points of dominant rectus
Score (NMS, scores 0-9) to assess pre fracture functional mobility femoris muscle (RF). This electrophysiological testing was done
and Mini Mental State Examination (MMSE) to assess cognitive before, immediately after 30 minutes of rNMES (during) and 30
function. Three and 10 days post surgery the patients performed minutes after the end of NMES (post-rNMES) at day 1 and day
a 10-m walking test (habitual walking speed). ANALYSIS: Data are 7. Voluntary strength (Nicholas hand dynomometer), discomfort
presented as median(range). Comparisons between the groups were associated to rNMES (VAS) and muscle fatigue (Borg Fatigue
calculated with the Mann-Whitney U test. RESULTS: Mean age Index) were also measured. ANALYSIS: Repeated non-parametric
was 81.5 yr (60-95)(RTES) and 82 yr (60-99)(SR). The majority measures for a small group of subjects were used (Friedman and
of the participants had a relatively high functional mobility level Welcoxon test). RESULTS: 1 session of rNMES induced a late
pre fracture, NMS=9(2-9)(RTES) and NMS=9(2-9)(SR). MMSE was significant facilitation of primary motor cortex excitability. In fact,
performed in 45 patients from both groups and very few were MEPs increased by 77±12% 30 minutes post-rNMES and by 15±9%
cognitively impaired, scores were 27(13-30)(RTES) and 28(20- immediatly after rNMES compared to control values. However, a
30)(SR). 35 patients from RTES and 25 from SR were able to 7 day series of rNMES enhanced significantly the facilitation by
perform the 10-m walking test three days post surgery (29.53s 33±6% (110 ±14% vs 77±12%) in comparison to a single session of
(15.25-119.53), and 42.17s (16.75-115.00), p = 0.112). Data on 10- training. No change was observed immediatly after rNMES sessions
m walking test at three and 10 days post surgery existed in 26 at day 1 and at day 7, (15 ±9% vs. 0±4%). The muscle strength
patients from RTES and 19 from SR. Walking time improved in increased by 15±4% after 7 days of rNMES training. The level of
both groups, however the improvements were significantly greater comfort did not change (VAS= 3.7±0.6 after first training session and
in RTES compared with SR (from 27.44s (15.25-107.56) to 18.47s 2.8±0.4 after 7 sessions). A similar result was observed with the Borg
(11.00-37.00) vs. from 39.18s (16.75- 102.82) to 23.06s (15.00- Fatigue Index (1.2±1.4 after first training session vs 1.6±0.9 after 7
123.00), p = 0.008). CONCLUSIONS: More participants in RTES- sessions). CONCLUSIONS: A delayed facilitation of the contralateral
group were able to walk 10m three days post surgery and in MEPs surpassing the time of application of rNMES and an increase
those who performed the 10-m walking test three and 10 days post of muscle strength following rNMES, showed an important long
surgery the participants from RTES had a higher habitual walking term effect not only peripherally but also at the sensorimotor
speed than those from SR. Results from this study suggest that cortex level. This training induced brain plasticity. IMPLICATIONS:
resistance training and neuromuscular electrical stimulation of the These results suggest a possible implication in rehabilitation for
operated side may counteract some of the functional decline seen clients suffering from motor disorders involving poor motor control
in hip fracture patients post surgery. The non-blindedness is the and/or muscle weakness. KEYWORDS: Repetitive neuromuscular
primary limitation of this study. IMPLICATIONS: An accelerated electrical stimulation, transcranial magnetic stimulation, motor cortical
hospital stay improves recovery after hip fracture. Implementation excitability. FUNDING ACKNOWLEDGEMENTS: Faculty of health
of neuromuscular electrical stimulation and resistance training as Sciences. CONTACT: [email protected]
part of the peri-operative physical therapy program may further ETHICS COMMITTEE: University of Ottawa Research Ethics
improve functional ability in these patients. KEYWORDS: Resistance, Comitee
RANDOMIZED CONTROLLED TRIAL OF SENSORY-SPECIFIC TRAINING AND REHABILITATION IMPLICATIONS FOR THE
BALANCE TRAINING IN OLDER ADULTS: EFFECT ON TRUNK AND EXTREMITIES WHILE PERFORMING SWISS BALL
PROPRIOCEPTIVE REINTEGRATION AND INCREASED AND CONVENTIONAL EXERCISES: AN ELECTROMYOGRAPHIC
COGNITIVE DEMANDS ANALYSIS
Westlake K, Culham E; Queen’s University, School of Rehabilitation Escamilla R, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S,
Therapy, Kingston, Ontario, Canada Pecson A, Imamura R, Hreljac A; California State University,
Sacramento, USA
PURPOSE: The primary purpose of this randomized controlled trial
was to investigate the postural effects of training on postural recovery PURPOSE: Test the effectiveness of 13 exercises performed on a
immediately following proprioceptive perturbation both with and swiss ball and two conventional abdominal exercises (Crunch and
without a concomitant cognitive task in older adults. The secondary Bent-Knee Sit-up) performed on the ground on activating abdominal
purpose was to determine the effects of the exercise program on and extraneous musculature. RELEVANCE: While abdominal crunch
balance performance and confidence. RELEVANCE: Age-related and sit-up exercises activate abdominal musculature by actively
changes in the ability to adjust to alterations in sensory information flexing the trunk, there are numerous exercises performed on a
contribute to impairments in postural control and increased fall swiss ball that activate abdominal muscles either by actively flexing
risk in older adults. This study represents one of the few studies the trunk or by resisting trunk extension. Abdominal exercises that
that have examined the possibility to enhance sensory integration actively flex the trunk may be problematic for some individuals with
through training. PARTICIPANTS: Thirty-six healthy older volunteers. lumbar disk pathologies due to increased intradiscal pressure and
METHODS: Participants were randomly assigned to an 8-week lumbar spine compression, especially if extraneous muscles are
balance exercise group (n=17) or a falls prevention education group also active, such as the hip flexors, which may increase lumbar
(n=19), each led by a physical therapist. Postural recovery following stress. Individuals with osteoporosis may also not tolerate trunk
proprioceptive perturbation through vibration was measured using flexion due to the risk of vertebral compression fractures. However,
center of pressure (COP) velocity change scores. Change scores these individuals may be asymptomatic during abdominal exercises
were determined using the difference between mean COP velocity that resist trunk extension and maintain a relatively neutral spine
over 45s of quiet standing and the mean of six 5s intervals following and pelvis. In contrast, some individuals with facet joint syndrome,
perturbation both with and without a secondary math task. Clinical spondylolisthesis, and vertebral or intervertebral foramen stenosis
measures included lower extremity strength, Fullerton Advanced may better tolerate trunk flexion exercises compared to exercises
Balance (FAB) Scale, and Activities-Specific Balance Confidence that maintain an extended trunk. PARTICIPANTS: A convenience
(ABC) Scale. Baseline and post-intervention measurements were sample of 18 healthy males and females between 23-45 years old.
obtained in exercise and education groups. Follow-up measurements METHODS: Surface electrodes were positioned on the subject’s
were taken 8-weeks post-intervention only in the exercise group. dominant side over the upper and lower rectus abdominis, external
ANALYSIS: Analysis of variance (ANOVA) was used to analyze and internal obliques, rectus femoris, triceps brachii long head,
COP change scores and the effects of the interventions on clinical sternal pectoralis major, latissimus dorsi, and lumbar paraspinals.
measures. Bonferroni correction was applied. RESULTS: COP EMG data were collected from a Noraxon EMG system during
velocity change scores decreased by post-intervention in the exercise five repetitions for each exercise. Each repetition was performed
group indicating less destabilization, in the first time interval following in a slow and controlled manner, taking 3 s to complete followed
perturbation (1-5s) both with and without the secondary task (mean by 1 s rest. EMG exercise data were normalized by maximum
change score±SD, 1.12±0.58cm/s and 1.31±0.91cm/s) compared voluntary muscle contractions. ANALYSIS: Differences in muscle
to baseline (1.68±0.96 and 2.23±1.18cm/s) and post-intervention activity were assessed by a one-way repeated measures Analysis
education group scores (1.71±0.85cm/s and 2.00±1.05cm/s), of Variance, with Tukey’s post hoc analysis used for pairwise
p < 0.05. The time to restabilize was also reduced under the comparisons. RESULTS: Compared to all exercises: 1) upper and
no secondary task condition to 11-15s compared to a baseline lower rectus abdominis activity was significantly greater with the
time of 16-20s following perturbation. Changes were not attributed Rollout, Ball Crunch, Double Crunch, Crunch, Pike, and Abdominal
to increased lower extremity strength. Improvements in postural Dips; 2) external and internal oblique activity was significantly
recovery were not maintained at 8-week follow-up. Clinical findings greater with the Pike, Skier, and Knee-up; 3) rectus femoris activity
revealed increased post-intervention and 8-week follow-up FAB was significantly greater with the Prone Hip Extension, Knee-
scores (35.0±4.06 and 35.27±4.56, respectively) compared to up, Pike, and Sit-up; 4) triceps brachii, sternal pectoralis major,
baseline scores (30.94±4.81) in the exercise group, p < 0.02. and latissimus dorsi activity were significantly greater with the
ABC scores decreased in the education group post intervention Rollout, Pike, Skier, Decline Push-up, and Prone Hip Extension; 5)
(79.06±24.20) compared to baseline scores (87.48±10.71), p = 0.05, lumbar paraspinal activity was significantly greater with the Side
but not in the exercise group. CONCLUSIONS: A sensory-specific Crunch. CONCLUSIONS: The Rollout, Pike, Knee-up, and Skier
balance exercise intervention resulting in increased short-term were not only the best exercises for activating abdominal and
improvements in postural response to the sudden restoration of oblique muscles, but they were also the best exercises in activating
proprioception information is supported. IMPLICATIONS: Given that extraneous musculature. Interestingly, even the Decline Pushup
sensory inputs related to various environmental conditions are was as effective as the Crunch and Sit-up in activating abdominal
constantly changing, findings that postural adjustments to a change and oblique muscles. IMPLICATIONS: Performing exercises with
in sensory information are enhanced with sensory-specific training a swiss ball demonstrated different trunk and extremity muscle
are encouraging. Results are expected to lead to more efficient recruitment patterns compared to the conventional crunch and sit-
balance exercise interventions and ultimately, a reduction in fall up. Understanding how different exercises elicit muscle activity from
risk in older adults. KEYWORDS: Proprioception, Balance, Aging. the trunk and extremities is helpful to therapists in developing
FUNDING ACKNOWLEDGEMENTS: Kelly Westlake was supported specific abdominal exercises for their patients or clients to facilitate
by a Canadian Institutes of Health Research Fellowship. CONTACT: their rehabilitation or training needs. KEYWORDS: EMG, SPINE,
[email protected] LUMBAR. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
ETHICS COMMITTEE: Queen’s University Health Sciences and [email protected]
Affiliated Teaching Hospitals Research Ethics Board ETHICS COMMITTEE: California State University, Sacramento
VCEC Ballroom A VCEC Ballroom B & C
BALANCE CONFIDENCE AND WALKING ABILITY ONE MONTH RESEARCH IN PHYSIOTHERAPY IN SWEDEN AND AUSTRALIA
AFTER HIP FRACTURE – A RANDOMIZED CONTROLLED TODAY – A COMPARISON REGARDING RESEARCH AREA,
STUDY ON HOME REHABILIATION STUDY DESIGN AND ICF COMPONENTS
Zidén L1,2 , Kreuter M1 , Frändin K1 ; 1 The Sahlgrenska Academy at Steding K, Gummesson C; Department of Health Sciences, Divison
Göteborg University Inst. of Neuroscience and Physiology/Physical of Physiotherapy, Lund University, Lund, Sweden
Therapy; 2 The Vårdal Institute, Göteborg, Sweden PURPOSE: The objective was to describe the research presented
PURPOSE: The aim of the study was to explore if there was at the most recent meetings in physiotherapy in Sweden and
any difference between an intervention group, receiving home Australia. The aim was to describe the topics, study design used and
rehabilitation, and a control group, receiving conventional care, which components of the International Classification of Functioning,
regarding perceived balance confidence, indoor walking ability and Disability and Health (ICF) the study’s outcome measures focused
outdoor walking habits one month after discharge from hospital. on. RELEVANCE: Because of increased international exchange,
RELEVANCE: Hip fracture is one of the most common causes for professional and in the graduate program, international comparison
hospital admission among elderly people and the development of of research approach within the field is of increased interest.
effective rehabilitation programs, as well as evaluation of existing PARTICIPANTS: The book of abstracts from the Swedish Association
programs, is essential from a humanistic as well as from an of Registred Physiotherapists annual meeting in 2005 (152 abstracts)
economical point of view. PARTICIPANTS: Before hip fracture and from the Australian Physiotherapy Associations (APA) Interna-
surgery, 102 persons, admitted to Sahlgrenska University Hospital tional Physiotherapy congress in 2004 (119 abstracts) were included.
in Göteborg, were randomized into two groups, one receiving METHODS: Abstracts from each meeting were randomly selected.
home-based rehabilitation after discharge and the other receiving Sixty-five swedish and 65 australian abstracts were included in
conventional care and rehabilitation. Inclusion criterias were: Swedish the assessment. Thirty-two abstracts were systematically reviewed
spoken, at least 65 years old, living in the community in the independently by two researchers and the remaining by one
central/western parts of Göteborg. Patients with metastatic cancer researcher. All abstracts were reviewd twice to ensure consistency
or cognitive impairment, persons living in nursing homes and those and 28 were selected for test-retest. ANALYSIS: The topics, eg.
who did not give informed consent were excluded. METHODS: In Orthopaedics or Neurology, study design such as experimental study
this ranomized, controlled study the intervention group (IG) (n=48) or observational study, and the components of ICF addressed in
received home-rehabilitation including home-visits by physioterapists the outcome assessment were categorized. An abstract could be
(PT, occupational therapists(OT)and occasional nurse visits during classified into several categories/components. RESULTS: Inter and
2-3 weeks after discharge. The PT intervention was focused on intrarater reliability was satisfactory, with only a few differences in the
supporting and encouraging activity confidence and outdoor walking. categorization. The most common area/topic was Orthopaedics. A
The control group (CG) (n=54) received conventional care. Mean quantitative study design was more common than a qualitative design
age of the participants were 81.9 years (IG 81.2, CG 82.5). in both Sweden and Australia. Researchers from both countries
The participants in the two groups were similar concerning living often chose to do observational studies or used an experimental
conditions, walking habits and number of medical diagnoses before design/did treatment studies. Among the Australian abstracts, the
the fracture. Primary outcome was balance confidence, measured studies more often involved the ICF components body structure/body
by Falls Efficacy Scale (FES), and secondary outcomes were indoor function compared to the Swedish studies. Among the Swedis studies
walking ability, measured by Timed Up and Go (TUG) and outdoor activity/participation components were more often focused on than
walking habits. ANALYSIS: T-test was used to compare the two body structure/body function. CONCLUSIONS: Physiotherapeutic
groups concerning TUG. Non-parametric statistic analyses were research in Sweden and Australia both covered many topics,
used to compare the two groups; Mann-Whitney U-Test for Falls however similar between the countries. The most common study
Efficacy and Chi Square for independence in outdoor walking. design used was a cross sectional quantitative observational study.
RESULTS: At the one-month follow up, the participants in the IG IMPLICATIONS: The findings support similarities within the field in
had received in average 2.3 PT, 1.9 OT and 0.25 nurse visits. Total the international perspective. A secondary finding was that the design
FES score was significantly higher in the intervention group (mean of the abstracts affected how difficult the review and categorization
rank for IG 65.5 and for CG 35.5, p < 0.001). Mean value for TUG was. Structured abstracts gave the best information and facilitated
was significantly lower for the IG (25.1 seconds) compared to the the review. This should be encouraged to enhance clarity and offer
CG (34.4 seconds, p = 0.018). Also, a significantly greater number of readers a better overview of the research. KEYWORDS: Sweden,
persons in the IG took outdoor walks regularly compared to the CG Australia, research. FUNDING ACKNOWLEDGEMENTS: None.
(88% compared to 46%, p > 0.001). CONCLUSIONS: The results
indicate that individuals who have participated in a home-based
rehabilitation program, in which the PT intervention is focused on Research Report Platform Presentation
encouraging and supporting activity confidence and outdoor walking, 2368 Sunday 3 June 17:35
perceive a higher degree of balance confidence, perform better VCEC Meeting Rooms 11-12
on Timed Up and GO and take outdoor walks more often than ULTRASOUND TREATMENT COMPARED TO ANTIBIOTICS FOR
those who have received conventional care. IMPLICATIONS: Since ACUTE AND CHRONIC SINUSITIS
home rehabilitation with the described direction and content seems
Høsøien E1 , Lund A2 , Vasseljen O3 ; 1 Røros Physical Institute;
to have effect on the participants’ perceived balance confidence, 2 Røros Medical Center; 3 NTNU, Norwegian University of Science
indoor walking ability and outdoor walking habits it might be a
and Technology, Faculty of Medicin, Trondheim
useful model within this field of geriatric rehabilitation. KEYWORDS:
Hip fracture, home rehabilitation, balance confidence, Timed Up PURPOSE: The purpose of the study is to compare therapeutic
and Go outdoor walking. FUNDING ACKNOWLEDGEMENTS: The ultrasound and antibiotics in the treatment of acute and chronic
study was financially supported by the Vårdal Institute, Göteborg sinusitis. An alternative treatment to antibiotics is especially important
University and Mearchant Hjalmar Svenssons Research Foundation for those who are allergic to antibiotics or are pregnant, or for
in Göteborg. CONTACT: [email protected] those who seek alternative treatment. The effect and costs of the
ETHICS COMMITTEE: The research Ethical Committee of Göteborg, two different methods of treatment will be compared. RELEVANCE:
Sweden The prevalence of acute and chronic sinusitis is 5% in the
general population. Those who seek medical treatment are normally were calculated using SPSS. RESULTS: The systolic blood pressure
prescribed antibiotics. Both WHO and national health plans have as varied significantly during srt (p = 0.004). Before the therapy it was
a goal the reduction of the use of antibiotics. PARTICIPANTS: 44 at an average of 130.7 mmHg and rose slightly to 140.1 mmHg
persons with clinical symtoms of acute or chronic sinusitis and SR after the first series. During the 5 series the systolic blood pressure
over 10 will be randomly assigned either to ultrasound treatment or varied randomly between 136.0 und 142.1 mmHg. The variation of
antibiotics. METHODS: 44 persons with clinical symtoms of acute or the diastolic blood pressure was significant as well (p = 0.033). It
chronic sinusitis and SR over 10 will be randomly assigned either to increased from 89.5mmHg, measured before the therapy, to 98.2
ultrasound treatment or antibiotics. Patients will complete a 5- item mmHg after the first series. During the 5 series diastolic blood
questionaire on their symptoms on a VAS scale, on the first, fourth pressure varied between 92.2 and 98.2 mmHg at random. The lactate
and twenty-first day of treatment. The items are pain and density in varied between 1.9-2.0 mmol/l over all series. In comparison to the
forehead, nose and teeth. In addition, the long-term effect of the two values before the test (1.9 mmol/l) no significant increase could be
methods of treatment will be investigated by questionnaire at one- detected (p = 0.521). The heart rate varied randomly between 93 and
year follow-up. The ultrasound treatment is applied at 1.0 W/cm2 101 beats/minute (p = 0.131). CONCLUSIONS: During the 5 series
CW intensity for ten minutes to the forehead, both sides of the of srt the results showed only a marginal increase in the systolic
nose and below the eyes for four succeeding days. The antibiotics and diastolic blood pressure compared with the values before the
treatment consists of Amoxcillin/Imacillin 500mg tablets; one tbl., test. Lactate and heart frequency did not exceed the measurements
three times a day for ten days. ANALYSIS: Group differences and at rest before the therapy. The strain caused by Zeptor-training
changes within groups will be analyzed. RESULTS: The preliminary is comparable to cardio vascular and metabolic strain between
results based on the initial three assessments of 26 subjects show a values during rest and the aerobic threshold. IMPLICATIONS: It
marked and rapid significant reduction of symptoms on all outcome offers a good neuromuscular effect, a minimum training effort and
variables in both groups, but with no significant difference between overall as only a slight strain. For this reason srt on a Zeptor®
groups. This indicates that ultrasound is as effective as antibiotics vibration plate seems to be very suitable for patients following a
for sinusitis. Complete data and final analyses will be presented stroke. KEYWORDS: cardiovascular strain, stochastic resonance
at the Congress. CONCLUSIONS: If the tendency shown by the therapy, stroke. FUNDING ACKNOWLEDGEMENTS: This survey
questionnaire prevails, the study will be the first to provide evidence was unfunded. CONTACT: [email protected]
for comparable efficacy of therapeutic ultrasound and antibiotics for ETHICS COMMITTEE: local ethical commitee of Berne
sinusitis, and thus that ultrasound may be a valuable alternative to
antibiotics. IMPLICATIONS: If the tendency prevails, there might be
a possibility that ultrasound treatment equals antibiotics and thus
can be a valuable alternative. KEYWORDS: Ultrasound, sinusitis, 3290 Sunday 3 June 17:35
antibiotics. FUNDING ACKNOWLEDGEMENTS: The project got VCEC Meeting Room 17
15.000 Norwegian kroner/ca. 1875 Euro/ca. 2500 US dollars SENSITIVITY AND SPECIFICITY OF A TWO STEP SCREENING
from Norsk Fysioterapiforbund, avd. Sør-Trøndelag for ultrasound PROCEDURE FOR FOUR TO SIX MONTH OLD INFANTS
equipment. CONTACT: [email protected] Meade V1 , Sweeney J, Chandler L, Woodward B; 1 Rocky Mountain
ETHICS COMMITTEE: Medisinsk etisk komite University of Health Professions, Provo Utah
PURPOSE: The US federal government has recognized the
Research Report Platform Presentation importance of early and accurate identification of children with
2344 Sunday 3 June 17:35 developmental delay or disability through the Individuals with
VCEC Meeting Room 16 Disabilities Education Act (IDEA) which requires states to set up
ACUTE CARDIOVASCULAR AND METABOLIC STRAIN DURING methods to find eligible children. Eligible children are not always
STOCHASTIC RESONANCE THERAPY (ZEPTOR® WHOLE- identified in a timely manner. Current screening relies on either
BODY VIBRATION PLATE) WITH PATIENTS FOLLOWING A surveillance or tests for early detection; both strategies are expensive
STROKE and may over- or under- identify children. The purpose of this study is
to select infants initially identified by parents concerns and then test
Herren K1 , Hotz-Hängärtner C1 , Oberli A1 , Mathis J2 , Radlinger L1 ;
1 Research Physiotherapy, University Hospital Berne, Switzerland; the infants using an observational screening tool requiring parent
2 Department of Neurology, University Hospital Berne, Switzerland participation. RELEVANCE: These two steps will actively involve
parents and result in a more sensitive and specific process of
PURPOSE: A treatment with stochastic resonance therapy (srt) on child find during community surveillance. PARTICIPANTS: Parents
a Zeptor® vibration plate has been shown to increase force and of infants aged 4 to 6 months, living in Houston Co. MN, were
power of leg muscles, balance and movement velocity. The aim of invited to attend a screening clinic in their area. METHODS: This was
this study was to investigate the physical strain for patients with an observational screening study. Parent concerns were measured
a stroke during srt. RELEVANCE: Stroke is the leading cause of by attendance at the clinics and answers on the Parent Concerns
disability among adults. Hypertension is one of the established risk Survey. Parents who choose to attend were compared to a random
factors for the occurrence of this disease. This means that one group of parents who choose not to attend. Step two consisted of
should avoid strenuous exercises that might increase blood pressure active parent involvement using a structured observational screen,
when treating patients with a stroke in physical therapy. This study the Meade Movement Checklist. All infants were independently
demonstrates the amount of physical strain during srt for these evaluated at 6 months using the Bayley Scales of Infant Development
patients. PARTICIPANTS: 20 patients (15 men, 5 women, 57.8 + 10.5 II and the Movement Assessment of Infants. ANALYSIS: Scores on
years) with a recent stroke were included in the study. METHODS: the MMCL were compared to BSIDII, MAI and parent descriptions
In a cross-sectional study the patients had to perform a stochastic of their infant’s development on the ASQ at 8 to 9 months of
resonance therapy with individual sub-maximum vibration-frequency. age. Two by two tables evaluated sensitivity, specificity, positive
Thereby the patients stood on the Zeptor® with slightly bent knees. predictive and negative predictive values of parent concerns and the
The training consisted of 5 series of 1 minute each with 1 minute rest MMCL. RESULTS: Of the 213 eligible infants, 55 (25%) attended
in between. Blood pressure, heart rate and lactate were measured one clinic and parents completed the survey and MMCL. Forty
before (at rest) and during srt. The study was approved by the ethics three (78.2%) infants were evaluated by the principle investigator,
committee of Berne. ANALYSIS: The descriptive statistics and the who was blind to all screening information. Parents who attended
nonparametric analysis of variance of the dependant measurements the clinics had significantly more concerns on the survey than
(Friedman-Test: before therapy and during 5 series) of parameters parents who did not attend. 60% of parents’ concerns included
questions about feeding issues. There were significant correlations guide, have evolved in response to ongoing review. RESULTS: Over
between the MMCL and MAI and BSID II. There was no correlation a three year period, 193 questionnaires were returned (128 Year 2
between any scores at 4 and 6 months and the pass/fail on the students; 65 Year 3 students). Two cohorts (2002 and 2003) had
ASQ between 8 to 9 months. The specificity of the PCS was 81% completed questionnaires for both Year 2 and Year 3 but these
and sensitivity 60%. The specificity of the MMCL was 88.2% and were not matched due to the anonymity of submission. One cohort
sensitivity was 77.8%; PPV was 63.6% and NPV was 93.8%. When (2004) had only completed Year 2. Descriptive statistics show that
both BSID scores and medical diagnosis categories were combined greater than 50% of respondents agreed that the portfolio contributed
to determine referrals, 15 infants were referred for further evaluation to the positive outcomes outlined in 10 of the 16 statements.
(27.7%). Referrals represented 7.04% of the 213 invited and 34.8% The most recent cohorts, 2004 for Year 2 and 2003 for Year 3,
of the independent evaluations completed. CONCLUSIONS: Parent reported completing the portfolio was an ‘effective use of time’,
concerns were used in step one to increase specificity and ‘rule more than the cohort from the previous year (p = 0.010 and p = 0.044
out’ typical infants. An observational screening test was used in respectively). Respondents felt that completing a portfolio did not
step two to increase sensitivity. Parents with questions about their lead to ‘better marks’ in assignments (86%), ‘better preparation
infant took the opportunity to have those questions answered. for assignments’ (73%) nor provided ‘reassurance about course
IMPLICATIONS: Parents’ listed their concerns and identified 25% related concerns’ (73%). On average, students reported spending
of a birth cohort for a second screen. This resulted in both 1.3 hours per day during their clinical placement on portfolio-
increased specificity and sensitivity in screening 4 to 6 month old related activity and more than 5%, but less than 10%, of this was
infants. KEYWORDS: Screen, Infants,Parent concerns, Community spent in normal work hours. CONCLUSIONS: Students identified
surveillance, Prevention. FUNDING ACKNOWLEDGEMENTS: Grant benefits from completing a reflective practice portfolio that extend
support from The Houston County Early Childhood Initiative, to their broader learning experience. There seems to be improving
Houston County, Minnesota; Clinic setups and Screening services acceptance of the portfolio from its initial implementation. It is
through Houston County Interagency Early Intervention Committee, unclear if this is because of changes to the portfolio requirements
Early Childhood Family Education in Caledonia, Houston, La and guidance, or because of the new professional requirements
Crescent/Hokah and Spring Grove, Houston County Public Health, for CPD and registration. IMPLICATIONS: Clinical-based learning
Hiawatha Valley Education District, Houston County, Minnesota, can be facilitated by a reflective practice portfolio and has the
USA. CONTACT: [email protected] potential to benefit the broader learning experience of physiotherapy
ETHICS COMMITTEE: IRB of Rocky Mountain University of Health students. KEYWORDS: portfolio, undergraduate, learning. FUNDING
Professions, Provo, Utah ACKNOWLEDGEMENTS: Nil. CONTACT: [email protected]
Platform Presentations, Monday 4 June Research Report Platform Presentation

Research Report Platform Presentation PP Crystal Pavilion B & C
1082 Monday 4 June 08:30 MUSCULAR DISUSE INDUCES MOTOR PERFORMANCE
PP Crystal Pavilion A DISRUPTION AND MUSCLE SPINDLE SENSITIVITY CHANGE IN
THE USE OF A CLINICALLY-BASED REFLECTIVE PRACTICE PARALLEL
PORTFOLIO: A SURVEY OF UNDERGRADUATE STUDENT Kaneko F1 , Kizuka T2 , Yamada H3 , Yokoi T1 , Yasojima T4 ,
OPINION Masuda T5 ; 1 National Institute of Advanced Industrial Science
Jones L1,2 , Hammond J1 , Horgan T1 ; 1 School of Physiotherapy, and Technology (AIST), Tsukuba, Japan; 2 University of Tsukuba,
Faculty of Health and Social Care Sciences, Kingston University Tsukuba, Japan; 3 Tokai University, Hiratsuka, Japan; 4 Kyushu
and St. George’s, University of London; 2 Faculty of Medicine, Kyoritsu University, Kitakyushu, Japan; 5 Tokyo Medical and Dental
University of Sydney University, Tokyo, Japan
PURPOSE: Reflection of clinically-based learning experiences can PURPOSE: One strategy in motor output modulation is to adjust
be facilitated by the use of a portfolio. Such a portfolio was introduced the short latency reflex gain and thereby effect changes in the
into year 2 and 3 of an undergraduate physiotherapy programme. spinal reflex gain thought to be the possible reason for the disrupted
This study investigated student opinions of the portfolio and its motor performances after immobilization. The present study was
contribution to their learning experience. RELEVANCE: In the UK, designed to test whether the spinal level short latency reflex gain
a profile from a similar reflective practice portfolio will be used as could be changed and, if so, determine where in the circuit of
part of the re-registration requirements with the Health Professions the short latency reflex it originated as a retrograde adaptation.
Council. Therefore students should have a successful and meaningful RELEVANCE: Muscular disuse, caused by joint immobilization and
introduction to the activity of collecting evidence and using reflection bed rest, is frequently encountered in physical therapy. Prevention
to construct knowledge, in their training. This study provides some measures, matched to the physiological mechanism of the motor
insight into the acceptance and meaningfulness of a portfolio to dysfunction following the disuse of muscles, are needed for every
the students. PARTICIPANTS: Undergraduate students who had patient. PARTICIPANTS: The lower extremities of nine healthy
completed a portfolio for assessment were asked to participate. males were immobilized for one week using a plaster cast. These
METHODS: A survey by questionnaire (modified from Capstick, subjects lived at home at night using a bilateral crutch and spent
2003) was undertaken, where students were asked to download, time every day at our research institute. The study was approved
complete and submit responses anonymously at the end of each by the local ethical committee of AIST; all participants gave
academic year to assist review of learning and teaching. The modified informed consent prior to participation. METHODS: Both before and
questionnaire consisted of 16 positive statements relating to the ex- after the immobilization, the following parameters were measured
perience of learning, and students were asked whether they thought while recording an electromyogram of the soleus muscle. The
the process of completing the portfolio contributed to these. Also maximum voluntary contraction (MVC) of the triceps surae and
questions were included to identify the perceived clarity of guidelines the variability of the force curve during a force modulation task
and time taken to complete the portfolio. Group email reminders were measured as indications of motor performance. In addition,
were given to optimise response rate. ANALYSIS: Analyses were the short latency stretch reflex (SLSR) of the soleus muscle was
performed using SPSS including descriptive statistics, Chi-squared recorded during a ballistic passive ankle dorsiflexion movement.
and Fisher’s exact analyses. Comparisons across cohorts were The passive torque of the triceps surae was measured as an
relevant as the structure and content of the portfolio, and the student indication of the mechanical properties of the muscle-tendon complex
Platform Presentations, Monday 4 June S111
during passive dorsiflexion. The H-reflex was recorded following sectional design, cultures were evaluated for both the amount
electrical stimulation to the posterior tibial nerve in a resting condition. (number of colony forming units (CFUs)) and type of bacteria
The H-reflex slope drawn from the H-M curve was adopted as a present. All samples containing greater than five CFUs per cm2 were
parameter that indicates the H-reflex gain. ANALYSIS: To test for considered contaminated. The 44 ultrasound transducer heads were
the immobilization effect for each motor performance and the H- then re-evaluated using a repeated measures design for the amount
reflex gain, a paired t-test was used. SLSR and passive torque and type of bacteria present after cleaning with 70 percent alcohol.
during ballistic dorsiflexion wer statistically analyzed using a two- ANALYSIS: Due to the observational nature of the measurements
way analysis of variance. RESULTS: The MVC of the triceps surae taken in both phases of this study (number of CFUs and type
significantly decreased and the variability of the force curve during of bacteria present), statistical analysis was undertaken using
force modulation task significantly increased after immobilization. The descriptive statistics. RESULTS: 27 percent of ultrasound transducer
normalized amplitude and area of the SLSR significantly increased heads were contaminated with microorganisms. Organisms isolated
after immobilization, but there was no significant difference between were predominantly those found in normal skin and environmental
the passive torque measured before and after immobilization. The flora. By contrast, 28 percent of ultrasound gels were heavily
H-reflex gain was not significantly changed after immobilization contaminated (up to 300 CFUs per cm2) with opportunistic and
compared with its value before immobilization. CONCLUSIONS: The potentially pathogenic organisms, including Coagulase negative
new findings in this study were that the SLSR response increased staphylococci, Stenotrophomonas maltophilia, Staphylococcus au-
after immobilization. The mechanical properties of the muscle-tendon reus, Acinetobacter baumannii, and Rhodotorula mucilaginosa. No
complex did not substantially change. Therefore, some factor other multi-resistant organisms were identified. All ultrasound equipment
than the mechanical properties may have caused the enhanced and gel brands were found to be similarly contaminated. Levels
SLSR response. The absence of a change in the H-reflex gain of contamination on ultrasound transducer heads were reduced by
after immobilization probably suggests that the enhanced SLSR 93.6 percent following cleaning with 70 percent alcohol (p 0.01).
after immobilization originates in the muscle spindle sensitivity. CONCLUSIONS: Therapeutic ultrasound equipment is a potential
IMPLICATIONS: An intervention to prevent an alteration in the source of infection in physiotherapy patients. The risk of infection from
muscle spindle sensitivity after immobilization that we explored in the ultrasound transducer heads can be simply and effectively removed
present study may make possible the maintenance of normal motor by cleaning with 70 percent alcohol between patients. However,
performance, even following muscular disuse. KEYWORDS: Disuse, ultrasound gels also harbour large numbers of potentially pathogenic
Immobilization, H-reflex, Stretch reflex, Muscle spindle. FUNDING organisms, implicating them in the spread of infection. Thus further
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] research and clearer guidelines on care and maintenance procedures
ETHICS COMMITTEE: Local ethical committee of AIST for ultrasound gels in clinical practice are needed. IMPLICATIONS:
The high levels of contamination identified on therapeutic ultrasound
equipment suggest that physiotherapists need to be cognizant that
such equipment is a potential source of infection, particularly in
579 Monday 4 June 08:30 individuals who are immuno-compromised or who have open skin le-
VCEC Ballroom B & C sions. KEYWORDS: Bacterial Contamination, Infection, Ultrasound.
PHYSIOTHERAPY AND INFECTION: COULD THERAPEUTIC FUNDING ACKNOWLEDGEMENTS: No funding was received for
ULTRASOUND UNITS BE A SOURCE OF INFECTION? this study. CONTACT: [email protected]
Schabrun S1 , Chipchase L1 , Rickard H2 ; 1 School of Health ETHICS COMMITTEE: University of South Australia Divisional ethics
Sciences, University of South Australia, Adelaide, Australia; 2 School committee (Health Sciences)
of Pharmacy and Medical Sciences, University of South Australia,
Adelaide, Australia Research Report Platform Presentation
PURPOSE: Infections acquired in the healthcare setting are 734 Monday 4 June 08:30
becoming an increasingly widespread and costly problem. A VCEC Meeting Rooms 11-12
significant number of patients now acquire infections linked to MOTOR IMAGERY TRAINING IMPROVES HAND MOVEMENT IN
contaminated healthcare equipment, predominantly in the hospital PERSONS WITH HEMIPLEGIA
setting. However, with the current shift towards community-based
Grabherr L1 , Jola C2 , Berra G3 , Möckli R4 , Theiler R3 , Mast F1 ;
care, a larger number of immuno-compromised and high risk 1 Université de Lausanne, Lausanne, Switzerland; 2 University
patients are accessing community services, making physiotherapy
College London, London, United Kingdom; 3 Stadtspital Triemli,
equipment, such as therapeutic ultrasound, a potential source of
Zürich, Switzerland; 4 SUVA Rehaklinik, Bellikon, Switzerland
infection. Despite this, there is a paucity of published research
into contamination levels on physiotherapy equipment with only PURPOSE: The objective of this experiment is to investigate whether
one available study into interferential therapy and an absence repeated imagined hand movements improve motor performance and
of research into therapeutic ultrasound.Thus, the purpose of this thus could be used as an effective rehabilitation technique for persons
study was to determine the degree of bacterial contamination on with hemiplegia. RELEVANCE: Recent studies using neuroimaging
therapeutic ultrasound transducer heads and ultrasound gel after techniques provide evidence that motor imagery involves some of the
routine clinical use and to evaluate the efficacy of recommended same neural systems engaged while carrying out actual movements.
infection control procedures in relation to therapeutic ultrasound Such findings have a remarkable potential for application such as
equipment. RELEVANCE: Therapeutic ultrasound is the most in brain rehabilitation. Even though there is compelling scientific
commonly used electrophysical agent in contemporary Australian evidence from the cognitive neurosciences, only a few clinical studies
physiotherapy practice. With the increasing prevalence of multi- have adressed the question whether and how motor imagery can
resistant organisms and the high rates of morbidity and mortality be an effective means to treat persons after a stroke. Until now
associated with such infections, it is important for physiotherapists only sporadic attempts have been pursued for integrating motor
to be aware of any infection risk posed by therapeutic equipment. imagery in cognitive-therapeutic exercises (e.g, Prof. C. Perfetti, Italy).
PARTICIPANTS: Microbiological cultures were obtained from 44 PARTICIPANTS: 25 participants with hemiplegia (aged between 37
ultrasound transducer heads and 43 ultrasound gels dispensed via and 92) were recruited from two hospitals. After giving their informed
tubes or bottles. Equipment and gels were drawn from a sample consent they completed a questionnaire including tests for hemiplegic
of convenience encompassing six public hospitals, eight private status, ideomotor apraxia, sensory body perception, neglect, mental
practices and three residential disability and aged care facilities in imagery, and cognitive abilities. The minimum requirements the
Adelaide, South Australia. METHODS: Using a prospective cross participants had to fulfill were the condition of cognitive adequacy
to understand the tasks and to have good postural control (to be through an education programme reveal about learning to be a
able to sit at a table). They were then assigned to either the IMAG physiotherapist?” was addressed to the findings from four earlier
or the EXEC training group. METHODS: All participants received studies. ANALYSIS: Together the findings constituted the raw data
6 sessions of training during which the patients were blindfolded. which would produce new integrative knowledge about the learning
The participants in the IMAG group had to imagine moving their process over time. A phenomenographic approach to analysis
hand to a certain position without actually executing the movement was used to explore differences and similarities with the aim of
while the participants in the EXEC group were instructed to try to describing the phenomenon of learning physiotherapy. RESULTS:
actually execute the movement. Each training session was followed Three patterns of learning range from a cognitive to a cultural
by a test session. The task was to rotate the hand around the little view of learning to be a physiotherapist. The patterns highlight
finger as accurately as possible to a predetermined end position. We differences in orientation towards patients, aim and focus of learning,
designed a special apparatus allowing for controlled execution and ways in which the learning activity occurs, and together with whom
correct measurements of the end position. The deviation (measured and in which context learning takes place. Performing treatment
in degrees) between the predetermined and the actual end position is learning to cure body structure/function by giving treatment and
indicates the precision of the hand movement. ANALYSIS: Repeated instructing patients in an exclusive physiotherapy setting. Solving
measure ANOVAs and Student’s t-tests were used to analyse the problems is learning to solve movement ability problems by educating
data. RESULTS: Both training groups showed a significant increase clients in a rehabilitation setting and Managing health is learning
in performance over the 6 test sessions (F(1,23)=19.895; p < 0.001). to enable individuals to move in an every day life activity by
The training group (IMAG, EXEC) interacted with the amount of designing and/or organising activities for them. CONCLUSIONS:
test sessions (F(1,23)=5.410; p < 0.05) suggesting that the IMAG The identified patterns of learning experiences show a variety in
group benefited more from the training than the EXEC group. T-Tests learning focus, in ways of learning and in views of knowledge and
confirmed that the IMAG group was able to perform more precise learning and are influenced by the context in which learning occurs
hand movements than the EXEC group after the sixth training session and by learning partners participating in the physiotherapy activity.
(p < 0.01) while there was no such difference after the baseline test IMPLICATIONS: An awareness of different learning patterns in a
(p = 0.876) or the first training session (p = 0.969). CONCLUSIONS: student cohort can inform curricula development to ensure that all
Mental imagery can be an effective means to improve motor students are purposefully exposed to different learning patterns and
rehabilitation in persons with hemiplegia. Mental rehearsal of a different contexts of learning, with guidance of appropriate learning
hand movement improved the accuracy of a motor action more partners. KEYWORDS: Student learning; physiotherapy education;
efficiently than the conventional training. IMPLICATIONS: This study qualitative metasynthesis. FUNDING ACKNOWLEDGEMENTS: The
provides evidence for the benefit of motor imagery training in persons Board of Education, Karolinska Institutet, Sweden and Physiotherapy
with hemiplegia and thus suggests the integration of cognitive Research Foundation, UK,. CONTACT: [email protected]
training in conventional physiotherapy practice. KEYWORDS: Motor
Imagery, Hemiplegia, Stroke. FUNDING ACKNOWLEDGEMENTS:
This research was supported by SNF Grant 611-066052 (FWM).
CONTACT: [email protected] 1835 Monday 4 June 08:30
ETHICS COMMITTEE: Approved by two Swiss medical ethic com- VCEC Meeting Room 18
mittees: «SPUK ZH Stadtspitäler» and «Kantonale Ethikkommission PROGNOSTIC INDICATORS FOR SUCCESSFUL PROSTHETIC
Aargau». REHABILITATION IN OLDER DYSVASCULAR UNILATERAL
TRANS FEMORAL AMPUTEES
Research Report Platform Presentation Cumming J1,2 , Rome K1,2 , Whittaker V1,2 , Handoll H1,2 ; 1 The
1438 Monday 4 June 08:30 James Cook University Hospital, Middlesbrough, England; 2 The
VCEC Meeting Room 16 University of Teesside, Middlesbrough, England
LEARNING TO BE A PHYSIOTHERAPIST – A LONGITUDINAL PURPOSE: The aim was to develop profiles of older (over 60
STUDY OF LEARNING FROM A STUDENT PERSPECTIVE years old) transfemoral prosthetic limb users to inform prosthetic
provision. Relationships between clinical, social and demographic
Lindquist I1 , Engardt M1 , Richardson B2 ; 1 Dept. of Neurobiology,
variables and outcomes including level of mobility and use of
Care Sciences and Society, Division of Physiotherapy, Karolinska
prosthesis were explored. RELEVANCE: New referrals to prosthetics
Institutet, Stockholm, Sweden; 2 School of Allied Health Professions,
centres in the UK are assessed for their capabilities for prosthetic
University of East Anglia, Norwich NR4 7TJ, UK
rehabilitation. Evidence is limited underpinning the clinical decision
PURPOSE: To explore the phenomenon of learning to be a path and needs development. Transfemoral amputees use 65% more
physiotherapist over a three year education programme from a energy for walking. The low success rate in older transfemoral
student perspective. RELEVANCE: Development in physiotherapy amputees in terms of independent mobility and function may be a
and in learning theories, the new disease panorama and a changing reflection of impairment, disability or handicap. PARTICIPANTS: The
health care system call for curricular review. The study invites entire population of 206 older people (over 60) with transfemoral
students to share their experiences of learning. It elucidates students’ amputation referred to the Cleveland Prosthetic Centre between
views of the role and purpose of physiotherapy and of different January 2000 and June 2005 were included in this mixed history
modes of learning. The knowledge will constitute an important basis retrospective cohort study. METHODS: Variables of interest included:
in developing curricula for physiotherapy education. PARTICIPANTS: co morbidities, sensory impairments, aetiology of amputation,
A strategically selected cohort of twenty-one physiotherapy students indicators of pre-amputation and post amputation level of mobility
from Sweden and the UK including males and females, mature and function, mobility and limb use at 3 and 6 months post
students and school-leavers, those with high entry qualifications prosthetic issue, problems associated with the remaining limb,
and those with low, with and without work experience within social circumstances and level of support available or required.
or outside health care. METHODS: A metasynthesis of findings The primary measure of success was based on mobility outcomes
of four single, earlier studies analysed by a phenomenographic and usage. Data was abstracted from case notes. A customised
approach, was used to create a new interpretation and capture data collection form was developed to input data into SPSS
the longitudinal character of variation in learning experience. The (Statistical Package for Social Sciences) ANALYSIS: Data analysis
findings of the single studies were drawn from one hundred eleven was mainly descriptive and comparative. Bi-variate correlations were
interviews of students through the education programme. A question: used to explore the relationships between aspects of clinical profiles
“What do experiences described by the physiotherapy students outcomes. RESULTS: 114/206 referrals (55.34%) were issued with
a functional prosthesis. 99/114 had a recorded mobility grade at of the spines of all 12 cadavers. ANALYSIS: We calculated the
6 months, 8 (7%) died, 6 (5%)became bilateral. Only 53 (53.33%) mean lateral distances and standard deviations for each thoracic
were relatively successful in mobility (independent indoor or outdoor level. RESULTS: Mean distances for each thoracic level ranged
mobility). Those people who stopped limb wearing at 6 months between 27.1mm and 33.1mm, with an overall mean of 30.1mm
(n=38) significant variables (p < 0.05) were co-morbidities: peripheral for all cadavers and all thoracic levels. Standard deviations for
vascular disease, ulceration / gangrene other leg, respiratory disease, each level ranged from 4.1mm to 10.2mm. CONCLUSIONS: The
arthritis, bladder problems, peripheral neuropathy and total number mean distances demonstrated that the most prominent points of the
of co-morbidities; in addition, no complaint of phantom limb pain, TPs of the thoracic spine are generally located approximately 3cm
already dependent on a powered chair, More than 8 medications, lateral to the most prominent point of the SP of the adjacent cranial
low level mobility 6 months pre-amputation, not independent with vertebrae. However, as evidenced by the large standard deviations,
dressing, time to casting >8 weeks, aetiology dysvascularity. Full variability of these distances is high, making generalizations about
time limb wearing at 6 months correlated to fewer comorbidities, the exact location of the TPs difficult. The most variability was seen
previous mobility level, not having home help and Barthel Index>12 in the caudal thoracic levels (T11 and T12), which was consistent
at assessment. CONCLUSIONS: Older people with a transfemoral with our findings in previous investigations. IMPLICATIONS: This
amputation have a low success rate (26%) in terms of useful mobility information should allow clinicians to more accurately locate
with a prosthesis. Good pre-amputation mobility, fewer co-morbidities, the TPs of the thoracic spine using surface palpation of the
low dependence and recovery of independence post amputation are SPs, and improve the precision of their examination, differential
major positive indicators of success. Particular co-morbidities were diagnosis, and intervention techniques for patients with thoracic spine
associated with prosthetic mobility failure. Future work should focus dysfunction. KEYWORDS: Thoracic Vertebrae, Palpation, Surface
on user satisfaction, perceived exertion, capabilities, comfort and Anatomy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
cosmesis. In addition future work should examine clinical risk of older [email protected]
people mobilising with a transfemoral prosthesis. IMPLICATIONS:
Assessment needs to consider factors contributing to success
or likely failure. Alternative modes of mobility such as powered Research Report Platform Presentation
chairs may offer greater independence and re-integration into 1083 Monday 4 June 08:50
community life. KEYWORDS: transfemoral amputation; older person; PP Crystal Pavilion A
prosthetic rehabilitation. FUNDING ACKNOWLEDGEMENTS: This A FOCUS GROUP STUDY OF STUDENT PHYSIOTHERAPISTS
project was funded by the Health Foundation, UK. CONTACT: PERCEPTIONS OF REFLECTION
[email protected] Roche A, Coote S; Department of Physiotherapy, University of
Limerick, Ireland
Research Report Platform Presentation PURPOSE: Reflective practice is a learning strategy that involves
787 Monday 4 June 08:30 thinking critically about one’s actions (Clouder, 2000). This is
VCEC Meeting Rooms 19-20 a recognised component of continuing professional development
A CADAVER STUDY TO INVESTIGATE THE LATERAL (CPD), itself fundamental to progressing the physiotherapy pro-
DISTANCES OF THE TRANSVERSE PROCESSES FROM THE fession. The reflective practice module within the undergraduate
SPINOUS PROCESSES OF THE THORACIC SPINE physiotherapy programme at University of Limerick (U.L.) is a
first within physiotherapy curricula in Ireland. However, research
Geelhoed M, Brewer P, Ortega C, Cervantes G, Cockrum M,
is required to determine how this module influences students’
Robbins S; Department of Physical Therapy, University of Texas
perceptions of reflection. RELEVANCE: With the present climate of
Health Science Center at San Antonio, San Antonio, TX, USA
accountability, physiotherapists have embraced the call for evidence-
PURPOSE: The purpose of our study is to investigate the lateral based practice (EBP) and clinical effectiveness to underpin their
distances of the transverse processes (TPs) from the spinous pro- practice. An essential component of being clinically effective is
cesses (SPs) of the thoracic spine. RELEVANCE: This information critical self-appraisal through reflection. Mandatory documentation
will assist clinicians in locating the TPs using surface palpation. of a chartered physiotherapist’s CPD activities, already exists in
Many examination and intervention techniques for manual therapy of some countries, and is an imminent proposal in Ireland. Therefore
the thoracic spine require hand or finger placement over the TPs. evaluation of a novel educational strategy endeavouring to enable
However, surface palpation of the thoracic TPs is difficult due to physiotherapy students to reflect effectively on their practice is of
their depth relative to more superficial structures. The more easily interest to the profession on an international level. PARTICIPANTS:
palpable SPs provide landmarks to orient clinicians for palpation 20 Year 3 & Year 4 Physiotherapy students at U.L. were randomly
of the deeper structures. Our previous investigation proposed a selected. Year 1 & 2 students were excluded as the module is during
model to predict the cranial/caudal location of the level of the TPs Year 3. Students volunteered, gave informed consent and the U.L.
of the thoracic spine based on the location of the SPs, and this Research Ethics Committee granted ethical approval. METHODS:
study is intended to augment those findings to provide clinicians A qualitative research design of focus groups was employed. Three
with a more complete model for locating the TPs of the thoracic focus groups were held in total; with Year 3 students before and
spine using surface palpation. PARTICIPANTS: We dissected and again after their reflective practice module, examining any change
measured 12 cadavers. METHODS: We placed the cadavers in in their perceptions of reflection. A third was held with Year 4
the prone position, and removed as much muscle and connective students, to determine their perceptions a year after completing the
tissue as possible from the SPs and TPs to expose them fully for module and with subsequent placement experience. The researcher
palpation and measurement. Using the index fingertip, we determined led the sessions which all followed a similar questioning structure,
the most prominent point of the SP and TPs of each thoracic outlined by Krueger (1998, p21). An independent observer noted
vertebra and placed pins in them to assist with measurement. Our group dynamics during each session. ANALYSIS: Sessions were
previous investigation proposed that the TPs in the thoracic spine audio taped, transcribed verbatim and subject to thematic analysis.
are generally located in a transverse plane at the level of the Transcripts were examined to identify concepts (such as significant
most prominent point of the SP of the adjacent cranial vertebra. sentences) and arranged into four major themes by comparing
Therefore, we chose to measure the lateral distances between concepts across each group. The observer’s notes were used to
the pins inserted in the most prominent points of the TPs of one support the analysis and participants read a descriptive statement
level and the SP of the level above using a digital caliper. We of their session(s) to confirm accurate interpretation. RESULTS:
measured the lateral distances of all 12 thoracic levels on both sides Students demonstrated a more advanced level of reflective ability
post-module completion, in considering its impact on their future FEV1 p = 0.0001; PEF p = 0.001; FEV1/FVC % p = 0.0001). A strong
actions. They perceived personal and professional benefits to relationship was evident between performance on the shuttle run and
practising reflection, which they felt resulted in a more evidence- the test of motor co-ordination (r = 0.64, p = 0.0001 and single leg
based approach to practice, compared to initial negativity before stand (r = 0.5 p = 0.0001). Although there was a relationship between
the module. They perceived these skills as strategies to continue shuttle run and respiratory function measures (r = 0.3-0.34, p = 0.01-
in facilitating their CPD. A barrier to reflecting which the students 0.04) in the control group, no correlations were found between
experienced was the negative attitude towards the concept amongst these measures in the extremely preterm children. CONCLUSIONS:
some qualified physiotherapists. CONCLUSIONS: The students Extremely preterm born children without significant disability at the
involved fully support inclusion of the reflective practice module in age of 11-13 years perform less well on tests of motor co-ordination,
their training and acknowledge its role in improving their confidence, balance, functional strength, aerobic fitness and respiratory function
clinical reasoning and facilitating their CPD once qualified. Negativity than term born peers of the same age. Despite deficits in respiratory
regarding reflective practice amongst clinicians may discourage function in the extremely preterm group, there was no correlation
reflection in the practical setting. IMPLICATIONS: Further studies between respiratory function measures and the aerobic fitness
are required, to generalise to a wider population the initial findings measure in that group. A major determinant of physical fitness
regarding this novel approach to teaching reflective practice. was motor co-ordination in both groups but particularly in the
Investigations to explore why negative attitudes towards reflection preterm children. IMPLICATIONS: Physical therapy for all extremely
prevails in the clinical setting are also of interest. KEYWORDS: preterm born children should be directed towards improving motor
Reflective Practice, Qualitative Research, Curriculum Develope- co-ordination, postural stability and balance throughout childhood.
ment, Continuing Professional Development (CPD). REFERENCES: KEYWORDS: Aerobic fitness, motor co-ordination, extreme prema-
Clouder, L. (2000) “Reflective Practice in Physiotherapy Education: turity. FUNDING ACKNOWLEDGEMENTS: Mater Trust. CONTACT:
a critical conversation”. Studies in Higher Education, 25 (2), 211- [email protected]
221. Krueger, RA. (1998) “Developing questions for focus groups”. ETHICS COMMITTEE: Mater Hospital Ethics Committee ref no. 449;
London: Sage publications. FUNDING ACKNOWLEDGEMENTS: University of Queensland, Medical Research Ethics Committee
None. CONTACT: [email protected], [email protected]
ETHICS COMMITTEE: University of Limerick Research Ethics
committee
VCEC Ballroom B & C
THE EFFECTS OF LIGHT ENERGY ON WOUND BACTERIA IN
1200 Monday 4 June 08:50 THE RAT: IMPLICATIONS FOR PRACTICE
Nussbaum E1,2 , Lilge L2,3 , Mazzulli T1,2 , Pritzker K1,2 ; 1 Mount
THE PHYSICAL FITNESS OF CHILDREN BORN EXTREMELY Sinai Hospital, Toronto, Canada; 2 University of Toronto, Toronto,
PRETERM Canada; 3 University Health Network, Toronto, Canada
Danks M1,2, , Burns Y1,2 , Gray P1 , O’ Callaghan M1 , Poulsen L1 ,
PURPOSE: To determine whether laser light (LLLT) improves
Watter P2 ; 1 Growth & Development Research Unit, Mater Health
healing of infected wounds in the rat by killing bacteria while
Services, Brisbane, Australia; 2 University of Queensland, Australia
simultaneously accelerating host tissue activity. RELEVANCE:
PURPOSE: The study investigated the physical fitness of extremely Physical therapists use LLLT to treat chronic wounds. The effect
low birthweight and preterm children aged 11-13 years compared of LLLT on infected wounds has been inadequately studied despite
with term controls. Measures of physical fitness and endurance likely its known biomodulatory effects on bacteria in vitro. It appears
to contribute to fitness and physical abilities of healthy adolescent possible that irradiation of contaminated wounds might stimulate
school children were investigated to determine which factors were bacterial growth, which could further inhibit healing. PARTICIPANTS:
associated with physical performance. RELEVANCE: Problems of Sprague-Dawley rats (14 per group). METHODS: Dorsal wounds
physical fitness, endurance and motor control at school age have the (1x1cm) were inoculated or sham-inoculated with P. aeruginosa.
potential to adversely affect their health, learning and behavior and Wounds were irradiated or sham-irradiated three times weekly
frequently require intervention. PARTICIPANTS: Fifty-six children from Day 1-19 using 635 or 808nm lasers (continuous wave or
who were born 27 gestation weeks or <1000g, who received 3800Hz) at radiant exposures of 1 or 20J/cm2 . Wound area and
care in the Neonatal Intensive Care Unit and are now 11-13 years bacterial growth were measured three times weekly. ANALYSIS:
of age were included. Children with moderate or severe neuro- Healing over time was analyzed using a linear mixed model from
developmental problems or sensory impairments were excluded.The Day 1-8 and a non-parametric bootstrap method from Day 10-
controls were fifty-five term born children matched for age, sex 19 (to account for a change in rate over time). Bacterial growth
and schooling. METHODS: Aerobic fitness was measured by the was analyzed using a Generalized Estimating Equations model.
standardized 20-meter Shuttle Run Test. Computerised spirometry Significance was set at a=0.05. RESULTS: Wound Healing Rate
was used to measure respiratory function. Functional strength tests of Sham-infected wounds: irradiated versus sham-irradiated controls.
vertical jump and seated throw were used. Single leg stand measured There was no evidence of improved healing over the 19-day period
stability and motor co-ordination was tested using the Movement using any LLLT protocol. Compared with controls, healing was worse
Assessment Battery for Children (MABC). Anthroprometric measures at Day 3 in the 635nm group at high radiant exposure (20J/cm2 ;
were collected and the BMI calculated. ANALYSIS: For continuous, p < 0.0001) and in various 808nm groups (1J/cm2 and 20J/cm2 ;
normally distributed outcomes an analysis of variance (ANOVA) p < 0.0001, p < 0.001), and also from Day 3-10 in the high 808nm
was used to investigate group differences in means. Strength group (20J/cm2 ; p = 0.03). Infected wounds: irradiated versus sham-
of association was measured using either correlation coefficients irradiated controls. Compared with controls, healing was worse at
(Spearman Rank or Pearson as appropriate) or odds ratios. Day 3 in the 808nm group at high radiant exposure (20J/cm2 ), and
RESULTS: Significant differences between the groups were found from Day 3-8 in various 808nm groups (1 and 20J/cm2 ; p < 0.002,
for measures of weight (p = 0.008), height (p = 0.025), BMI (p = 0.027), p < 0.002). In contrast, healing improved from Day 3-8 in the 635nm
head circumference (p = 0.0001) and functional strength tests (seated group at low radiant exposure (1J/cm2 ; p = 0.0002), and from Day 10-
throw p = 0.008; vertical jump = 0.032). The results indicate that 19 in various 808nm groups (1 and 20J/cm2 ; p = 0.0014, p < 0.001
the preterm children performed less well than controls on the and 3800Hz 1J/cm2 ; p = 0.0172). Bacterial Growth Sham-infected
shuttle run (p = 0.0001), single leg stance (p = 0.0001), motor co- wounds. Normal flora (alpha- and beta-hemolytic streptococcus,
ordination (p = 0.0001) and respiratory function (FVC p = 0.025; diptheroid bacteria, Bacillus spp.,) predominated in sham- and
635nm-treated wounds at 1J/cm2 . In contrast, 635nm irradiation at dependent variables. RESULTS: No significant baseline differences
20J/cm2 effectively cleared sham-infected wounds of all organisms existed (p > 0.05). Groups did not differ significantly in mean change
from Day 3-19 (<0.0001). Bacteria were also reduced in the early scores between 0-6 weeks on the ARAT (p = 0.68), RMA (p = 0.06),
period irradiating at 808nm (1 and 20J/cm2 ; p < 0.0137, p = 0.0002). or NHPT (p = 0.51). Between 0-18 weeks the difference in mean
P. aeruginosa infected wounds. In non-irradiated wounds potentially NHPT change was significant (p = 0.05), with greater improvement
pathogenic bacteria predominated until Day 8 (S. aureus, coagulase- for the UTE group than the BTE group (0.15 pegs/sec + 0.15;
negative staphylococci (CNS) and P. aeruginosa) and simultaneously 0.10 pegs/sec + 0.03 respectively). No other significant differences
the presence of normal flora decreased. All bacteria were reduced were found. Baseline severity significantly influenced change on
at Day 3 using irradiation at 635nm (20J/cm2 ; p = 0.023). Irradiation all measures between 0-6 weeks and 0-18 weeks (p < 0.05). This
at 808nm (1 and 20J/cm2 ) increased bacteria (S. aureus and CNS) was not related to treatment allocation. No other interaction effects
compared with sham-irradiated wounds (p = 0.0014, p < 0.0001), and existed. CONCLUSIONS: BTE appears no more effective than
reduced the presence of normal flora. CONCLUSIONS: Clearing UTE for UL recovery in individuals with acute stroke even after
wounds of normal flora and increasing growth of staphylococcal controlling for initial impairment severity. In the long-term, UTE
species prolonged healing. Healing improved only when wound training appeared most beneficial for dexterity. Some of the selected
bacterial balance closely matched that of controls. Effects of LLLT outcome measures have been criticised for limited sensitivity,
on bacterial growth should urgently be examined in human wounds. therefore future research should determine optimal intervention for
IMPLICATIONS: LLLT that radically alters the normal bacterial BTE training utilising measures more sensitive to improvements.
balance in wounds could negatively affect healing. The presence IMPLICATIONS: This study indicates that there is no advantage in
of normal flora in wounds is important for stimulating granulation replacing conventional UTE with BTE in acute stroke for improvement
tissue and preventing colonization of the wound surface by bacteria of unilateral upper limb performance. KEYWORDS: Upper Limb,
that cause infection. KEYWORDS: wounds, infection, light therapy. Stroke, Therapeutic Exercise. FUNDING ACKNOWLEDGEMENTS:
FUNDING ACKNOWLEDGEMENTS: This work was supported by a This work was funded by the Chief Scientist Office, Scottish Executive
grant from the Canadian Institutes of Health Research. Health Department. CONTACT: [email protected]
ETHICS COMMITTEE: Animal Care Committee, Mount Sinai ETHICS COMMITTEE: Tayside Committee on Medical Research
Hospital Research Institute Ethics

BILATERAL UPPER LIMB THERAPEUTIC EXERCISE IN ACUTE “SELF EVIDENCE OF THE SELF DIRECTEDNESS” –
STROKE: A RANDOMIZED CONTROLLED TRIAL PHYSIOTHERAPY STUDENTS’ OPINIONS ABOUT SELF DIRECT-
Morris J1,3 , Van Wijck F2 , Joice S1 , Ogston S1 , MacWalter R3 ; EDNESS AND ITS DEVELOPMENT DURING THE EDUCATION
1 University of Dundee, Dundee, Scotland; 2 Queen Margaret Helminen E; Jyvaskyla University of Applied Sciences, Jyvaskyla,
University College, Edinburgh, Scotland; 3 Ninewells Hospital, Finland
Dundee, Scotland
PURPOSE: The first aim of this study is to investigate what is written
PURPOSE: Upper limb (UL) deficits contribute to limitations in activity to the curriculum about the physiotherapy students self directedness.
and participation for individuals with stroke. Studies conducted in the The second aim is to study what are physiotherapy student’s
chronic post-stroke stage suggest that bilateral therapeutic exercise opinions about their self directedness and how it changes during the
(BTE) may improve UL recovery. However effectiveness of this education. The third aim is to find out what kind of factors prevent and
intervention in acute stroke and responses related to severity of promote self directedness in learning. RELEVANCE: One of the most
impairment have not been fully explored. The purpose of this study important goals of higher education is student’s self directedness
was to compare BTE with Unilateral Therapeutic Exercise (UTE) for according to education legislations of Finland. There have been
UL recovery in the acute post-stroke period and to determine if sever- conflicts between this goal and the implementation of education.
ity of initial impairment influences recovery. RELEVANCE: Novel The concepts of self directedness are complex. PARTICIPANTS:
training approaches for stroke are emerging from developments in Physiotherapy Students (n 44) took part of the reseach. METHODS:
neuroscience and behavioural science. In applying new interventions This study is qualitative long – term study. The main research method
to clinical practice, physiotherapy research must determine when and is theme interview. Other methods are questionaire, self evaluation
for whom such approaches are most effective. Here an intervention and learning diaries. ANALYSIS: Analysing method is content
previously studied in chronic stroke is examined in acute patients analysis. RESULTS: Physiotherapy students (n 44) began their
with differing degrees of severity. PARTICIPANTS: A cohort of education in 1998 and the last student graduated January 2003. The
individuals admitted to an acute hospital with acute stroke presenting curriculum emphasized student’s self directedness and self- direction
with new UL impairment (n=106). Consent was provided within in learning, but the students did not understand the language of the
local ethical guidelines. METHODS: Design: Randomised controlled curriculum in the beginning of the education. The comprehension
trial. Intervention: Participants were randomised to receive BTE or of the work of the physiotherapist increased through the education.
UTE 2-4 weeks following stroke onset. Both groups participated The level of students self directedness was low in the beginning, but
in standardised training (20 minutes, 5 days/week, for 6 weeks) it developed during the education. Year 1998 students thought that
in addition to normal rehabilitation. The BTE group trained both self- direction means independent decision making. Students found
arms simultaneously but independently; the UTE group trained the that student’s own motivation, goal setting and learning atmosphere
affected arm only. Outcome Measures: Action Research Arm Test promoted self directedness. Restricted factors were other student’s
(ARAT), Rivermead Motor Assessment Upper Limb Scale (RMA) low motivation and the action of the teacher. The best learning
and Nine Hole Peg Test (NHPT), recorded at baseline, 6 weeks environment was clinical practice. CONCLUSIONS: One of the
and 18 weeks by a blinded assessor. ANALYSIS: Change scores conclusion is that the meaning of students self directedness should
(between 0-6 weeks, and 0-18 weeks) were examined using t-tests be stated clearly in the curriculum. There should also be more
and non-parametric equivalents. Three severity sub-groups were orientation to the physiotherapist work in the beginning of the
defined from ARAT and NHPT baseline data. Main and interaction education. Self directedness can be promoted by motivating feedback
effects of sub-group and treatment allocation were examined using from the teacher, permissive learning atmosphere and functional tutor
factorial ANOVA with change on ARAT, RMA and NHPT scores as program. IMPLICATIONS: According these results it is possible to
develop the curriculum, tutor-program, students self direction in learn- Research Report Platform Presentation
ing and teaching methods. KEYWORDS: Physiotherapy, pedagogic, 1902 Monday 4 June 08:50
self-direction in; learning. FUNDING ACKNOWLEDGEMENTS: The VCEC Meeting Room 18
work was unfunded. CONTACT: eeva.helminen@jamk.fi GRANDSTAND FUNCTION & FEEDBACK – SIT-TO-STAND AS
ETHICS COMMITTEE: Ethich was not required. Only permission of HOME EXERCISE FOR MOBILITY LIMITED ADULTS OVER 80
the director of our School and the students. YEARS OF AGE
Rosie J, Taylor D; Physical Rehabilitation Research Centre, AUT
Research Report Platform Presentation University, Auckland, New Zealand
1078 Monday 4 June 08:50 PURPOSE: To investigate the effect of functional home exercise
VCEC Meeting Room 17 on strength and performance measures in adults over 80 years of
THE PROVISION OF PHYSICAL THERAPY FOR ELDERLY age with mobility limitations. RELEVANCE: Lower limb weakness is
NURSING HOME RESIDENTS highly prevalent among older adults and is associated with reduced
Leemrijse C1 , De Boer M2 , Dekker J2 , Ribbe M2 , Van den Ende C3 ; functional performance, increased disability and increased incidence
1 Netherlands Institute for Health Services Research, Utrecht; and severity of falls. Low intensity unsupervised progressive
2 Institute for Research in Extramural Medicine, VU University resistance training can be performed safely at home by frailer older
Medical Centre Amsterdam; 3 Sint Maartenskliniek, Nijmegen adults, however, studies into the effect of these programmes show
varying results as to their impact on functional outcomes. Little
PURPOSE: The aim of this study was to investigate how many analysis has been done as to whether functional home exercise,
residents receive physical therapy in nursing homes. Furthermore, such as repetitive sit-to-stand training, is an effective alternative to
to analyze factors that contribute to the variation in provision traditional progressive resistance training for the frailer older adult.
of physical therapy both between nursing homes and between PARTICIPANTS: Community dwelling older adults were invited to
residents. RELEVANCE: Physical therapy plays an important role participate, 66 older adults took part in the study. Participants were
in improving ADL functioning, discharge rates and survival rates. It 80 years of age or older, able to walk 4 metres with or without
is, however, unclear how many or which nursing home residents an aid, sedentary, and mobility limited. Exclusion criteria included;
receive physical therapy. Furthermore, there is a lack of insight currently receiving physiotherapy treatment, medically unstable,
into the determinants that influence the decision for treatment.
medical conditions that contraindicated participation in a resistance
PARTICIPANTS: A random sample of 600 residents aged 55 years
exercise programme or physical conditions that prevented attempting
and older was taken from a random sample of 15 nursing homes.
either exercise protocol. METHODS: A randomised controlled clinical
Residents had to be admitted for either rehabilitative services or
trial was conducted to compare repeated sit-to-stand exercises using
for long term institutional care. METHODS: Data from participating
the GrandStand with seated knee extensions using ankle weights.
residents were collected through interviews with the nursing home
The GrandStand is a simple biofeedback device that is placed in
physician and the physical therapist. As part of these highly
the participant’s chair providing a visual record of the number of
structured interviews a questionnaire was filled out by the researcher,
sit-to-stands completed. Both exercise protocols were performed by
in presence of the physician and therapist, enabling them to consult
participants daily for 6 weeks. ANALYSIS: Analysis was performed
the medical file of the resident simultaneously. ANALYSIS: Multilevel
on an intention to treat basis. Independent sample t-tests were
analysis was applied because of the intrinsic hierarchical nature of
used to assess any difference between the GrandStand group
the data. Multilevel logistic regression analysis was used to define
and knee extension group at baseline, and any between-groups
the variation in the provision of physical therapy between nursing
homes, and the factors that determine whether a resident receives change in difference scores following the final assessment. Paired
physical therapy or not. RESULTS: On average, 69% of the 600 samples t-tests were used to assess the difference between baseline
residents received physical therapy, but this percentage differed and outcome measures within each group. Statistical significance
significantly across nursing homes. Characteristics of the nursing was accepted if the 2-tailed p value was 0.05. RESULTS:
homes itself, such as the amount of full time equivalents of available Results showed no statistically significant differences between the
physical therapy, contributed the most to this difference. None of the groups at baseline; there was large variability within each group
residents’ medical diagnoses had a significant influence on referral to in degree of mobility limitation and in baseline measure results.
physical therapy, whereas the presence of co-morbidity enlarged the There was a statistically significant difference at the post-intervention
chance of receiving physiotherapeutic treatment. Residents admitted assessment the Berg Balance Scale mean score for the GrandStand
for rehabilitation and residents staying at a somatic ward were more group alone, indicating an improvement in balance over the 6-
likely to receive physical therapy, as compared to residents admitted week exercise period (GrandStand group t = −3.624, p = 0.001).
for long term care and residents staying at a psycho-geriatric ward. This represents a mean increase of approximately 1.7 points in
Furthermore, as more time had elapsed after admission, the chance Berg Balance Scale score. There was no statistically significant
of receiving physiotherapy slightly diminished. Finally, the more full effect of either intervention on the other outcome measures.
time equivalents physical therapy present in the nursing home, the CONCLUSIONS: In a highly variable population of older adults
more likely a resident was to receive treatment. CONCLUSIONS: with mobility limitations, low intensity functional home exercise using
Physical therapy is most likely provided to residents with good the GrandStand was more effective than low intensity progressive
cognitive functioning, recently admitted for rehabilitation to a nursing resistance training at improving Berg Balance Scale score. While
home with a relatively large number of physiotherapists available. statistically significant, the improvement in Berg Balance Scale score
This suggests a potential underuse of physical therapy for long was modest raising the issue of what extent of change in score is
term residents with cognitive problems. IMPLICATIONS: It is recom- clinically significant in this population. IMPLICATIONS: The results
mended that physiotherapists working in nursing homes reconsider indicate a longer duration functional training study may be warranted
which residents may benefit from treatment. This may need a shift based on the improvements over this short programme. Clinically
in focus of physiotherapists from ‘recovery and discharge’ to ‘quality significant change in Berg Balance Scale score also requires further
of life and well being’ of residents. More insight is needed into the investigation in this population. KEYWORDS: older adults, home
residents’ needs and into the efficiency of provided care, in order to exercise, functional training. FUNDING ACKNOWLEDGEMENTS:
establish the optimum amount of physiotherapeutic care for nursing Sam Doogue, Whakatane, New Zealand. AUT University, Auckland
home residents. KEYWORDS: Nursing homes, elderly. FUNDING New Zealand. CONTACT: [email protected]
ACKNOWLEDGEMENTS: This project was financed by ZonMw – the ETHICS COMMITTEE: Ethical approval was obtained from the AUT
Netherlands Organisation for Health Research and Development. University Ethics Committee
VCEC Meeting Rooms 19-20 PP Crystal Pavilion B & C
QUALITY OF TRANSVERSUS ABDOMINIS DURING TRAINING IS ACUTE CHANGES IN MUSCLE COORDINATION INDUCED BY
ASSOCIATED WITH TEMPORAL CHANGES IN FEEDFORWARD EXPERIMENTAL PAIN DO NOT AFFECT CERVICAL MUSCLE
ACTIVATION FATIGABILITY DURING SUSTAINED ISOMETRIC CONTRACTION
Tsao H, Hodges P; Division of Physiotherapy, The University of Falla D1 , Farina D1 , Kanstrup Dahl M2 , Graven-Nielsen T1 ; 1 Center
Queensland, Brisbane, Australia for Sensory-Motor Interaction (SMI), Department of Health Science
PURPOSE: There is evidence for consistent deficits in feedforward and Technology, Aalborg University, Aalborg, Denmark; 2 Sector
activity of the deep abdominal muscle, transversus abdominis (TrA) of Anesthesia, Northern Jutland, Denmark
in people with low back pain (LBP). In a recent study we showed PURPOSE: To investigate whether an acute change in the motor
that training of isolated voluntary contractions of TrA induced strategy, induced by experimental neck muscle pain, affects trends
immediate improvements in feedforward activity and this was not of EMG variables over time during sustained cervical flexion and
replicated by training that involved general activity of the abdominal extension. RELEVANCE: People with persistent neck pain show
muscles (i.e., sit-up). As individuals vary in their ability to contract greater cervical muscle fatigue during sustained isometric cervical
TrA independently from other abdominal muscles, we aimed to contractions compared to healthy individuals. The differences in
examine the relationship between the quality of isolated training
myoelectric manifestations of fatigue in people with neck pain with
and changes in timing of feedforward activation. RELEVANCE:
respect to healthy controls may be due to differences at the muscle
Improved understanding of the relationship between quality of motor
level, in the neural control or both. Experimental muscle pain may
training and changes in timing of muscle activation will aid in
provide a model to help differentiate whether pain-induced alterations
further development of rehabilitation strategies for people with LBP.
of the control strategy affect muscle fatigability as reflected in the
PARTICIPANTS: Eleven volunteers with recurrent LBP lasting longer
surface EMG signal. If this hypothesis is rejected then the greater
than three months and of sufficient intensity to limit activities of
myoelectric manifestations of fatigue observed in people with chronic
daily living were recruited. METHODS: Feedforward control of the
neck pain cannot be solely due to a change in neural control.
abdominal muscles was assessed during single rapid arm flexion
PARTICIPANTS: Fourteen volunteers (6 female) participated after
and extension tasks to perturb the trunk in a controlled manner
providing informed consent. Participants (age: 26.3±3.6 yr; height:
before and immediate after motor training. Surface and fine-wire
1.73±0.11 m; weight: 71.9±14.6 kg) were free of neck pain, had
electromyographic activity (EMG) was recorded from the abdominal,
back and deltoid muscles. Subjects were trained to activate TrA no past history of orthopaedic disorders affecting the cervical spine
independently from the other abdominal muscles with feedback of and no history of neurological disorders. METHODS: Surface EMG
contraction using real-time ultrasound imaging. TrA EMG activity signals were detected from the sternomastoid and splenius capitis
was maintained at 5% of the maximum root-mean-square EMG muscles bilaterally during sustained cervical flexion and extension
amplitude. A rating out of ten was given to each subject according contractions at 25% of the maximal force. Measurements were
to their ability to contract TrA in isolation, and was determined performed before and after experimental pain by injection of 0.5
through palpation of contraction, observation of ultrasound image ml of hypertonic and isotonic saline into either the sternomastoid
and EMG recordings. This score has been shown previously to be or splenius capitis in two experimental sessions. EMG average
associated with the functional activity of this muscle. ANALYSIS: The rectified value (ARV) and mean spectral frequency (MNF) were
relationship between changes in onset of TrA EMG following training estimated from consecutive 4-s signal portions throughout the
and scores for quality of training was examined using Pearson’s sustained contraction. ANALYSIS: A three-way ANOVA was applied
correlation. RESULTS: As expected, activation of TrA was delayed to the values of ARV and MNF for the sternomastoid and splenius
in all subjects prior to training and the timing of onsets of TrA capitis muscles with condition (baseline, isotonic and hypertonic
EMG was changed by training. There was a significant correlation saline), side (ipsilateral and contralateral to injection) and time (5
between scores of the quality of isolated voluntary training and intervals) as repeated measures. Significant differences revealed by
changes in onset of TrA EMG for rapid arm flexion and extension ANOVA were followed by post-hoc Student-Newman-Keuls pair-wise
tasks (p<0.05). CONCLUSIONS: These findings suggest that the comparisons. Statistical significance was set at P < 0.05. RESULTS:
magnitude of change in timing of TrA was related to the quality During cervical flexion, injection of hypertonic saline in sternomastoid
of training; that is, activation of the TrA with a greater degree or splenius capitis resulted in lower estimates of sternomastoid
of isolation was associated with greater changes in timing. The ARV on the side of pain (55.1±29.9 mV vs. 42.3±18.9 mV; P < 0.01).
results suggest that mere repetition of TrA contractions without Estimates of sternomastoid MNF during flexion were reduced
precision during motor training may not induce similar improvements bilaterally following noxious stimulation of the sternomastoid (113.5
in feedforward activation. IMPLICATIONS: The findings provide ±19.8 Hz vs. 107.6 ±16.9 Hz; P < 0.05) and splenius capitis (113.8
evidence that feedforward postural adjustments may be trained in ±20.5 Hz vs. 109.2 ±18.6Hz; P < 0.01). Trends over time of both
a patient group with deficits in this coordination, and that changes sternomastoid and splenius capitis ARV and MNF during sustained
not only depend on the manner in which the muscle is trained but flexion and extension were not changed following hypertonic saline
also on the quality of isolated TrA contractions. KEYWORDS: motor injection. CONCLUSIONS: Experimentally-induced neck muscle
training, low back pain, feedforward postural adjustments. FUNDING pain resulted in changed muscle coordination during sustained
ACKNOWLEDGEMENTS: Funding was provided by the National cervical contractions in the absence of a change in myoelectric
Health and Medical Research Council of Australia. CONTACT: manifestations of fatigue. IMPLICATIONS: The results suggest that
[email protected] the greater changes over time of EMG features during sustained
ETHICS COMMITTEE: Medical Research Ethics Committee of the contractions observed in patients with chronic neck pain, more
University of Queensland, Brisbane, Australia likely represent chronic adaptations of the peripheral properties of
the neuromuscular system. This knowledge has relevance for the
development of therapeutic interventions for the rehabilitation of
people with neck pain disorders. KEYWORDS: muscle fatigue, pain,
electromyography. FUNDING ACKNOWLEDGEMENTS: Deborah
Falla is supported by a Fellowship received from the National Health
and Medical Research Council of Australia (ID 351678). This study
was supported by the Danish Technical Research Council and by the
European project “Cybernetic Manufacturing Systems” (CyberManS; Research Report Platform Presentation
contract nr. 016712). CONTACT: [email protected] 2140 Monday 4 June 09:10
ETHICS COMMITTEE: Ethical approval for the study was granted VCEC Meeting Rooms 11-12
by Den Videnskabsetiske Komite for Viborg og Nordjyllands Amter EXPLORING THE ATTENTIONAL FOCUS OF FEEDBACK IN
(Approval number: VN 2005/38). RETRAINING THE HEMIPLEGIC ARM
Durham K, van Vliet P, Sackley C, Badger F; School of Health
Sciences, The University of Birmingham, 52 Pritchatts Road,
Research Report Platform Presentation Edgbaston, Birmingham, B15 2TT, England
VCEC Ballroom B & C PURPOSE: Movement feedback during physiotherapy for the
treatment of stroke, may positively influence the outcomes of training.
THE EFFECTS OF LOW LEVEL LASER THERAPY (LLLT) ON
The attentional focus of feedback can be either internal (about
HUMAN BREAST CANCER CELL LINES IN VITRO
the body) or external (about the effect on the environment). An
Laakso L, Powell K, McDonnell A; Griffith University, Brisbane external focus of attention is more beneficial to motor learning
and Gold Coast, Australia in healthy subjects. The purpose of this study was to examine
PURPOSE: This research examined the response of two breast feedback used in current practice and describe in particular the
cancer cell lines (MCF-7 and MB-435) in vitro to a range of laser attentional focus when training the hemiplegic arm. RELEVANCE:
doses at two commonly used wavelengths (780nm and 830nm). This study precedes a clinical trial comparing internal and external
RELEVANCE: LLLT is being used increasingly for the management focus feedback in training the hemiplegic arm. Together, these studies
of post-mastectomy lymphoedema without undisputed evidence of will improve outcome for individuals affected by stroke, by first
its effectiveness in this disorder. In particular, information regarding investigating the feedback physiotherapists currently give in everyday
dose-response relationships and safety (in malignant conditions) clinical practice, and then comparing the effectiveness of each
remains elusive. This research set out to clarify dose/response type of feedback. The work will contribute to rehabilitation of older
relationships in cell culture as a starting point towards making people with cardiovascular disease. PARTICIPANTS: Four inpatients
clinical recommendations for use. PARTICIPANTS: In vitro cell cul- and four outpatients with stroke and eight physiotherapists were
tures. METHODS: Well-differentiated human breast adenocarcinoma purposively recruited from two hospitals. Patients were selected who
(MCF-7) and less differentiated human breast ductal carcinoma (MB- scored three to thirteen on the upper limb section of the Rivermead
435) cell lines were grown and passaged using standard aseptic Motor assessment, who were currently receiving physiotherapy for
tissue culture protocols. 96-well tissue culture plates were seeded their upper limb and gave informed consent. Patients presenting
with 1 x 104 cells per well in fresh growth medium, and allowed with severe sensory deficits and receptive speech difficulties were
to grow for 48-72hrs before exposure to laser. A single dose of excluded. METHODS: A triangulated methodology was used, in-
laser was performed at energy densities of 0.5, 1, 2.5, 10 and corporating video recordings, interviews and questionnaires. Clinical
12J/cm2 for 780nm laser, and 0.5, 1, 2.5, 10 and 15J/cm2 for 830nm data was collected measuring cognition, perception, pain, motor
laser. Cell proliferation was assessed 24hrs after laser treatment and sensory impairment. Treatment session(s) were then video-
by calorimetric spectrophotometry. ANALYSIS: Percentage growth recorded in the usual neuro-rehabilitation setting. This was followed
differences between treated and control means, and Student t-tests by separate interviews with patients and therapists and therapists
with 95% confidence limit were calculated. Alpha level was set at also completed a questionnaire. ANALYSIS: All data was collected
0.05 for all tests. RESULTS: Laser irradiation at 780nm using doses by the primary author and transcribed verbatim. An iterative
from 0.5 to 5J/cm2 produced no significant difference in proliferation framework was then developed to analyse the transcripts. Thematic
of MCF-7 (adenocarcinoma) cells. A positive trend in MCF-7 cell analysis was conducted independently by the researchers and
proliferation was evident at a dose of 10J/cm2 (13.37% mean concordance was achieved about the emergent themes. Frequencies
percentage increase) becoming significantly increased at 12J/cm2 of the use of instruction and informative feedback were obtained.
(p < 0.05). In the MB-435 (ductal carcinoma) cells, laser irradiation RESULTS: Informative feedback was rarely used. The attentional
at 780nm (doses from 0.5 to 5J/cm2) also resulted in no significant focus of instructions and feedback were primarily internal. Statements
difference, but at 10J/cm2 there was a significant increase in cell that helped to reinforce or provide motivation were evident in
proliferation compared to negative controls (p < 0.05). At 830nm, laser all eight treatments which patients reported as being beneficial.
irradiation using doses from 0.5 to 2.5J/cm2 did not affect MCF- Verbal instructions were observed more frequently than informative
7 cell proliferation, however, at higher doses of 10 and 12J/cm2, feedback in all eight treatments. This was often associated with non-
significant increases (p < 0.05) in growth were noted. There were no verbal gestures e.g. manual guidance. CONCLUSIONS: The lack
effects observed in MB-435 cells after laser irradiation at 830nm for of informative feedback in this sample reflects findings of the small
doses from 0.5 to 10J/cm2, but at 15J/cm2 there was a statistically number of previous studies that have investigated patient/therapist
significant increase (p < 0.05) in cell proliferation. CONCLUSIONS: interactions in stroke rehabilitation. Therapists may be underutilizing
The findings suggest that 780nm and 830nm laser at doses up to this important resource for facilitating motor learning in the hemiplegic
5J/cm2 do not stimulate cell proliferation in the two breast cancer arm after stroke. Where informative feedback was given to the
cell lines studied, however higher doses do appear to stimulate cell patient, the attentional focus was primarily internal. IMPLICATIONS:
proliferation irrespective of wavelength, and in both human breast This research suggests clinicians may need to increase the use of
carcinoma cell lines. We plan to investigate further the in vitro effects informative feedback during motor retraining. Extrinsic feedback can
of other typical laser wavelengths used in lymphoedema treatment positively change motor behaviour and is important where intrinsic
prior to extending the research to in vivo and clinical models. feedback systems are compromised. Utilizing this resource through
IMPLICATIONS: The results of this research imply that low doses of effective motor retraining could increase the level of skill achieved
laser of less than 5J/cm2 at the wavelengths stipulated are potentially and increase the speed of learning. Further work is required to
safe for clinical use in the presence of the two types of human breast examine the effects of whether feedback with an internal or an
cancers studied. Whilst findings from in vitro research cannot be external focus is more beneficial for stroke. KEYWORDS: Feedback,
considered transferable to clinical application, the findings provide attentional focus, upper limb. FUNDING ACKNOWLEDGEMENTS:
some guidance on targeting potential foci for future work using in This research is supported by The Stroke Association. CONTACT:
vivo models of treatment and in clinical applications. KEYWORDS: [email protected]
laser therapy, cancer. FUNDING ACKNOWLEDGEMENTS: Griffith ETHICS COMMITTEE: Sandwell and West Birmingham Local
University. CONTACT: L.Laakso@griffith.edu.au Research Ethics Committee
LEARNERS’ SUGGESTIONS FOR THE TEACHING OF CRITICAL DEVELOPING MODELS OF CARE FOR ARTHRITIS: EMERGING
INQUIRY AND CLINICAL DECISION MAKING ROLES FOR PHYSIOTHERAPISTS
Mabey R; University of North Dakota, Grand Forks, North Dakota, MacKay C, Veinot P, Devitt R, Badley E; Arthritis Community
USA Research and Evaluation Unit, Toronto Western Research Institute,
PURPOSE: Students and graduates of a three-year physical therapy Toronto, Canada
program were asked to provide insights and suggestions to facilitate
the teaching and learning of critical inquiry and clinical decision PURPOSE: The goal of this study was to identify the range
making. RELEVANCE: Physical therapy students are very interested of models of service delivery for arthritis incorporating enhanced
in coursework tied to hands-on patient/client care; however they roles for physiotherapists. RELEVANCE: With the aging of the
do not always appreciate the role of critical inquiry in clinical population and concomitant increase in arthritis, there is a growing
decision making. Linking critical inquiry to clinical decision making care gap between the number of people needing care for arthritis
and subsequent patient care is often frustrating to both faculty and access to appropriate services. Shortages in the number of
and students. The development of effective teaching strategies is specialists and geographic variation in their availability indicates
essential and student feedback is part of the development process. there is a need to explore alternative models of health care delivery
PARTICIPANTS: Students and graduates of the program (n=25) in order to ensure that people with arthritis have timely access
volunteered to participate in focus group interviews. METHODS: to quality care. Previous research suggests that physiotherapists
Interview questions were adapted from those of Steven Brookfield in emerging roles can facilitate access to services and provide
in ‘The Skillful Teacher.’ Questions addressed the highs and lows quality care for people with arthritis. PARTICIPANTS: A purposive
of learning critical inquiry and clinical decision making, teaching
sample of key informants included health care providers, academics
strategies which helped or hindered skill development, and learner
and administrators who work in the arthritis field from countries
strategies for success. Questions were given to participants prior to
interviews and responses were discussed, clarified, and expanded where access to specialists is via physician referral. METHODS:
during interview sessions. Interviews, scheduled at the participants’ Semi-structured interviews were conducted either by telephone or
convenience, lasted up to 1.5 hours. Sessions were recorded via in person using an interview guide. The interviews were taped and
note-taking and audiotape. ANALYSIS: In this qualitative study, notes transcribed. ANALYSIS: Qualitative data were analyzed using a
and audiotapes were analyzed for emergent themes. Data were constant comparative approach to identify common types of models
analyzed within and across cohorts, i.e., student level in the program of care and the strengths and challenges of each type of model of
or graduate status. RESULTS: Three broad categories of results are care. RESULTS: Seventy-four key informants were interviewed from
addressed: 1.) Responses to interview questions: Learning highs six countries. Four main types of models of care emerged. a) Models
were related to successes. It ‘just made me feel kind of good using health care providers in expanded clinical roles utilize the skills
to figure it out that quickly with a limited amount of information.’ of health professionals such as physiotherapists to increase efficiency
‘Intimidated,’ ‘frustrated,’ ‘frazzled,’ and ‘nervous,’ described learning of care by i) assessing patients with musculoskeletal conditions
lows. Helpful strategies included ‘keep it real’ and use active learning. and referring to the appropriate services including specialist care
Learners should ‘Be patient, be curious, be a good listener!’ and or ii) providing ongoing management of patients in collaboration
‘Ask for help!’ 2.) Responses related to status in the program: with a consultant. b) Specialized arthritis programs tend to focus on
Students early in the program focused on assignments. Graduates
delivery of comprehensive, multidisciplinary team care specifically for
tended to see the process in a global sense: connections were
arthritis. c) Models promoting remote/rural access include technology
made between assignments, courses, academic experiences, and
clinical experiences. Graduates focused on the teaching and learning such as telemedicine to improve access to services with a health
as applied to clinical practice. 3.) Responses related to personal professional facilitated clinical examination. d) Community-based
factors: While strategies for teaching and learning were suggested, care tends to focus on broader disease populations and offering
some of the challenges and frustrations were addressed by: ‘what community resources and support. Perceived strengths of models
drew me to PT was helping people and working with (patients) using physiotherapists include decreasing wait times to specialist
one on one . . . it’s just a personality thing . . . (a reason) why care and maximizing the skills of all providers. Challenges identified
it’s hard to get people to . . . (perform) research.’ CONCLUSIONS: for physiotherapists in expanded roles include lack of standardized
Educational experiences associated with critical inquiry and clinical training and need for support from professional regulatory bodies
decision making are similar to those of other subjects. Specific to expand scope of practice. CONCLUSIONS: There was no single
strategies may be implemented to facilitate the teaching and model that was identified by key informants that will work in
learning of critical inquiry and clinical decision making. Resistance to all populations and in all circumstances. Alternative models have
coursework may be related to personal preferences and motivations. emerged internationally in an ad hoc way in part to address
IMPLICATIONS: While physical therapy students from one site issues in access to care and many include a broadening of skills
provided data for this study, educators from other programs may within or outside traditional scope of practice. IMPLICATIONS:
find this research useful as they promote the development of
Further research is needed to understand the effectiveness and
critical inquiry and clinical decision making skills in their learners.
cost-effectiveness of such models. To advance the development
KEYWORDS: critical inquiry, clinical decision making, physical
of models of care using physiotherapists in expanded clinical
therapy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
[email protected] roles, a collaborative approach is needed to standardize training,
ETHICS COMMITTEE: University of North Dakota Institutional develop core competencies and address issues in scope of practice.
Review Board: IRB #200311-119, Approved 11/18/03; 7/22/04 KEYWORDS: Models of care, Emerging roles, Access to care.
FUNDING ACKNOWLEDGEMENTS: This Project was funded by the
Ontario Ministry of Health and Long-Term Care. Views expressed in
this presentation are not the views of the Government of Ontario.
Board
STRAIN ON THE PECTORALIS MINOR MUSCLE DURING THE SOCIAL POSITIONING STRATEGIES OF PHYSIOTHERAPY
SHOULDER MOTIONS AND STRETCHING TECHNIQUES: A STUDENTS AND CLINICAL EDUCATORS IN FEEDBACK
CADAVERIC BIOMECHANICAL STUDY SESSIONS
Muraki T1 , Miyamoto S2 , Oshiro S1 , Fujii M1 , Miyamoto H1 , Molloy E1 , Clarke D2 , Webb G, Remedios L; 1 Monash University,
Takasaki H3 , Izumi T1 , Hidaka E1 , Uchiyama E4 , Aoki M2 ; Melbourne, Australia; 2 The University of Melbourne, Melbourne,
1 Graduate School of Health Science, Sapporo Medical University, Australia
Sapporo, Japan; 2 Department of Physical Therapy, Sapporo
Medical University, Sapporo, Japan; 3 Shinoro Orthopaedic Clinic, PURPOSE: Face-to-face feedback in clinical education has been
Sapporo, Japan; 4 Department of Anatomy, Sapporo Medical identified as an important but problematic process in aiding student
University, Sapporo, Japan learning. The health education literature identifies tensions inherent
in the clinical educator’s role as both assessor and mentor, and
PURPOSE: Shortening of the pectoralis minor muscle is believed highlights the tendency for feedback to elicit negative affective
to limit scapular motions and contribute to shoulder contracture or responses in both students and clinical educators. This study
impingement syndrome. However, it is unclear how much the muscle used a ‘Positioning Theory’ framework to investigate the social
processes, including identity construction and power negotiation,
is lengthened during shoulder motions and stretching techniques.
implicit in feedback sessions. RELEVANCE: Invariably, health
The purpose of this study is to measure strain on the pectoralis
education literature views feedback as a key tool in facilitating
minor muscle in order to determine shoulder motions for stretching
learning. Despite these claims, there is a notable absence of
the muscle. RELEVANCE: This study contributes to the development
empirical studies investigating the feedback sessions in situ. An
of stretching exercises of the shortened pectoralis minor muscle.
understanding of how feedback is practised is central to informing
PARTICIPANTS: Six frozen-thawed transthoracic specimens from six
conceptions of ‘effective’ learning practice and, ideally, should
fresh cadavers were used. Specimens with shoulder contracture were positively influence physiotherapy curriculum design and ongoing
excluded. METHODS: Strains on medial and lateral fiber groups of professional development. PARTICIPANTS: Nine students and 12
the pectoralis minor were directly measured by precise displacement clinical educators were ‘purposively selected’ to participate in
sensors (Pulse Coder, LEVEX, Kyoto, Japan) during three passive this in-depth qualitative study. Participants were selected across
shoulder motions, i.e. flexion, abduction, and external rotation at three institutions affiliated with the School of Physiotherapy, The
90º abduction. The strains during three stretching techniques, i.e. University of Melbourne, and represented three practice domains
two scapular retraction methods (at shoulder 0º flexion and 60º of cardiothoracic, musculoskeletal and neurological physiotherapy.
flexion) and shoulder horizontal abduction with 90º external rotation METHODS: Nine student-clinical educator feedback sessions were
were also measured. ANALYSIS: One-way analysis of variance and videotaped at the half-way point and completion point of the
post hoc multiple comparisons tests (Bonferroni and Dunnett) were clinical placement (18 sessions in total). Post-session interviews
used to examine the differences of strain in three different shoulder were conducted with all participants to elicit their understanding
motions and stretching techniques. The a level of significance was of the feedback encounters. ANALYSIS: The transcripts from the
set at 0.05. RESULTS: During shoulder flexion and abduction, the 18 videotaped sessions and 36 interviews were analysed using
strains on both fiber groups increased linearly in the range of 30 Harre’s (1999) Positioning Theory. This analytical lens was used to
º to 180º and became significantly greater in the range of 60 º to interpret the social dimensions implicit in feedback sessions including
180º compared to the strain at 0 º. The strain did not significantly the expectations that both parties carried into the sessions, and
increase throughout external rotation at 90º abduction. Although the participants’ responsibilities in feedback as enacted through
mean strains at 180º abduction (56.2±16.5% on lateral fiber and the conversation. RESULTS: Both students and clinical educators
48.2±15.7% on medial fiber) and 180º flexion (54.9±17.3% on colluded to create a feedback culture where educators were
lateral fiber and 49.0±16.8% on medial fiber) were the greatest positioned as the authorative ‘diagnosers’ of student performance,
in all shoulder motions, they were not significantly greater than and the students were positioned as ‘attentive listener’. The tendency
the strain at external rotation at 90º abduction (40.5±15.1% on for clinical educators to assume the position as ‘diagnoser’ and
lateral fiber and 33.8±14.3% on medial fiber). In the comparison ‘fixer’ was viewed as ‘the physio way’; an artefact from their clinical
of three stretching techniques, scapular retraction at 60º flexion role as physiotherapist. Students identified reasons for resisting
responsibility for self-evaluation including respecting authority, saving
(52.0±17.2% on lateral fiber and 46.6±14.8% on medial fiber) and
face (minimising risk and exposure) and lacking the skills in self-
horizontal abduction with 90º external rotation (48.0±14.3% on lateral
diagnosis and self-regulation. CONCLUSIONS: In contrast to the
fiber and 42.6±14.8% on medial fiber) significantly stretched the
literature’s support of the importance of two-way feedback for learn-
muscle compared to scapular retraction at 0º flexion. However,
ing, this study indicated that both students and clincical educators
mean strains during these two techniques were not greater than
were responsible for generating a one-way feedback exchange.
the strain at 180 º of flexion and abduction. CONCLUSIONS: Our The clinical educator was positioned as responsible for ‘diagnosing’
findings indicate that the pectoralis minor muscle was lengthened at and ‘remedying’ deficits in student performance and students
180º shoulder flexion or abduction. The amounts of muscle strains resisted taking responsiblity for self-evaluation. IMPLICATIONS:
during three traditional stretching techniques were not greater than The positioning practices observed across the eighteen feedback
the strain at 180º shoulder flexion and abduction. IMPLICATIONS: sessions are likely to not only influence students immediate learning
Muscle stretching at 180º shoulder flexion or abduction can be experiences, but may additionally influence their ability to develop
considered an additional effective stretching technique of the as independent, reflective and self-evaluative practitioners. Changes
pectoralis minor muscle. KEYWORDS: Pectoralis minor, Stretch, in curriculum, and more transparent education of students and
Shoulder. FUNDING ACKNOWLEDGEMENTS: No grants or outside clinical educators is required to encourage students to ligitimately
funding were received in support of this research. CONTACT: engage in self-evaluative processes. KEYWORDS: Feedback; Self-
[email protected] evaluation; Positioning Theory. FUNDING ACKNOWLEDGEMENTS:
ETHICS COMMITTEE: Institutional Review Board of Sapporo The researchers would like to acknowledge the assistance of the
Medical University Australian Postgraduade Award (APA) and the Australian and New
Zealand Association for Medical Education (ANZAME)in funding this to consider these factors when designing exercise interventions for
project. CONTACT: [email protected] persons with disabilities. Additionally, physical therapists need to
ETHICS COMMITTEE: Ethical approval granted by Human Research adopt an advocacy role for public policies that create environmental
Ethics Committee (HREC) at The University of Melbourne, August support for physical activity. KEYWORDS: Physical activity; barriers;
2003 self-efficacy. FUNDING ACKNOWLEDGEMENTS: This work was not
funded by an external agency. CONTACT: [email protected]
ETHICS COMMITTEE: This work was approved by the Institutional
Research Report Platform Presentation Review Board at the University of Ilinois at Chicago.
PP Crystal Pavilion B & C Research Report Platform Presentation
RELATIONSHIP OF PERSONAL CHARACTERISTICS, EXERCISE 1731 Monday 4 June 09:30
ATTITUDES, AND ENVIRONMENTAL FACTORS TO EXERCISE VCEC Ballroom B & C
ACTIVITY IN PERSONS WITH PHYSICAL DISABILITY
ULTRASOUND PHONOPHORESIS OF PANAX NOTOGINSENG
John D; Department of Physical Therapy, University of Illinois at EXTRACT IMPROVES THE STRENGTH OF REPAIRING
Chicago, Chicago, USA LIGAMENTS
PURPOSE: Existing evidence points to an epidemic of physical Ng G, Wong R; Department of Rehabilitation Sciences, Hong Kong
inactivity in the United States, and illustrates the disparity between Polytechnic University
physical activity levels in persons with and without disability. PURPOSE: This study aimed to examine the combined effect of
Research on determinants of physical activity and exercise has therapeutic ultrasound and herbal panax notoginseng extract and
shown that exercise is a complex health behavior inclusive of multiple to compare it with the therapeutic ultrasound alone for treating
factors and levels of influence. Further investigation of these factors medial collateral ligament injury in a rat model. RELEVANCE: The
is needed in persons with disabilities. This study addressed this phonophoretic effects of therapeutic ultrasound has been utilized
need by investigating the association of personal characteristics, clinically to facilitate the absorption of topical drugs. Herbal plant
exercise perceptions, and environmental factors to exercise activity in extracts are commonly used in the Chinese community to treat
persons with physical disability. RELEVANCE: This study identifies musculoskeletal problems and panax notoginseng (PN) is a popular
some of the key factors that are associated with exercise activity ingredient in many herbal formulae. If the combined treatment effects
in persons with physical disability and identifies factors that are of therapeutic ultrasound and PN extract could enhance tissue
barriers to exercise. This knowledge can be used to design exercise healing, it will have a vital impact on the potential application of this
interventions for this population. PARTICIPANTS: Data was collected treatment approach in the management of musculoskeletal injuries.
with 102 subjects who self-reported physical disability and mobility Furthermore, the success of this treatment will be a major step
impairments, recruited from the community. METHODS: A data forward in bridging the eastern and western therapeutic methods.
collection instrument was developed which compiled measures of PARTICIPANTS: Twenty sexually matured male Sparague Dawley
demographic characteristics, limitations of activities of daily living, rats were used in this study. METHODS: All the rats received
exercise self-efficacy, cognitive-emotional barriers, unmet need for surgical resection to their left medial collateral ligament (MCL) and
limitations of activities of daily living, environmental barriers, social were randomly dividied into 3 groups, namely, Group 1 (combined
environmental support, physical environmental support, and physical ultrasound PN treatment, n=7); Group 2 (ultrasound treatment alone,
activity levels. Data was collected in face to face interviews with n=7); and Group 3 (no treatment control, n=6). On day 3 after the
each participant. Eleven subjects were selected for follow-up semi- surgery, the rats were subjected to their respective treatment daily for
structured interviews which examined attitudes, and facilitators 6 days a week. Group 1 received 4 minutes of continuous ultrasound
and barriers to physical activity. ANALYSIS: Multiple regression (1 MHz) at the intensity of 1.2 W/sqcm using the contact method with
analyses were performed with minutes of weekly exercise activity a coupling gel that contained PN extract. Group 2 received the same
as the dependent variable, and self efficacy; perceived barriers, ultrasound treatment but with a normal ultrasonic coupling gel. Group
socio-environmental support; physical environmental supports; levels 3 received a placebo treatment similarly to the other two groups but
of unassisted and assisted ADL limitations; and demographic with the power of the ultrasound machine turned off. ANALYSIS:
characteristics of race, gender, age, income level, and education level On day 17 after surgery, the rats were killed and the MCL on both
as independent variables. The transcribed semi-structured interviews legs were mechanically tested with a material testing system for the
were analyzed for key concepts, and these were grouped into related ultimate tensile strength. Results of the left side were normalized
categories or themes. RESULTS: There were significant associations against that of the right side for each animal and the normalized data
to exercise activity at the levels of personal characteristics, exercise were compared with a one-way ANOVA at 0.05 level of confidence.
attitudes, and environmental factors. Younger age, lower income, RESULTS: Result of ANOVA showed significant difference (p = 0.022)
higher education, higher self-efficacy, lower cognitive-emotional among the 3 groups. Post-hoc contrasts revealed that the normalized
barriers, and lower environmental barriers were associated with tensile strength in Group 1 (74.6 +/− 14.9) was significantly higher
higher levels of exercise activity in persons with physical disability. than that of Group 2 (57.5 +/− 14.3) and Group 3 (51.9 +/− 12.0),
High self-efficacy and motivation for exercise, and the construction whereas no significant difference was found between Group 2 and
of exercise as a daily routine emerged as key concepts in interviews Group 3. CONCLUSIONS: We conclude that the combined treatment
with subjects who reported regular exercise. Interview subjects who of therapeutic ultrasound and PN extract could produce a more
reported low of exercise expressed the need for transportation favorable outcome on the strength of the repairing ligament at
support, accessible facilities in their communities, and instrumental 2 weeks after injury in rats. IMPLICATIONS: The present study
support for exercise. CONCLUSIONS: There are some key factors implies that therapeutic ultrasound application coupled with a gel
that are important in promoting physical activity in persons with that contained a Chinese herbal medicinal extract may produce
physical disability. Those of older age and with lower education may more favorable outcome than ultrasound therapy alone on soft tissue
require additional targeting and support in achieving regular exercise. injuries. The efficacy of this combined therapy on human has yet
Specific strategies that address self-efficacy, cognitive-emotional to be tested. KEYWORDS: Therapeutic ultrasound, ligament, herbal
barriers, and environmental barriers may be needed. Future medication, phonophoresis. FUNDING ACKNOWLEDGEMENTS:
research exploring factors associated with exercise in persons with The financial support from Department of Rehabilitation Sciences,
disability needs to include larger and more diverse samples across Hong Kong Polytechnic University for this study is acknowledged.
socioeconomic levels, community locations, and across differing ETHICS COMMITTEE: The Animals Ethics Subcommittee of Hong
levels of physical disability. IMPLICATIONS: Physical therapists need Kong Polytechnic University
Research Report Platform Presentation by an APA Neurology-Tagged Grant. GLM is supported by a
2897 Monday 4 June 09:30 Nuffield Oxford Medical Fellowship and is on leave from the School
VCEC Meeting Rooms 11-12 of Physiotherapy, The University of Sydney, Australia. CONTACT:
DOES MIRROR THERAPY IMPROVE UPPER LIMB SENSORY [email protected]
AND MOTOR RECOVERY EARLY POST-STROKE? A ETHICS COMMITTEE: The Royal Brisbane and Women’s Hospital
RANDOMISED-CONTROLLED TRIAL Human Research Ethics Committee and The University of Queens-
land Medical Research Ethics Committee.
Acerra N1,2 , Souvlis T1 , Brauer S1 , Moseley L1−3 ; 1 Division of
Physiotherapy, The University of Queensland, Brisbane, Australia;
2 Physiotherapy Department, Royal Brisbane and Women’s Hospital, Research Report Platform Presentation
Brisbane, Australia; 3 Oxford Centre for fMRI of the Brain & 2836 Monday 4 June 09:30
Department of Physiology, Anatomy & VCEC Meeting Room 16
PURPOSE: The current study assessed mirror therapy versus sham POSITIONING PRACTICES OF ASIAN-EDUCATED STUDENTS IN
therapy on early post-stroke upper limb resting pain and sensorimotor AN AUSTRALIAN PROBLEM-BASED LEARNING CLASSROOM:
recovery. RELEVANCE: During mirror therapy participants perform ACCESS TO POSITIONS THAT MATTER
bilateral limb movements and watch the unaffected hand and its Remedios L; University of Melbourne, Melbourne, Australia
mirror image, while keeping the affected hand hidden from view
behind a partition. Mirror therapy is hypothesised to either (i) PURPOSE: This presentation examines the positioning practices
provide sensory feedback important for sensorimotor integration and of Asian-educated students in a small-group learning context.
recovery, or, (ii) activate the ipsilateral motor cortex to enhance Positioning Theory (Harre and Van Langenhove, 1991) is a theoretical
sensorimotor recovery. Mirror therapy was associated with improved framework that used conversation as data for understanding how
motor recovery in a chronic (>6 months) post-stroke population and individuals negotiate their social context. It is a useful frame
improved sensation, function and pain intensity in pain patients. for examining how students experience and shape their learning.
However, mirror therapy has not been evaluated to determine RELEVANCE: Physiotherapy classrooms are cross-cultural learning
its effect on early post-stroke pain and sensorimotor recovery. contexts and it is important that educators are better informed of
PARTICIPANTS: Forty acute (<two weeks) stroke patients were the leaning experience being provided for students from different
recruited from an acute rehabilitation hospital. To increase patient cultural and educational backgrounds. PARTICIPANTS: Thirteen
homogeneity, only first-time ischaemic stroke patients participated. International students who had previously completed the majority
All participants met study inclusion/exclusion criteria. METHODS: of their pre-tertiary education in East Asia and South-East Asia
Blinded assessments included a motor assessment (grip strength were recruited for this study. While these students had shared
and the Motor Assessment Scale (MAS)) and a quantitative sensory regionality and all were from Confucian heritage backgrounds,
assessment (resting pain intensity, sensory detection, pressure-pain there was a marked diversity in cultural, linguistic and educational
threshold, and hot/cold sensation). Participants were assessed prior backgrounds. Seven students were purposively sampled for closer
to treatment, following treatment and one month post-treatment. examination of positioning practices. METHODS: The data presented
Participants were randomly assigned into either mirror-therapy or here is drawn from a subset of data taken from a two-year
sham-therapy (non-reflective surface) for 20 minutes daily for two ethnographic study that examined the experiences and responses of
weeks, in addition to usual care. Both groups performed bilateral overseas (Asian) educated students to PBL in the first year of their
(as able) simple motor tasks and sensory stimulation progressed undergraduate experience. Participant observation, semi-structured
by complexity. Participants in the intervention group watched the interviews, video data and video-stimulated recall interviews were the
mirror image of the unaffected upper limb during intervention, with primary sources of data collection. For this secondary analysis, seven
the affected limb hidden from view. Sham group participants were PBL tutorials were video taped so as to capture the conversational
unable to view the unaffected limb during intervention. ANALYSIS: exchanges between seven Asian-educated students and other group
Results were analysed on an intention to treat basis. A RM-ANOVA ANALYSIS: Positioning theory was used as the analytical framework
was used to detect differences between groups (2), times (3), and for examining the positions that were assigned to Asian-educated
sites (4). RESULTS: There were no between-group differences at students as well as the positions they adopted, accepted and con-
baseline. Subjects who underwent mirror therapy demonstrated at tested. An existed list of positions commonly assigned and adopted
each of the three upper limb sites: improved sensory detection (post: in small group collaborative work among senior school students
p < 0.05, follow-up: p < 0.01), pressure-pain threshold (post: p < 0.05, (Barnes, 2003) was expanded and modified into a table of positions
follow-up: p < 0.01), and hot/cold sensation (post: p < 0.05, follow-up: commonly seen in PBL tutorials. This classification was used to
p < 0.01); improved grip strength (post: p < 0.05, follow-up: p < 0.01) examine the positioning of Asian-educated students. RESULTS: Key
and MAS scores (post: p < 0.05, follow-up: p < 0.01); and decreased findings were that Asian-educated students did not adopt all positions
resting pain intensity (post: p < 0.01, follow up: p < 0.01) compared identified as positions that matter. Further, both tutors and local group
with the sham group post-treatment and at follow-up. There was members were found to assign only a limited number of positions to
no statistically significant change in sensation at the remote (leg) Asian-educated students and in some cases to even contest their
site. CONCLUSIONS: Mirror therapy was associated with improved adoption of key positions. However, despite working within a limited
early post-stroke upper limb motor recovery, sensory recovery, and repertoire of positions, there was evidence of diverse responses
resting pain intensity. Mirror therapy had no effect on a remote site in to assigned positions with some students contesting positions
the leg, suggesting that mirror therapy has a local treatment effect. assigned to them. CONCLUSIONS: Positioning practices in PBL
Further research is needed to determine the optimum frequency tutorials suggested an embedded power structure that did not allow
and duration of mirror therapy and if it is equally effective when un- Asian-educated students full group membership and opportunity to
supervised. IMPLICATIONS: This is the first known RCT of mirror negotiate as empowered group members. Further research is needed
therapy in a post-stroke population. The results of this study support to examine tutors’ positioning of students and strategies used by
the use of mirror therapy in an acute stroke unit. Mirror therapy tutors that actively facilitate students’ access to positions that matter.
was well received by stroke patients and is a simple and cost- IMPLICATIONS: This study foreground factors that limit access some
effective intervention that can improve the rehabilitation outcome. students have to positions that matter within the PBL context. For all
KEYWORDS: Stroke rehabilitation, somatosensation, sensorimotor students to access the learning opportunities available in PBL, tutors
integration. FUNDING ACKNOWLEDGEMENTS: NEA is supported need to scaffold the students’ negotiation of the power structure oper-
by NHMRC Grant ID 409919 and The Royal Brisbane & Women’s ating in small group leaning contexts. KEYWORDS: Asian-educated
Hospital Research, Australia. The current research was supported students, Positioning Theory, Cross-cultural learning. FUNDING
ACKNOWLEDGEMENTS: Australian Post-graduate scholarship Research Report Platform Presentation

(The University of Melbourne). CONTACT: [email protected] 2321 Monday 4 June 09:30
ETHICS COMMITTEE: University of Melbourne, Faculty of Educa- VCEC Meeting Room 18
tion, Human Research Ethics Committee ANALYSIS OF THE CLINICAL FACTORS DETERMINING THE
CAPACITY TO PERFORM BRIDGING ACTIVITIES AMONG FRAIL
OLDER ADULTS
Research Report Platform Presentation Pilon M1,2 , Nadeau S2,3 , Piotte F2 ; 1 CSSS Bordeaux-Cartierville-
1994 Monday 4 June 09:30 St-Laurent, Montréal, Québec, Canada; 2 School of Rehabilitation,
VCEC Meeting Room 17 Faculty of Medicine, Université de Montréal, Québec, Canada;
3 Centre de recherche interdisciplinaire en réadaptation du Montréal
COMPARING DISCHARGING POLICY FOR STROKE PATIENTS
BETWEEN THE UK AND JAPAN Métropolitain, Institut de réadaptation de Montréal, Québec, Canada
Kato G, Takahashi K, Akasaka K, Kurikawa M, Tokita K, Sawada Y; PURPOSE: To identify the most important clinical variables de-
Department of Physical Therapy Saitama Medical School Junior termining the execution of bridging activities in frail older adults.
Colloge Saitama Prefecture, Japan RELEVANCE: Physical therapists often use bridging activities to
PURPOSE: Nowadays, the importance of researching health policy assess and train the hip muscle strength and lower-limb motor control
has been increased because of its characteristic, “health service during rehabilitation. These activities have hardly been studied.
is scarce resource” which is influenced by social environment, PARTICIPANTS: A convenient sample of 30 frail older adults (mean
such as aging society, economic situation, etc. Moreover, health age ±SD: 80.4 ±7.2) were recruited at a Montreal geriatric health
staffs have gradually been involved in the health policy making center. All gave their written consent prior to the assessment.
process. It would be difficult to say that, as a member of medical METHODS: After collecting demographic data, a trained physical
staffs, physical therapists sufficiently participate in the policy making therapist used several clinical tests (e.g. 10 meters walk, Time Up and
process because not many researches based on policy science have Go, Berg balance test, Lower Extremity Coordination Test, Functional
been achieved by physical therapists have been shown up in Japan. Autonomy Measurement System) to assess the walking ability,
Therefore, this study aim to study about health policy, and facilitate coordination and level of autonomy of the participants. The maximal
puting more physical therapists into the policy process effectively. static strength of the trunk flexors and extensors, hip extensors,
RELEVANCE: This study concerns the discharging policy for stroke hip abductors, knee flexors and extensors was assessed using
patients for following reasons. First, stroke is world-widely known a hand-held Nicholas dynamometer. The subjects then performed
as a main cause of disability. Second, “bed-blocking”in the UK, and three different Timed Bridge Tests (TB Tests): 1) a hold test (TB-
“socially being inpatient”, a situation that patient have to stay in the Static), 2) a 5-repetitions dynamic test (TB-5rep) and 3) a 60
hospital because of their social reasons have been recognized as seconds dynamic test (TB-60s). For all trials, a physical therapist
a social problem in both countries. Third, many physical therapists recorded the height of the bridge with a pelvialtimeter, the duration
play a strong role in the process of discharging stroke patients. (TB-Static and TB-5rep) or the number of repetitions (TB-60s).
DESCRIPTION: To achieve understanding discharging policy for ANALYSIS: Descriptive statistics were calculated to establish the
stroke patients, following procedure based on qualitative method was subjects’ characteristics, clinical variables and performance in the
carried out. First, “Advocacy Coalition Framework”, one of policy TB Tests. The level of association between the ability to perform the
science tools to demonstrate policy, was applied. Secondly, the three TB tests and the clinical variables were first examined with
data for the framework was collected through databases, Internet Pearson’s correlation coefficients then with multiple linear regression
sites, and library catalogue. The key words were ‘stroke’, ‘discharge’, analyses using a stepwise method. RESULTS: Results revealed that
‘comparative’, ‘policy’, ‘health’, ‘long term care’, ‘continuing care’, the heights attained in the three bridge tests were related to one
and ‘community care’. Finally, discharging policy for stroke patients another (r > 0.95) and the duration of execution of the TB-5rep was
was compared between the UK and Japan to help interpreting the significantly associated (r = 0.65) with the number of repetitions of
policy with understanding what is same, and what is different between the TB-60s. Except for the duration of TB-5rep, which showed an
them. EVALUATION: This study achieved to illustrate two countries’ association with the weakest knee extensor strength, there were
discharging policy for stroke patients. By reviewing 50 literature the no significant associations between the clinical variables and the
framewark was completed. CONCLUSIONS: The comparison carried TB test parameters, with r values generally lower than 0.30. The
out in this study indicates some differences between them. First, the multiple linear regression analyses did not find important predictors
UK discharging policy intends to control discharging process with the of the TB performance, even with the summation of the muscle
responsibility set by law, in contrast Japanese one was controlled by strength for a given muscle. The best models explained 31% of
the national insurance schedule. In concrete, if the stroke patients the variance in the data and were obtained for the heights of the
overstayed in the hospital with social reasons, and then the local TB-5rep and TB-60s and for the duration of the TB-Static test.
government has to pay for the additional fee in the UK. In Japan, The variable most often selected was again the strength of the
it is not possible that hospitals receive the normal payment for weakest knee extensor. CONCLUSIONS: The performance of the
overstaying from the Japanese national insurance scheme but may TB Tests is poorly explained by the strength of the lower limbs
accept reduction of medical expenditure due to reducing the national or the trunk as well as by other clinical variables. Thus, the TB
medical care cost. Secondly, the quantity of medical services, such as tests described cannot be used to appreciate the lower-limb muscle
the opportunity to access to the hospital beds, computed tomography strength at the hip. Further studies are required to identify the
scans, Magnetic Resonance Imaging, is more frequently carried factors that determine the TB test performance. IMPLICATIONS:
out in Japan. However, there is less quantity of social services in Clinicians should not rely on the individual’s performance in a
Japan. On the other hand, in the UK, more multiple professionals are bridge test to evaluate the strength of the hip muscles among the
involved in the discharging process for stroke patients. Particularly the geriatric rehabilitation population. KEYWORDS: Elderly, strength,
quantity of social services, such as social works, is higher in the UK. mobility. FUNDING ACKNOWLEDGEMENTS: This project was
IMPLICATIONS: Because of lack of medical services, ‘bed-blocking’ supported by the Ordre professionnel de la Physiothérapie du
tends to be caused in the UK, however ‘socially being inpatient’ Québec and the Fonds de Marie-Anne Lavallée. The authors thank
in Japan caused by the difficulties happened at the point when M. Beaudry and M. Labadie for their technical support. CONTACT:
patients discharge from hospital. KEYWORDS: Health policy, Policy [email protected]
Science, Physical Therapist. FUNDING ACKNOWLEDGEMENTS: ETHICS COMMITTEE: CSSS Bordeaux-Cartierville-St-Laurent
None. CONTACT: [email protected] ethic’s committee
Research Report Platform Presentation process is student focused education, where learning and especially
2436 Monday 4 June 09:30 learning outcomes are of great importance. A goal for the curricula
VCEC Meeting Rooms 19-20 is that the student masters the core knowledge of physiotherapy.
COLLAGEN AND ELASTIN CROSSLINKS IN HUMAN Interaction between the core knowledge and pedagogic strategies,
INTERVERTEBRAL DISCS AND LIGAMENTUM FLAVUM: AGE, learning environment and the construction of the studies is
GENDER AND SPINAL LEVEL INFLUENCES essential. DESCRIPTION: This project is a development work
to investigate how physiotherapy students at Arcada experience
Tan C1 , Kent N2 , Singer K1 ; 1 Centre for Musculoskeletal Studies,
their learning through self-directed studies. The data was obtained
University of Western Australia, Australia; 2 PathCentre, Queen
through a questionnaire, which consisted of five closed and seven
Elizabeth II Medical Centre, Nedlands, Western Australia
open questions. Eighty percent of the physiotherapy students at
PURPOSE: The objective of the study was to determine the Arcada (n=56) answered questions about study planning, study
distribution of collagen and elastin crosslinks in spinal disc and techniques, learning and supervision. The questions were answered
ligamentum flavum due to age, gender and spinal level influences. anonymously. The results were analyzed qualitatively according to
RELEVANCE: Elastic fibers are commonly reported in the matrices categories. EVALUATION: This study showed that reading literature
of ligament connective tissues, however the presence of these is the most common activity in self-directed studies. To make
tissues in spinal discs is still not fully investigated and determined. notes, both during independent reading and during lessons is
PARTICIPANTS: Tissue samples from cadaveric spinal discs (n=77) another method used by students for self-directed studies and
and ligamentum flavum (n=364) were obtained from 24 formalin- learning. Factors that support self-directed learning are repeating,
fixed and 2 fresh spines. The mean age of all spines was 57 SD 26 time for reflection and a quiet learning environment. Study planning
years. METHODS: Spinal ligament and disc samples were harvested is facilitated by a structured curriculum and teacher supervision.
and analyzed for collagen, Pyridinoline, deoxypyridinoline and elastin Motivated, engaged and competent teachers encourage students
crosslinks, isodesmosine and desmosine. Crosslinks were extracted into self-directed studies. CONCLUSIONS: The results show that
from hydrolyzed samples by cellulose partition chromatography, physiotherapy students at Arcada concentrate their self-directed
and analyzed by reverse-phase HPLC. ANALYSIS: Results were studies on learning theory, but they do not seem to use time in
quantitative data, analysed using ANOVA and regression analysis learning practical skills. Further studies about the students’ ability to
to determine relationships between age, gender, spinal levels and self-reflective and critical thinking in self-directed studies are needed.
biochemical parameters. RESULTS: Elastin crosslinks were only IMPLICATIONS: Clearly structured studies combined with support
detected in lumbar discs but yielded results in all ligamentum flavum from the teachers can be used for helping students spend more self
tissues. The distribution of elastin crosslinks in the ligament was -directed time in learning practical skills. KEYWORDS: Self-directed
significantly lower with age (p < 0.05), higher in females (p < 0.05) studies, learning, didactics. FUNDING ACKNOWLEDGEMENTS:
and lumbar region (p < 0.01). CONCLUSIONS: The collagen and None. CONTACT: ira.jeglinsky@arcada.fi
elastin content and extent of crosslinks in the ligamentum flavum and
spinal discs varied significantly depending on the age, gender and
spinal region. IMPLICATIONS: This study provides prelimary data
on the varied distribution of collagen and elastin crosslink content 3170 Monday 4 June 09:50
in human spinal discs compared with spinal ligamentum tissues. PP Crystal Pavilion B & C
Such data provides clinicians treating spinal patients with information SUBJECTIVE AND MUSCULAR FATIGUE IN PEOPLE WITH
on the biochemical changes in the soft tissues in relation to age, PERIPHERAL NEUROPATHY
hormonal and biomechanical factors. KEYWORDS: Human spinal Graham R1 , White C2 ; 1 Manchester Metropolitan University,
discs, ligamentum flavum, collagen, elastin, crosslinks, age, gender, Manchester, UK; 2 King’s College London, London, UK
spinal region. FUNDING ACKNOWLEDGEMENTS: This study was
funded in part through the National Health and Medical Research PURPOSE: The study aimed to examine the complex interaction
Council funding (970244). between subjective fatigue report and muscular fatigue in people
ETHICS COMMITTEE: Ethics approval was granted by the Ethics with peripheral neuropathy. RELEVANCE: Up to 80% of people with
committe of Curtin University of Technology, Western Australia peripheral neuropathy complain of persistent and severe feelings of
fatigue that appear to be independent of their neurological status
and which worsen after physical exertion. However, it is unclear
Research Report Platform Presentation to what extent muscle fatigue contributes to this subjective fatigue.
2411 Monday 4 June 09:50 PARTICIPANTS: 13 people with peripheral neuropathy (Diagnoses:
PP Crystal Pavilion A Guillain Barré Syndrome, 4; Chronic Inflammatory Demyelinating
SELF-DIRECTED LEARNING AMONG PHYSIOTHERAPY Polyradiculoneuropathy, 7; Multifocal Motor Neuropathy, 1; Parapro-
STUDENTS teinaemic Demyelinating Neuropathy, 1) and 13 healthy volunteers,
aged between 18 and 70 were recruited. METHODS: Subjective
Jeglinsky I; The Faculty of Social and Health care. Arcada, Helsinki,
fatigue was evaluated using the Fatigue severity scale, Fatigue impact
Finland
scale and Piper fatigue scale questionnaires prior to measurements
PURPOSE: The Physiotherapy education at Arcada is built on of quadriceps femoris muscle performance. These included peak
integrative pedagogic to prepare the students for practice in different force, voluntary activation and the response to low and high
contexts. The new curriculum for the physiotherapy degree focuses frequency electrical stimulation. All participants underwent testing
on the students’ learning process. Defining learning outcomes and on two separate occasions at least one week apart. Three muscle
developing new pedagogic methods have become a challenge for fatiguing protocols were performed to evaluate i) aerobic muscle
the teachers. There is a need for developing methods to facilitate metabolism under conditions that broadly mimic daily activity, ii)
students’ ability to take the initiative to diagnose their learning needs, the response to a 60 second sustained maximal isometric muscle
formulate learning goals, identify resources for learning, select and contraction, and (iii) decline in force after 3 minutes of intermittent
implement learning strategies, and evaluate learning outcomes. The electrical stimulation. ANALYSIS: 2-tailed independent t tests were
aim of this project was to investigate the didactic possibilities to used to assess differences between healthy and PN participants
support self directed learning among the physiotherapy students in subjective fatigue, peak isometric force (MVIC), induced fatigue,
at Arcada. RELEVANCE: The striving of a common European voluntary activation, EMG, response to high and low frequency
area for higher education has put the reforms into an every day electrical stimulation at baseline and after fatiguing protocols.
reality for teachers and students. An important part of this Bologna Pearson product moment correlations were used to examine
associations between subjective and muscular fatigue measures. at 1 inch (p = 0.87). No differences were found between distances
RESULTS: Participants with PN had significantly greater subjective (p = 0.33) or the In vivo (p = 0.78) or In vitro (p = 0.24) condition.
fatigue (p < 0.05) and were significantly weaker (Mean MVIC force CONCLUSIONS: The shortest exposure time (5 seconds) was
±SD, NKg−1 : 5.4±2, p < 0.05), than healthy volunteers (7.5±2.2). sufficient to kill bacteria at the closest distance (1 inch). The
However, there was no significant difference between PN and healthy collaboration of two health professions resulted in confirmation of
groups for any measures of muscle performance. PN participants the abiotic effect of UVC and specific recommendations for physical
demonstrated a similar decline in MVIC after a sustained 60 second therapy practice. IMPLICATIONS: Results of this interdisciplinary
isometric contraction (% of initial MVIC force: PN, 60±14% Healthy, research suggest that UVC may provide an effective, safe, and
59±18%), comparable decrease in low: high frequency stimulated cost-beneficial alternative to pharmacologic intervention for infected
force ratio after voluntary fatiguing muscle activity (PN, 0.13±0.18; wounds, particularly important for antibiotic intolerant patients
Healthy, 0.11±0.15) and a similar decline in initial force following and antibiotic resistant organisms. It also suggests that UVC is
intermittent electrical stimulation (PN, 60±13% of initial; Healthy, effective in killing a variety of organisms, possibly simultaneously,
63±11%).There were no significant associations between measures and organisms with different susceptibility patterns. Furthermore,
of muscular fatigue and subjective fatigue report in either group. it appears that multiple exposures to UVC are necessary to
CONCLUSIONS: These results indicate that subjective fatigue is totally eliminate pathogens from an infected wound. This study
significantly more severe in people with PN than healthy participants. also evidences that the roles of health practitioners must expand
However, there is little evidence to suggest that primary muscle and include interdisciplinary research to substantiate and inform
fatigue is responsible for this. IMPLICATIONS: The relationship changing clinical practice. If best practice is often interdisciplinary,
between subjective and muscular fatigue in people with PN is unclear. education must be as well. KEYWORDS: Ultrviolet-C, Infected
Future studies should seek to evaluate other causes of subjective Wounds. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
fatigue in this patient group and to examine muscular fatigue relative [email protected]
to a known external resistance, as this may relate more overtly
to subjective fatigue. KEYWORDS: Fatigue, muscle weakness,
peripheral neuropathy. FUNDING ACKNOWLEDGEMENTS: We
wish to acknowledge Guy’s, King’s and St Thomas’ Charitable 2986 Monday 4 June 09:50
Foundation for their support of this study. VCEC Meeting Rooms 11-12
ETHICS COMMITTEE: Ethical approval was granted by the King’s IS NIGHT SPLINTING AS EFFECTIVE AS TILT TABLING AT
College London and Guy’s Hospital Research Ethics committees, PREVENTING ANKLE CONTRACTURE EARLY AFTER STROKE:
London UK. A RANDOMISED CONTROLLED TRIAL
Ada L1 , Robinson W2 , Smith R3 , Aung O4 ; 1 University of Sydney,
Research Report Platform Presentation Sydney, Australia; 2 Bankstown Hospital, Sydney, Australia; 3 Multiple
2698 Monday 4 June 09:50 Sclerosis Centre, Sydney, Australia; 4 St. George Hospital, Sydney,
VCEC Ballroom B & C Australia
ABIOTIC EFFECTS OF ULTRAVIOLET-C IRRADIATION PURPOSE: To examine the efficacy of prolonged stretching (via
ON IN VITRO AND IN VIVO CULTURED BACTERIA: overnight splinting vs tilt-tabling) in preventing ankle dorsiflexion
INTERDISCIPLINARY LABORATORY RESEARCH TO PHYSICAL contracture early after stroke. RELEVANCE: Calf shortening is a
THERAPY PRACTICE common problem after stroke. Limitation in ankle range is a major
Henderson R, Vanik J, Banning J, Han H; Rosalind Franklin secondary problem after stroke which leads to reduced mobility
University of Medicine & Science, North Chicago, USA and independence. PARTICIPANTS: 29 stroke patients who were
previously ambulatory, within 2 weeks of a first disabling stroke,
PURPOSE: The purpose of this study was to investigate the currently immobile but had not already developed contracture in
abiotic effect of Ultraviolet-C (UVC) irradiation on four bacteria the affected ankle of greater than 10 degrees compared with the
commonly found in infected wounds with an an interdisciplinary non affected limb, had no pre-existing skin or circulatory problems
research initiative involving physical therapy and clinical laboratory contraindicating application of splints and did not have severe
science faculty and students. RELEVANCE: Physical therapists use difficulty in communication participated in the study. The study was
a variety of interventions to manage infected wounds, including approved by the individual hospital and university ethics committees
UVC. However, limited information is available concerning treatment and subjects gave informed consent before initial measures were
parameters or the effectiveness of UVC therapy for treatment of completed. METHODS: A randomised controlled trial was carried
infected wounds in the contemporary clinical setting. Physical therapy out in two metropolitan mixed rehabilitation units. The experimental
alone lacks the skill set to address these issues which require group had their affected ankle splinted at plantargrade overnight
an interdisciplinary approach. PARTICIPANTS: Physical therapy and the control group were stood on a tilt table with the affected
and clinical laboratory science faculty served as research mentors ankle at maximum dorsiflexion for 30 min. Maximum passive ankle
and interdisciplinary advocates for physical therapy students in this dorsiflexion and the sit-to-stand item of the Motor Assessment
collaborative laboratory research to address an issue with importance Scale were measured before and after 4 weeks of intervention,
and implications for physical therapy practice. METHODS: Staphy- and after 6 weeks follow up by an assessor blinded to group
lococcus aureus, Escherichia coli, Pseudomonas aeruginosa and allocation. ANALYSIS: Two-way ANOVAs (group x time) were used
Klebsiella pneumoniae were irradiated with UVC at two distances and to determine whether there was a greater effect of the night
four different durations for two conditions, In vitro (Plated American splinting program than the tilt table program on maximum passive
Type Culture Collection organisms) and In vivo (organisms harvested dorsiflexion and sit-to-stand performance. Analysis of data from
from infected wounds). Irradiated plates were incubated for 24-48 Weeks 0 and 4 compared the immediate effect of the splinting
hours and viable colonies were counted. ANALYSIS: Percent kill program with the tilt table program while analysis of data from Weeks
rates were calculated from surviving colony counts. The One-way 0 and 10 determined whether any benefits of the intervention were
Independent ANOVA and Bonferroni t-Test were used to determine maintained. RESULTS: There was no difference in the change in
differences between the four irradiation durations at each distance. maximum passive dorsiflexion between the night splinting group
The Independent t-Test was used to determine differences between and the tilt tabling group, either by Week 4 (p = 0.61) or by Week
the two exposure distances and conditions. RESULTS: Mean percent 10 (p = 0.75). However, neither group lost range in their ankles
kill rates ranged from 84-100%. Kill rates were significantly different over the intervention period. The experimental group started at
between exposure durations at 3 inches (p 0.0001), however, not 14 deg and finsished at 14 deg which was similar to the control
group who started at 12 deg and finished at 14 deg. Both groups interchangeable, in providing a full care service in the lifelong man-
lost 4 deg in the 6 weeks following the cessation of intervention. agement of chronic disability. KEYWORDS: Occupational therapy
CONCLUSIONS: Night splinting appears to be as effective as titl and physiotherapy professional role; health education outcome; phe-
tabling at preventing ankle contractures after stroke. IMPLICATIONS: nomenography. FUNDING ACKNOWLEDGEMENTS: Physiotherapy
Clinicians can choose to implement night splinting or tilt tabling Research Foundation, Chartered Society of Physiotherapy, UK.
to prevent ankle contracture depending on the requirements of CONTACT: [email protected]
the individual patient. KEYWORDS: stroke, stretch, contracture. ETHICS COMMITTEE: University of East Anglia, Schools of Health
FUNDING ACKNOWLEDGEMENTS: The Physiotherapy Research Ethics Committee
Foundation of Australia. CONTACT: [email protected]
ETHICS COMMITTEE: The Ethics COmmittee for humna research, Research Report Platform Presentation
the University of Sydney
Research Report Platform Presentation FACTORS AFFECTING DEMAND FOR REHABILITATION
2930 Monday 4 June 09:50 SERVICES IN ONTARIO, CANADA
VCEC Meeting Room 16 Landry M1−3 , Jaglal S1,2,4 , Wodchis W2,4 , Raman J1 , Cott C1−3 ;
1 Department of Physical Therapy, University of Toronto, Toronto,
OCCUPATIONAL THERAPY AND PHYSIOTHERAPY STUDENTS’
PERSPECTIVES OF PROFESSIONAL ROLE – THERE IS A Ontario, Canada; 2 Toronto Rehabilitation Institute, Toronto, Ontario,
DIFFERENCE! Canada; 3 Arthritis Community Research and Evaluation Unit
(ACREU), Toronto, Ontario, Canada; 4 Department of Health
Richardson B, Garnham E; University of East Anglia, Norwich, UK Policy, Management and Evaluation, University of Toronto, Toronto,
PURPOSE: To explore perspectives of professional role held by Ontario, Canada
graduating 3rd year occupational therapy and physiotherapy students PURPOSE: Demand for health and rehabilitation services often
on a shared BSc (Hons) course. RELEVANCE: Shared learning in exceeds supply in an environment of economic scarcity creating
health education courses is encouraged to promote inter-professional pressure on the health care system. In this research, we explore the
team work. Demographic changes and projected increasing inci- variables that affect demand for rehabilitation services in Canada’s
dence of chronic disabilities have led to continuing debate of future most populous province of Ontario. RELEVANCE: Rehabilitation
health care needs and the rationale for retaining the individuality continues to emerge as an essential aspect of health delivery
of some health professions PARTICIPANTS: 8 occupational therapy across the continuum of care. However, many rehabilitation services
and 8 physiotherapy students from an education programme with (especially outpatient and ambulatory community services) are
50% shared courses, were strategically selected from responses generally considered to be beyond the insurable limits of the Canada
to an open invitation to participate in a study of professional Health Act. As a result, outpatient and ambulatory rehabilitation
socialisation. Selection aimed for maximum variation of sex, age, services are increasingly shifted beyond the publicly funded sector,
earlier work experiences, educational background to ensure a rich and financed through a mix of public and private financing. It
diversity of the phenomena. METHODS: A qualitative approach was is critical to understand the demand for these services in order
taken by three researchers to explore perspectives of professional for policy makers to plan and implement appropriate funding and
socialisation throughout a three year course. A semi-structured delivery structures that ensure access to services. PARTICIPANTS:
interview of 30-40 minutes was carried out with each participant Informed by the results from a literature and data search, we
by one of the researchers within three months of completing the conducted a series of 42 key informant telephone interviews between
course. Each interview opened with the same question “please tell September 1 and November 18, 2005. A purposive sampling
me about a patient who you have found interesting as an occupational strategy was used to identify key informants across Ontario. The
therapist/physiotherapist”. A commonly agreed interview guide and sampling frame was selected in order to obtain maximum variation
a phenomenographic approach was used to explore the varied sampling regarding the dimensions and implications of the issues
conceptions of the role of an occupational therapist or physiother- being examined. The sampling frame of participants was selected
apist. ANALYSIS: All interviews were transcribed and analysed according to the following criteria: (1) Setting (2) Employment
by a phenomenographic method. Reading and familiarisation of Type, and (3) Professional Background. Only potential informants
each transcript was carried out by two researchers, independently, judged to have extensive knowledge and experience in Ontario’s
within and across the professions. Interview content was condensed rehabilitation sector were invited to participate. METHODS: Policy
and relevant statements identified which were summarised and case study methodology was used, which combined primary (key
compared for similarities and differences. The two researchers informant interviews (N=42) conducted with multiple stakeholders
then compared and agreed qualitatively different categories across and secondary (review of publicly available documents) data sources.
the summaries which were described and designated with titles. ANALYSIS: The transcribed data were entered into a qualitative
Finally the categories were contrasted and related to each other. data analysis software package (NVivo) for systematic coding.
RESULTS: Complex and varied descriptions of the phenomenum of The research team then performed content analysis to identify
professional role emerged. Themes of identification of outcomes and emerging themes that arose form the key informant interviews.
achieving goals; impact of the context; use of reasoning; continual The themes were based on collective perceptions and experiences
learning were identified in which distinct differences in underpinning of the informants that addressed the issues of demand in the
health beliefs, styles of reasoning, framing the problem, and rehabilitation sector. RESULTS: The demand for rehabilitation is
focus of intervention clearly distinguished occupational therapy and rising expeditiously, and there are 7 factors identified that will continue
physiotherapy perspectives of professional role. CONCLUSIONS: to affect this growing demand. These include (1) an aging population,
Perceptions of the professional role of occupational therapists and (2) increasingly chronic and complex conditions, (3) overall population
physiotherapists present distinctly contrasting but complementary growth, (4) increasing public expectations, (5) advances in health
views of client centred care which together emphasize a continuum of care technology, (6) expanding scope of rehabilitation practice,
health care provision valid to life long client centred care and modern and (7) emphasis on health promotion and disease prevention.
health care needs. IMPLICATIONS: Distinctly differing perspectives CONCLUSIONS: The presence of demand for rehabilitation does
of occupational therapy and physiotherapy on the focus, reasoning not signal that there is, or will be, sufficient financial and/or human
and rationale for health and social care suggest the importance resources to meet these same demands in Ontario. IMPLICATIONS:
of retaining the two professional roles as complementary, but not Access to services is increasingly based on eligibility or availability
of funding rather than demand. Further research is required to Västerbotten, the Swedish Research Council K2005-27VX-15357-
understand the degree to which the presence of unmet rehabilitation 01A, Erik and Anne-Marie Detlof’s Foundation, the Borgerskapet in
has short and long-term implications at the client and health system Umeå Research Foundation, and the Dementia Fund. CONTACT:
levels. KEYWORDS: Supply, Demand, Rehabilitation. FUNDING [email protected]
ACKNOWLEDGEMENTS: Ontario Ministry of Health and Long Term ETHICS COMMITTEE: The study was approved by the Ethics
Care (MOHLTC) and the Ontario Neurotrauma Foundation (ONF). Committee of the Medical Faculty of Umeå University (§391/01).
ETHICS COMMITTEE: University of Toronto Research Ethics Board
Research Report Platform Presentation VCEC Meeting Rooms 19-20
2458 Monday 4 June 09:50 DOES SUSTAINED LUMBAR ROTATION INDUCE NUCLEUS
VCEC Meeting Room 18 PULPOSIS DEFORMATION IN A PREDICTABLE MANNER? – AN
THE EFFECT ON ADL OF A HIGH-INTENSITY FUNCTIONAL MRI INVESTIGATION
EXERCISE PROGRAM AMONG OLDER PEOPLE DEPENDENT Fazey P1 , Song S2 , Price R3 , Singer K1 ; 1 Centre for
IN ADL: A RANDOMIZED CONTROLLED TRIAL Musculoskeletal Studies, The University of Western Australia, Perth,
Littbrand H1 , Lundin-Olsson L1 , Gustafson Y1 , Rosendahl E1,2 ; Western Australia; 2 Department of Radiology, Royal Perth Hospital,
1 Umeå University, Department of Community Medicine and Perth, Western Australia; 3 Dept of Medical Technology & Physics,
Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå, QEII Medical Centre, Perth, Western Australia
Sweden; 2 Luleå University of Technology, Department of Health
PURPOSE: To predict the in vivo effect of sustained lumbar
Sciences, Physiotherapy Unit, Luleå, Sweden
rotation positions on nucleus pulposis deformation using MRI with
PURPOSE: To investigate if a high-intensity functional weight-bearing asymptomatic volunteers. RELEVANCE: Physiotherapists commonly
exercise program reduces the dependency in personal care and use active and passive non weight-bearing rotation (torsion)
mobility among older people dependent in activities of daily living techniques in the management of low back pain. Discogenic low
(ADL), with focus on people with dementia. RELEVANCE: The back pain is common yet the mechanical effect of sustained
number of older people with disability increases. Physical functional lumbar rotation techniques is unknown with respect to the nucleus
capacity can be improved by high-intensity exercise program, but pulposis. PARTICIPANTS: 12 subjects comprising: 5 females and
there is no strong evidence that physical exercise is an effective 7 males with a mean age of 44 years (range 24-57) were
method to reduce disability. PARTICIPANTS: 191 older people recruited. Inclusion criteria were: no significant history of back pain
dependent in ADL, living in residential care facilities, and with a Mini- requiring intervention within the previous year and body shape
Mental State Examination (MMSE) score of 10 participated in this amenable to positioning within the MRI. Exclusion criteria were
study (the FOPANU Study). Their mean score ± SD of the Barthel related to the general contraindications to magnetic resonance
ADL was 13.1±4.2 and 52% of the participants had a diagnosed imaging. METHODS: Subjects were positioned in a variety of supine
dementia disease. METHODS: The participants were randomized to postures including: left lumbar rotation and combinations of flexion,
a high-intensity functional weight-bearing exercise program (the HIFE extension and left rotation, within a 1.5 T magnetic resonance imager
Program) or a control activity, including 29 sessions over 3 months. (Siemens, Berlin, Germany). T1 and T2 weighted images were
The Barthel ADL Index, which includes ten items that are summarized obtained (TR/TE[5160/102] field of view 210mm, 384x384 matrix).
to a total score of 20, was used to assess independency in personal Flexion to extension range from L1 to S1 was derived from T1
care and mobility. The assessments were performed, by persons sagittal sequences; T1 coronal images were used to assess direction
blinded to the participants’ group allocation, before the intervention, and segmental lateral flexion angles; and nucleus hydration patterns
at 3 months (directly after the intervention period), and at 6 months. evaluated from mid disc axial T2 weighted images. In this series
ANALYSIS: Between-group effects on the total score and each item 30 discs were examined. Acquisition time for each image was 4-6
were analyzed by ANCOVA and by logistic regression, respectively, minutes. ANALYSIS: Selected axial images were post-processed in
using the intention-to-treat principle. RESULTS: When analyzing all Image-J [NIH, Bethesda, USA] to derive average hydration profile
participants, there was no statistical significant difference between maps of the nucleus. The effect of age on nuclear deformation and
the groups at 3 or 6 months in total score of the Barthel ADL direction was noted. The direction of nuclear deformation, if present,
Index. Analyses for each item revealed that a lower proportion of was subsequently quantified in relation to the associated segmental
participants in the exercise group had deteriorated regarding mobility lateral flexion. RESULTS: Acceptable intra-observer reliability of
indoors (item 7) at 3 and 6 months (4% and 8%) compared to the all angular and displacement assessments was achieved with
control group (16% and 20%), P = 0.01 and 0.03, respectively. Among coefficients of variation <4.5%. Subjects assessed in combined
people with dementia, there was a significant difference in total score sagittal and axial plane positions demonstrated an average sagittal
in favor of the exercise group at 3 months (mean difference 1.1, change in range of 44º from extension to flexion between L1 and S1
P = 0.03), but not at 6 months. CONCLUSIONS: A high-intensity (range: 18–60º), which resulted in a nuclear displacement of 16% of
functional weight-bearing exercise program does not appear to have disc hydration profile (range: 3.5-19%). On average a 5.5% coronal
an overall effect on ADL according to the Barthel ADL Index among displacement of the nucleus was recorded when rotation was coupled
older people who are dependent in ADL and living in residential with either flexed or extended positions (range 0.4-15%). In 75% of
care facilities, but the exercise program seems to have both short- discs, a contralateral lateral flexion direction could be predicted from
and long-term effect in maintaining mobility indoors. In the subgroup the nuclear deformation. Subjects assessed in axial plane rotation
of people with dementia, the exercise program seems to have a only demonstrated an average coronal displacement of 2.3% (range
short-term overall effect on ADL. IMPLICATIONS: A high-intensity 1.2-6.5%) with variability related to age; older subjects flexed less
functional weight-bearing exercise program seems to be a promising and exhibited reduced nucleus deformation. CONCLUSIONS: In
method to reduce disability regarding mobility indoors for older normal discs, sagittal plane postures typically induce a posterior
people living in residential care facilities. For people with dementia, nuclear migration in flexion and the converse in extension. In
the exercise program may have an overall effect in personal care general, these MRI torsion studies of lumbar discs resulted in
and mobility but continuously training may be needed to maintain nuclear deformation towards the area of least compression relative
the effect. KEYWORDS: Exercise therapy, Frail Elderly, Dementia. to the associated lateral flexion. IMPLICATIONS: The sustained
FUNDING ACKNOWLEDGEMENTS: This work was supported by supine positions adopted for this study preclude extrapolation to
grants from the County Council of Västerbotten, the Äldrecentrum weighbearing postures. However, treatment strategies that assume
the nucleus deforms in a stereotyped manner relative to position Research Report Platform Presentation
may be cautioned by these data. Further studies with older subjects 3280 Monday 4 June 10:10
with established disc degeneration or with scoliosis are currently in VCEC Meeting Rooms 11-12
progress. KEYWORDS: MRI, intervertebral disc, nucleus pulposis. IMPLIMENTATION OF A RANDOMIZED CONTROLLED TRIAL OF
FUNDING ACKNOWLEDGEMENTS: University of Western Australia VERY EARLY MOBILIZATION DOES NOT CHANGE STANDARD
research grant. CONTACT: [email protected] STROKE UNIT CARE
ETHICS COMMITTEE: Human research and ethics committee, Royal
Collier J1 , Thrift A1 , McQuinn A2 , Fu C2 , Grealy S2 , Bernhardt J1−3 ;
Perth Hospital, Perth Western Australia 1 National Stroke Research Institute, Melbourne, Australia; 2 School
of Physiotherapy, Univerity of Melbourne, Australia; 3 School of

Research Report Platform Presentation Physiotherapy, La Trobe University, Melbourne, Australia
3175 Monday 4 June 10:10 PURPOSE: During 2001/2, we found that 58 stroke patients spent
PP Crystal Pavilion B & C more than 50% of the day resting in bed and only 13% of the day
FATIGUE REPORT, ACTIVITY, CARDIOVASCULAR FITNESS AND engaged in activity likely to aid their physical recovery. This study
ENERGY COST IN PEOPLE WITH PERIPHERAL NEUROPATHY aimed to investigate whether the levels of patient physical activity
Graham R1 , White C2 ; 1 Manchester Metropolitan University, changed in response to stroke unit participation in A Very Early
Manchester, UK; 2 King’s College London, London, UK Rehabilitation Trial (AVERT). RELEVANCE: When therapy research
trials are performed within a stroke unit, researchers need to evaluate
PURPOSE: The aim of this study was to examine subjective feelings the impact of the experimental intervention on standard care. If
of fatigue as reported by people with peripheral neuropathy and to standard care is contaminated by the experimental intervention, the
investigate associations with health status, activity, cardiovascular trial methodology is compromised. PARTICIPANTS: Patients were
fitness and energy cost. RELEVANCE: Feelings of fatigue affect up to recruited from Austin Health and St. Vincents Hospital stroke units.
80% of people with PN, but factors that contribute to this subjective These centres were participating in AVERT Phase II, 2004/5. Patients
fatigue have not yet been established. PARTICIPANTS: 13 people less than 14 days post stroke were eligible. Patients receiving
with peripheral neuropathy (Diagnoses: Guillain Barré Syndrome, pallative care were excluded, as well as those patients recruited
4; Chronic Inflammatory Demyelinating Polyradiculoneuropathy, 7; to AVERT. METHODS: Behavioural mapping was undertaken to
Multifocal Motor Neuropathy, 1; Paraproteinaemic Demyelinating determine the activity levels of acute stroke patients. Ten-minute
Neuropathy, 1) and 13 healthy volunteers, aged between 18 and observations were conducted between 0800 to 1700 over one day
70 were recruited. METHODS: Subjective fatigue and health status with patient activity documented. Whole body movements were
were measured using the Fatigue severity scale (FSS), Fatigue grouped into five activity categories to reflect the degree of physical
impact (FIS) and Piper fatigue scales (PFS), and the medical work during these activities. These were: no activity (asleep, inactive),
outcomes short form 36 questionnaire. Resting heart rate and non-therapeutic activity (eating, watching TV in bed), minimal
the energy cost of comfortable walking on a flat surface (EO2 ) activity (transfer by hoist, sit in chair), moderate activity (standing,
was measured. An Actigraph® activity monitor also recorded daily sitting unsupported) and high activity (walking, stairs). The primary
activity levels over 5 days. ANALYSIS: 2 tailed independent t tests contamination outcome was the level of high activity. The secondary
were used to identify differences between groups and Pearson outcome was the level of non theraputic activity and no activity.
product moment correlations were used to determine associations ANALYSIS: Stepwise binomial logistic regression was used to
between subjective fatigue, health status, heart rate, EO2 and assess differences in activity between time periods (2001/2, 2004/5)
activity. RESULTS: Subjective fatigue was significantly greater in PN controlling for differences in patient characteristics. RESULTS: 53
participants on all questionnaires (Mean FSS ±SD: 4 ±1.8, FIS: stroke patients (mean age 74.7 years, 49% male) were recruited.
22.6 ±21.6, PFS: 2. 7±2.1) when compared to healthy participants Thirteen one day observations were completed. Patients spent 9%
(FSS: 2.3 ±0.8, p < 0.005; FIS: 6.8 ±6.9, p < 0.02; PFS: 1.22 ±1.1, of the day in standing and walking activities and 65% of the day in
p < 0.04). Elevated subjective fatigue was significantly associated bed involved in non therapeutic activities. No statistical differences
with increased limitations in social and physical activities and with between time periods were found (standing and walking: OR=0.980,
decreased social function and general health perception in people p = 0.159; bed: OR=1.004, p = 0.608). CONCLUSIONS: No change
with PN (r>0.6 for all, p < 0.05). They also had higher resting in the level of physical activity of stroke patients was found. We are
heart rates (79 ±11 beats per min) than healthy participants confident that measures taken in the AVERT intervention protocol to
(72±8 beats per min, p < 0.04). Additionally, participants with PN limit contamination of standard care are effective. IMPLICATIONS:
were less active (p < 0.03) and used more energy whilst walking The AVERT intervention protocol limits contamination of standard
(Mean EO2 ±SD:16.5 ±7 ml m−1 ) than healthy volunteers (11.1 care and can be used to evaluate the efficacy of a very
±2.3 ml m−1 , p < 0.02). However, no significant associations were early mobilisation intervention. KEYWORDS: contamination, stroke,
demonstrated between these factors and levels of subjective fatigue. randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
CONCLUSIONS: The current study indicates that subjective fatigue None. CONTACT: [email protected]
is a significant problem for people with PN that adversely affects ETHICS COMMITTEE: Human Ethics Committee, Austin Health;
health status. Despite no significant relationships between subjective Human Ethics Committee, St. Vincent Hospital
fatigue and cardiovascular fitness, energy cost or activity levels being
identified in this study, these factors were all significantly reduced
compared with healthy participants and warrant further investigation. Research Report Platform Presentation
IMPLICATIONS: This study indicates that subjective fatigue should 3235 Monday 4 June 10:10
be considered in the assessment of people with PN as it is associated VCEC Meeting Room 16
with reduced health status. Larger studies are now necessary to POST-QUALIFYING EDUCATION: FINAL YEAR PHYSIOTHERAPY
confirm these results and to investigate other possible contributors to STUDENTS’ KNOWLEDGE AND OPINIONS OF MASTER’S
subjective fatigue in this patient group. KEYWORDS: Fatigue, quality LEVEL STUDY
of life, peripheral neuropathy. FUNDING ACKNOWLEDGEMENTS:
Gray H, Kerr C; Glasgow Caledonian University, Cowcaddens
We wish to acknowledge Guy’s, King’s and St Thomas’ Charitable
Road, Glasgow, G4 OBA, Scotland, UK
Foundation for their support of this study.
ETHICS COMMITTEE: Ethical approval was granted by the King’s PURPOSE: The aim of this study was to investigate final year
College London and Guy’s Hospital Research Ethics committees, Physiotherapy students’ knowledge and opinions of Master’s level
London, UK. study and their intentions towards its undertaking. The study
particularly explored whether there was any relationship between to promote behaviours that optimize autonomy. RELEVANCE: Older
levels of perceived knowledge of and intentions to undertake this adults who experience a change in health status and require
type of post-qualifying education. RELEVANCE: Postgraduate study hospitalization are at risk for a long-term deterioration of functional
is the fastest growing sector within higher education in the United status. These individuals may benefit from home rehabilitation
Kingdom, particularly amongst the allied health professions. This is services on discharge from the acute setting to prevent this loss
partially due to the growing number of specialist posts within the of deterioration. PARTICIPANTS: Two hundred and one clients,
National Health Services (NHS), and has resulted in a rising demand aged 60 years and older, referred to home care services including
for Master’s level courses in Physiotherapy. To date, studies that have homemaking and/or nursing (but not rehabilitation services) following
investigated Physiotherapists’ opinions of post-qualifying education an acute hospital admission were selected. METHODS: In this
have focussed on qualified practitioners, and have not considered clinical trial, participants were randomized to receive either the
the views of undergraduate students. PARTICIPANTS: All final year occupational and physical therapy intervention focused on health
Bachelor’s degree Physiotherapy students (n=146) in Scotland were promotion/ rehabilitation in addition to the usual home care, or
invited to participate in the survey based study. Students were the usual home care services. The health promotion/ rehabilitation
recruited in lectures/ tutorials at the universities during visits by the intervention consisted of an average of 4 visits and follow up
researcher. There was a 93.8% response rate (n=137), with 89.1% phone calls by the therapy teams who helped the participants and
female and 10.9% male participants. The majority (83.9%) of the informal caregivers with problem solving skills related to setting
students were in the 20-24 years age banding, with 9.5% in the 25-29 and implementing health promotion/ rehabilitation goals. The study
banding, 5.1% between 30-34, and the remaining 1.4% were aged 35 participants were evaluated by independent blinded evaluators at
years and above. METHODS: A self-administered questionnaire was baseline and 3 and 6 months after the start of the intervention
designed and piloted by the researchers prior to distribution using for perceived health state as measured by the General Health
a group-administered method. The questionnaire covered four main Perception and Physical Functioning subscales of the Short Form
areas: demographics; perceived knowledge of Master’s level study; 36 (SF 36 Version 2). Other measures included cognitive screen,
intentions to undertake Master’s level study; and perceived barriers physical functioning, coping and caregiver stress. ANALYSIS: All
and benefits of Master’s level education. ANALYSIS: A descriptive analyses were intent-to-treat. Analysis of co-variance was used to
approach to data analysis was adopted, including frequency tables. assess the effect of the intervention on the general health and
Chi-square tests were carried out to determine the relationships physical functional subscales of the SF36. RESULTS: There was
between the nominal and ordinal level data. RESULTS: The key no overall benefit of the therapy intervention for the 161 participants
findings of this study were that the participants perceived they who completed all follow up evaluations on the primary outcomes,
had little knowledge of Master’s level study, which then correlated the SF 36 Physical Functioning or the General Health Perception
significantly with their intentions to commence it (p = 0.03). Only index at 3 months or 6 months or on any of the other outcome
29.9% of students planned to participate in Master’s level education, measures. However, when examining planned interactions at 6
29.2% did not intend to, and 40.2% were unsure. The main perceived months, the younger-old adults (mean=71 years,sd=4.6) who had
benefits to undertaking postgraduate study were: increased level fewer problem solving coping skills, and older adults (mean=82 years,
of knowledge (25.5%); improved skills (24.8%); and better career sd=4.6) with greater problem solver coping skills benefited from
prospects (20.4%). The main barriers identified were lack of: the intervention as indicated by the SF 36 General Health Index
funding (49.6%); time (21.9%); and motivation (11.7%). Interestingly, (p = 0.02). CONCLUSIONS: The intervention was not effective for all
there was no significant correlation between the student’s age participants; however, a subgroup of younger-old adults who were low
and their intention to undertake postgraduate study (p = 0.295). problem solvers and a subgroup of older adults with higher problem
CONCLUSIONS: It appears that the students who felt that they were solving benefited from the addition of the OT/PT health promotion/
informed about the nature and benefits of Master’s level study were rehabilitation intervention. IMPLICATIONS: The findings from this
more likely to consider it favourably and planned to undertake it at research will assist health providers to identify older adults who will
a later date. Future work could be undertaken to investigate in more benefit from a proactive health promotion intervention focused on
detail the main motivations and barriers to undertaking postgraduate optimizing independent living. These findings also provide evidence
qualifications. IMPLICATIONS: It appears that higher education to support an expanded interprofessional role for physical therapists
institutions and professional bodies should market the benefits of in the community. KEYWORDS: health promotion, rehabilitation, ag-
post-qualifying education to undergraduate Physiotherapy students in ing, interprofessional. FUNDING ACKNOWLEDGEMENTS: Health
order to promote their ambitions towards obtaining a higher degree. Transition Fund, Health Canada. CONTACT: [email protected]
Gaining a Master’s qualification is not only beneficial to the individual ETHICS COMMITTEE: McMaster University, Faculty of Health
Physiotherapist for career advancement, but also to the Health Science, Ethics Committee
Services to fill specialist posts, and to the profession for upholding
its international reputation. KEYWORDS: master’s; postgraduate;
higher education. FUNDING ACKNOWLEDGEMENTS: This study
was not funded. CONTACT: [email protected] 3110 Monday 4 June 10:10
ETHICS COMMITTEE: Glasgow Caledonian University’s School of VCEC Meeting Rooms 19-20
Health & Social Care’s Research Ethics Committee PARTICIPANT PERCEPTION OF MOVEMENT ABILITY ACROSS
SIX DIMENSIONS WITH AND WITHOUT PHYSICAL THERAPY
INTERVENTION: TESTING THE EXTENDED MOVEMENT
CONTINUUM THEORY
VCEC Meeting Room 18 Allen D1−3 ; 1 Health and Disability Research Institute, School of Public
Health, Boston University, Boston, MA, USA; 2 University of California,
THE EFFECTS OF AN EARLY HEALTH Berkeley, CA, USA; 3 Samuel Merritt College, Oakland, CA USA
PROMOTION/REHABILITATION INTERVENTION IN AN
OLDER ADULT HOME CARE POPULATION PURPOSE: The purpose of this study was to test two hypotheses:
participants will perceive differences across six dimensions of move-
Wishart L1 , Richardson J1 , Roberts J1 , Browne G1 , Gafni A1 ,
ment ability associated with 1) having a diagnosed movement disor-
Wilkins S1 , Henderson S2 ; 1 McMaster University, Hamilton,
der, and 2) receiving physical therapy intervention. RELEVANCE:
Canada; 2 Community Access Centre of Halton, Burlington, Canada
These hypotheses arose from the Movement Continuum Theory
PURPOSE: The purpose of this study was to evaluate the effective- (MCT). Proposed as a grand theory of physical therapy, the
ness of a home health promotion/ rehabilitation intervention designed MCT links the scientific basis of movement with physical therapy
principles and the effect of physical therapy in improving current Research Report Platform Presentation
movement capability. Subdividing the MCT’s unified construct of 2003 Monday 4 June 10:45
movement into multiple dimensions extends the MCT. If movement PP Crystal Pavilion A
is composed of multiple dimensions, different disorders should affect PREVALENCE OF DEPRESSION IN PATIENTS ADMITTED IN
designated movement dimensions in predictable ways. Furthermore, INTERMEDIATE CARE UNIT
patients should improve in affected dimensions upon successful
Yohannes A1 , Baldwin R2 , Connolly M3 ; 1 Department of
completion of physical therapy intervention. PARTICIPANTS: 69
Physiotherapy, Manchester Metropolitan University, Manchester, UK;
volunteers participated in the study. 35 adults having diagnosed 2 Department of Old Age Psychiatry, Manchester, UK; 3 Department
movement disorders (from post-operative musculoskeletal and pain
of Geriatric Medicine, Auckland, New Zealand
syndromes) and beginning outpatient physical therapy formed the
intervention group (mean age 47, range 19-85, 25 females). Adults PURPOSE: Intermediate care provides a wide range of services
without diagnosed movement disorders formed the 34-person no- intended to reduce possible hospital admission or readmission
intervention group (mean age 54, range 19-78, 17 females). and to provide further rehabilitation as a temporary transition from
METHODS: A 24-item self-report questionnaire based on the hospital to home. Older patients with acute medical illnesses may
extended MCT assessed perceived movement ability across six take longer period to regain full functional recovery compared to
dimensions: flexibility, strength, accuracy, speed, adaptability, and younger patients and hence they are most likely to use more hospital
endurance. The intervention group responded at the beginning of beds. RELEVANCE: Depression is very common in acutely ill older
and about two weeks into an episode of outpatient physical therapy patients with medical problems and its prevalence ranges from 20
as prescribed by the attending clinician. The no-intervention group to 40%. To date no studies have investigated the prevalence of
responded twice with approximately two weeks between exposures. depression and its predictors in older patients with chronic medical
ANALYSIS: Item response theory methods allowed estimation of illnesses admitted for further rehabilitation in intermediate care.
participant locations on each of the dimensions at baseline and PARTICIPANTS: Consecutive series of older patients with chronic
two weeks, anchoring item parameters on the same calibration for medical illnesses aged >60 years referred for further rehabilitation
comparability. Multiple regression controlled for baseline differences primarily for physiotherapy treatment from hospital or directly from
while examining significance of group membership on two-week their General Practitioners to intermediate care. Patients were
data. Paired t-tests across times, effect sizes, and minimal clinically excluded from the study because of terminal illness, refusal or written
important differences (MCIDs) were examined for each dimension. informed consent, psychotic disease, dysphasia severe enough to
RESULTS: The intervention group perceived lower movement prevent questionnaire completion or severe cognitive impairment.
ability at baseline compared to the no-intervention group. At two METHODS: Depression was assessed using the Hospital Anxiety
weeks, the intervention group had increased in their perception Depression scale (HAD). Patients self-completed the Nottingham
of movement ability in all dimensions; the no-intervention group Extended Activities of Daily Living Scale (NEADL) to assess physical
perceived no change. When controlling for differences in baseline disability. Cognitive impairment was examined using the Mini Mental
data between groups, group membership was significant only for State Examination (MMSE). All the scales were administered by the
strength and speed dimensions (p = 0.002 and 0.013 respectively). research physiotherapist who also extracted the sociodemographic
Effect sizes were highest for strength and speed, at 0.42 and characteristics after a few days stay in the intermediate care unit.
0.39 and with 63% and 57% of participants over the calculated The study was approved by the local research ethics committee.
MCID post-intervention, respectively. CONCLUSIONS: Having a ANALYSIS: Descriptive statistics were used to determine the
diagnosed movement disorder and receiving intervention were both prevalence of HAD depression >8 which is recommended as
associated with perceived differences in dimensions of movement clinically relevant with depressive symptoms. To examine factors that
ability. Participants in the intervention group perceived greater change predict depression a forward multiple regression analysis was used.
in strength and speed than in other dimensions after two weeks Significance was set at p < 0.05. RESULTS: Eighty patients (male
of intervention when controlling for baseline status. Effect sizes 28) mean age 80 years, range (60-97 years) were recruited. 29
were moderate for these dimensions after only two weeks. Evidence (36%) of the subjects had a HAD depression score >8. Predictors of
for the alternative hypothesis of a unified construct of movement depression in patients with chronic medical illnesses are: NEADL [t=
consists of significant increase in all dimensions with intervention −2.6, p < 0.009], number of falls in the past year [t= 2.24, p = 0.02],
for this sample. IMPLICATIONS: Physical therapy management and pack years [t= 2.24, p = 0.03]. Total R2 = 0. 15. Further analysis
research can benefit from a well-supported theory linking movement revealed 8% of the variance was contributed by physical disability,
and clinical practice. The extended MCT provides a potential basis 3% by frequency of falls and 2% by pack years. The MMSE was not
for focusing on specific movement dimensions affected by particular a predictor of depression. CONCLUSIONS: Depression is common
disorders. KEYWORDS: theory testing; research implementation; in older patients with chronic medical diseases. Depression was
outcomes research. FUNDING ACKNOWLEDGEMENTS: Post- associated with physical disability, frequency of falls in the past year
doctoral Fellowship from the National Institute on Disability and and number of cigarette smoked in pack years. IMPLICATIONS:
Rehabilitation Research, Grant number H133P0001. CONTACT: Healthcare professionals including physiotherapists should be aware
[email protected] of the high prevalence of depression in this patient group, and its
ETHICS COMMITTEE: Exempt status was given by the Committee possible management in older patients with a history of falls admitted
for the Protection of Human Subjects, University of California, in intermediate care unit. KEYWORDS: Depression, Intermediate
Berkeley, USA care, elderly care. FUNDING ACKNOWLEDGEMENTS: We would
like to thank the Research Institute for Health and Social Change
at the Manchester Metropolitan University for the financial support
provided for the researcher to conduct this study. CONTACT:
[email protected]
ETHICS COMMITTEE: The Wigan Research Ethics Committee
reviewed the study
TEMPORAL PROFILE OF THE RECOVERY IN SHOULDER THE EFFECTIVENESS OF COMMUNITY PHYSIOTHERAPY AND
STRENGTHS AFTER REPETITIVE EXERCISE ENHANCED PHARMACY REVIEW FOR KNEE PAIN IN OLDER
ADULTS: A RANDOMISED CLINICAL TRIAL
Takemoto Y, Miyashita K, Urabe Y, Ijiri T; Hiroshima University
Foster N1 , Hay E1 , Thomas E1 , Phelan M1 , Yates H1 , Peat G1 ,
PURPOSE: Acute fatigue of shoulder muscles is usually caused by Blenkinsopp A2 , Sim J1 ; 1 Primary Care Musculoskeletal Research
repetitive movements without adequate rests during sports activities Centre, Keele University, Keele, Staffordshire, UK; 2 Medicines
and/or manual labors. The influence of muscle fatigue may last for Management, Keele University, Keele, Staffordshire, UK
several days. However, there was little research in the recovery of
shoulder strength from muscle fatigue. Therefore, the purpose of this PURPOSE: This study tested the effectiveness of two primary
study is to demonstrate the temporal profile of shoulder strengths care treatment strategies for older adults with knee pain, enhanced
after muscle fatigue caused by repetitive shoulder abduction exercise. pharmacy review and community physiotherapy and compared
RELEVANCE: This result would provide new insight in preventing these with a control of advice only. RELEVANCE: Knee pain is
chronic muscle fatigue caused by repetitive sports activities or the most common cause of chronic musculoskeletal pain in older
manual labors and help us to establish more effective exercise adults, affecting approximately 25% of people aged over 55 years.
protocol. PARTICIPANTS: Twenty four healthy females who had no Guidelines for the management of knee pain and osteoarthritis
musculoskeletal problem on the shoulder joint were recruited for this recommend both non-pharmacological and pharmacological ap-
study. METHODS: Right shoulder and left shoulder were determined proaches. The traditional general practitioner / family doctor led
as the exercise side and non-exercise side, respectively. A dumbbell service is increasingly unsustainable, and alternative models, utilizing
of 5% of their maximum isometric shoulder abduction strength was the skills of other members of the healthcare team, need to be
used for the exercise. Shoulder abduction at the seated position was evaluated. PARTICIPANTS: 325 participants aged 55 years and over
performed in three sets of 50 repetitions through the range form 0 consulting their general practitioner with knee pain were recruited
to 90 degree. Isometric strength of Abduction(ABD), Flexion(Flex), (mean age 68 years) from 15 general practices. Exclusion criteria:
External rotation(ER), and Internal rotation(IR) were measured by potentially serious pathology such as inflammatory arthritis, previous
a hand held dynamometer before, immediately, one day, two days, or planned knee replacement, recent physiotherapy or intra-articular
and three days after the exercise. Muscle strength was expressed as injection to the knee. In total, 91% reached 6 month follow-up
the relative value to the muscular strength in the first measurement. and 88% reached 12 month follow-up. METHODS: This pragmatic,
ANALYSIS: One way ANOVA was used to compare muscle strengths multi-centre, randomized clinical trial randomly assigned participants
obtained by each measurement. Scheffe correction was applied. to enhanced pharmacy review (n=108), community physiotherapy
P < 0.05 was considered statistically significant. RESULTS: In the based on exercise (n=109), or a control (advice only) (n=108). The
exercise side, the mean ± SD of the ABD strengths were 83.7±8.3, primary outcome was change in the Western Ontario and McMaster
90.9±9.2, 93.2±11.0 and 98.6±10.5 immediately, one day, two days, Universities Osteoarthritis Index (WOMAC) pain scale (range 0 to 20)
and three days after the exercise, respectively. The Flex strengths and function scale (range 0 to 68) at 3, 6 and 12 months. Secondary
were 83.5±9.0, 92.2±10.5, 94.3±11.1 and 97.6±10.9. The ER outcomes included patients’ global assessment of change, the
strengths were 94.7±8.7, 97.4±8.7, 100.4±11.6 and 103.8±9.6. The internationally agreed Outcome Measures in Rheumatology Clinical
IR strengths were 93.1±9.9, 91.9±10.4, 94.3±11.4 and 98.2±8.5. Trials (OMERACT) clinical responder criteria, medication intake and
The ABD strengths were significantly decreased immediately, one further GP consultations over the follow-up period. ANALYSIS:
day, and two days after the exercise. The Flex and IR strengths Analysis was by intention to treat. RESULTS: Baseline WOMAC
were significantly decreased immediately, one day and two days pain scores (mean (sd)) were 9·1 (3·7) and function scores were
after the exercise. However, no change was observed in the ER 29·9 (12·8). At 3 months the mean reductions in pain scores were
strength of the exercise and all strengths in the non-exercise side. 0·41 (2·8) for control, 1·59 (3·2) for pharmacy and 1·56 (3·4) for
CONCLUSIONS: This study shows that significant loss of muscle physiotherapy, and for function were 1·02 (8·2); 2·61 (9·8) and 4·79
strength was caused by the repetitive exercise with light load. The (10·8). Compared with control, mean differences in change scores
shoulder abduction exercise decreased not only the ABD strength (95% CI) were: pain 1·15 (0·2, 2·1), function 3·77 (1·0, 6·6) for
but also the Flex and IR strength. The decreased muscle strengths physiotherapy; and pain 1·17 (0·3, 2·1), function 1·58 (−1·0, 4·2) for
were not fully recovered until three days after the exercise. In future pharmacy. At 3 months, there were significantly larger improvements
study, we need to investigate what interventions are more effective in pain (p = 0.014) and function (p = 0.008) for the physiotherapy
to fasten the recovery time from the fatigue. IMPLICATIONS: This group and in pain for the pharmacy group (p = 0.08), compared
result will enhance the knowledge of chronic injury prevention caused with control. More of the physiotherapy group (40%), compared with
by repetitive activities. KEYWORDS: Repetitive exercise, Shoulder the pharmacy (33%) and control groups (19%) were classified as
strength, Muscle fatigue. FUNDING ACKNOWLEDGEMENTS: This treatment responders at 3 months. Similar trends were observed at
study was not supported by any grant or commercial resource. 6 and 12 months but were not statistically significant. Significantly
CONTACT: [email protected] fewer participants in the physiotherapy group reported consulting
ETHICS COMMITTEE: The Ethics Committee of Hiroshima Univer- their GP for knee pain in the follow-up period and non-steriodal anti-
sity inflammatory usage was lower in the physiotherapy and pharmacy
groups. CONCLUSIONS: Evidence-based care for older adults with
knee pain by physiotherapists and pharmacists resulted in short-term
improvements in health outcomes, reduced medication use and high
patient satisfaction. IMPLICATIONS: Future studies need to test how
to improve long-term outcomes from both exercise-based physiother-
apy and pharmacy review. KEYWORDS: knee pain, osteoarthritis,
physiotherapy, pharmacy. FUNDING ACKNOWLEDGEMENTS: The
Arthritis Research Campaign, The National Co-ordinating Centre for
Research Capacity Development and the North Staffordshire Primary
Care Research Consortium, UK. CONTACT: [email protected]
ETHICS COMMITTEE: The North Staffordshire Research Ethics
Committee, UK
CHANGES IN LEVATOR ANI ANATOMICAL CONFIGURATION THE EFFECTS OF NON-PHARMACOLOGICAL INTERVENTIONS
AFTER PHYSIOTHERAPY IN STRESS URINARY INCONTINENT ON FATIGUE IN FOUR CHRONIC ILLNESS CONDITIONS: A
WOMEN: AN MRI STUDY CRITICAL REVIEW
Dumoulin C1 , Peng Q2 , Stødkilde-Jørgensen H3 , Shishido K4 , Smith C1 , Hale L234 ; 1 DipPT UK; 2 PhD; 3 MSc (physiotherapy);
4 BSc (physiotherapy)
Constantinou C2 ; 1 School of Rehabilitation, Faculty of Medicine,
University of Montreal; 2 Urology Depart, Stanford University School
PURPOSE: The purpose of this study was to identify and critically
of Medicine; 3 MR Research Centre, Institute of Clinical Medicine,
review studies which investigated the effectiveness of non pharmaco-
Arhus University; 4 Urology Depart, Fukushima Medical College
logical interventions used in physiotherapy practice to alleviate fatigue
PURPOSE: This study seeks to quantify the effect of pelvic floor in four chronic health conditions: multiple sclerosis (MS), Parkin-
muscle (PFM) training on the anatomical configuration of levator son’s disease (PD), cancer, and human immunovirus/autoimmune
ani using magnetic resonance imaging (MRI). RELEVANCE: PFM deficiency syndrome (HIV/AIDS) RELEVANCE: This review explores
training has proven to be effective in reducing stress urinary the evidence for the effects of non pharmacological interventions
incontinence and mixed urinary incontinence in women. However, on fatigue including aerobic and resistance exercise, energy
the underlying mechanism by which PFM training prevents urine management strategies and complementary and alternative thera-
leakage is not fully understood. PARTICIPANTS: Five women with pies. PARTICIPANTS: Not applicable METHODS: AMED, CINHAL,
urodynamically proven stress urinary incontinence participated in EMBASE, Ovid MEDLINE, PsycINFO and Cochrane database of
this study after giving informed consent. The participant’s mean systematic reviews were searched (1966 to 2006) using search
age was 45.8 + 9.47 years; the mean BMI was 26.67 + 3.53 terms: multiple sclerosis, cancer, Parkinson’s disease, HIV/AIDS,
and mean parity was 2.2 + 0.44 babies. METHODS: This is an fatigue, physiotherapy, physical therapy, aerobic, exercise, resistance,
institutional review board-approved, quasi-experimental pre-test/post- energy management, energy conservation, acupuncture, Tai Chi,
test design study, examining pre- and post-treatment MRI data. All complementary medicine, alternative medicine and yoga. Selection
image data were acquired with a General Electric SIGNA twin-speed, criteria included all study designs investigating effectiveness of
1.5 Tesla magnet. With subjects in the supine lying position, A PA interventions which are used (frequently or occasionally)in physio-
therapy practice, and which included a scale or subscale measuring
torso coil tuned for PFM imaging was centered at the symphysis
fatigue as an outcome measure ANALYSIS: Critical evaluation
pubis. A spoiled gradient sequence of T1-weighted images was
of each included study was conducted according to established
used with the following parameters: TR= 70 ms, TE min full,
critical appraisal guidelines. RESULTS: Twenty seven studies which
flip angle = 60º, field of view (FOV) 24 cm, slice thickness 3
fulfilled the selection criteria were included in the review: these
mm, 0.5 mm gap, matrix 256 x 256, NEX two, scan time 36 s.
studies investigated aerobic exercise, resistance exercise, energy
Eight axial images were acquired for two different conditions, at
management, acupuncture, Tai Chi and yoga.Of the twenty seven
rest and during a PFM voluntary contraction. Source images were
studies, there were 13 RCTs, 7 pilot studies, 3 pre/post test studies,
manually segmented and surface modeling was applied to build a
1 cohort, 1 case series, 1 case study, and 1 qualitative study. Analysis
3-dimensional model of the levator ani. Models were measured to
showed promising evidence for the effects of aerobic and resistance
determine the levator ani surface area and encircled volume at rest
exercise on fatigue in the cancer population; however, there was
and during a voluntary contraction in addition to the percentage
less evidence for exercise intervention in MS, PD and HIV/AIDS.
of levator ani retractions and bone movements during voluntary There was limited evidence for energy management of fatigue in
contractions prior to and after PFM training. ANALYSIS: Pre- and MS and cancer. There was little evidence found for the effects of
post-treatment mean values of the five parameters were compared complementary and alternative interventions on fatigue in all popu-
with paired t-tests to evaluate the changes. Two-sided P values lations, and no evidence for the effect of any non pharmacological
<0.05 were considered significant. All analyses were carried out intervention on fatigue in PD. CONCLUSIONS: The results of this
using SPSS for Windows (version 11.0) software. RESULTS: After study have highlighted a dearth of evidence for the effectiveness of
PFM training, the levator ani surface area at rest was significantly most non pharmacological interventions used for treatment of fatigue
smaller than before, decreasing from 144.45 + 9.60 mm2 to 132.37 in most of the conditions under review. IMPLICATIONS: Many of
+ 7.71 mm2 (P = 0.04). The relative reduction in volume encircled these interventions are frequently utilized by physiotherapists when
by the levator ani during contraction increased significantly, from treating individuals with chronic illness.The results from this study
−11.65 + 3.31 mm3 to −26.02 + 6.04 mm3 (P = 0.04). The percentage may inform the physiotherapy profession in several ways; by providing
of levator ani surface retraction during a voluntary contraction was an overview of current available evidence, to inform future clinical
significantly increased from 65.61% to 81.70% (P = 0.02). Pubic case reports, especially in those areas where no evidence is currently
movement during PFM contraction was significantly reduced, from available, and to clarify future direction for research therapists
1.45 + 0.59 mm to 0.44 + 0.27 mm (P = 0.05). CONCLUSIONS: when planning trials. KEYWORDS: Fatigue, illness, intervention, non
To our knowledge, this is the first study using MRI to describe pharmacological. FUNDING ACKNOWLEDGEMENTS: This review
changes in muscle morphology after PFM strength training. Evidence was conducted as part of the requirements for entry into a University
is provided to demonstrate that PFM training results in anatomical of Otago Physiotherapy Masters degree (by thesis). CONTACT:
changes of the levator ani and reduce pubic movement. These result [email protected]
give insight into the possible mechanisms trough which physiotherapy
enables the PFM to minimize urine leakage. IMPLICATIONS:
Although preliminary, this new information will contribute to a better
understanding of the PFM role in the treatment of urinary conti-
nence, ultimately aiding the development of improved PFM training
protocols. KEYWORDS: Magnetic Resonance Imaging, Pelvic floor,
Physiotherapy, Stress Urinary Incontinence, 3-dimensional modeling.
FUNDING ACKNOWLEDGEMENTS: C. Dumoulin was funded by a
post-doctoral award from the Fond de la Recherche en Santé du
Québec. CONTACT: [email protected]
ETHICS COMMITTEE: Institutional Review Board, Arhus University
BELIEFS REGARDING THE PATHOBIOLOGICAL BASIS OF ON CALL COMPETENCE – DEVELOPING A TOOL FOR SELF
PAIN INFLUENCE THE LEVEL OF PAIN DURING A CLINICAL ASSESSMENT
PROVOCATION TEST Thomas S1 , Broad M2 , Cross J3 , Gough S4 , Harden B5 , Ritson P6 ,
Coppieters M, Hodges P; Division of Physiotherapy, School of Quint M7 ; 1 University of the West of England, Bristol, UK; 2 Cardiff
Health and Rehabilitation Sciences, The University of Queensland, and Vale NHS trust, Cardiff, UK; 3 University of East Anglia,
St Lucia (Brisbane), Australia Norwich UK; 4 Manchester Metropolitan University, Manchester, UK;
5 Winchester and Eastleigh Health trust, Winchester, UK; 6 Royal
PURPOSE: This study investigated whether beliefs about the source Liverpool Childrens Hospital, Liverpool, UK; 7 Queen Alexandra
of symptoms, together with background knowledge of diagnostic Hospital, Cosham, UK
tests, influences pain perception during clinical tests. RELEVANCE:
With medical information on clinical tests and diagnoses widely PURPOSE: To develop and validate a self-evaluation tool (ques-
available to patients, clinicians are often confronted with patients tionnaire) to identify perceived competence and confidence felt
who have expectations about the outcomes of clinical tests and have by physiotherapists undertaking emergency duty. RELEVANCE:
Physiotherapists in the UK may be required to undertake Emergency
formulated their own diagnosis. The impact of this on pain provocation
Duty (On Call respiratory care) with little or no opportunity to
during clinical tests to diagnose musculoskeletal conditions is
work with patients with respiratory problems during their working
unclear. PARTICIPANTS: Fifteen asymptomatic and naive volunteers
week. This poses a challenge for therapists who need to maintain
participated in this study (9 females, 6 males; age, weight and height
and demonstrate their competence in this area. Emergency duty
(mean (SD)): 22 (6) years, 66 (12) kg, 172 (10) cm). METHODS:
guidelines (EDG) were published in 2002 and this self-evaluation
Experimental muscle pain was induced by infusion of hypertonic tool is being developed to help individuals identify specific learning
saline in the thenar muscles of the right hand. Pain intensity and needs based on these guidelines. The tool supports the reflective
size of the painful area were evaluated in 5 different arm positions approach to competence advocated by the Chartered Society of
with a different amount of nerve bed elongation. The arm positions Physiotherapy and could be used to provide evidence of continuing
corresponded with 5 stages of the neurodynamic test for the median professional development as required by the Health Professions
nerve. All participants received identical information regarding the Council. PARTICIPANTS: 180 Senior respiratory physiotherapists
biomechanics of the median nerve and the concept of differential attending ‘On course for on call’ conferences in Autumn 2005.
diagnosis via mechanical provocation of sensitised structures. Based METHODS: A questionnaire for rating self perceived competence
on additional information gathered from an information sheet, half of was developed from criteria in the Emergency duty guidelines (EDG).
the participants believed that infusion of hypertonic saline induced A triangulation approach was used to evaluate content validity.
local muscle pain (‘muscle group’) and half of the participants Respiratory experts completed the questionnaire and gave written
believed nerve pain was induced (‘nerve group’). Consequently, feedback and 15 particpated in semi-structured follow up telephone
participants in the ‘muscle group’ anticipated no changes in pain interviews. An initial pilot led to item refinement resulting in 12
with elongation or shortening of the nerve bedding in the five assessment, 10 treatment and 5 confidence items, and 10 additional
upper limb positions, whereas participants in the ‘nerve group’ range items addressing perceived competence in different situations.
anticipated changes in pain perception consistent with the amount Likert scales were used to rate each item. Ethical approval for the
of nerve bed elongation. The volunteers were randomly assigned study was obtained from Southmead Research Ethics committee.
to the ‘nerve’ and ‘muscle’ groups. ANALYSIS: Pain intensity and ANALYSIS: Descriptive statistics were compiled for each item.
size of the painful area were compared with a two-way analysis Internal consistency was analysed using Cronbach’s alpha. Total
of variance, with one group factor and one repeated-measures competence scores for each section were calculated. Themes were
factor. The level of significance was set at p < 0.05. RESULTS: derived from open questions and interviews (analysed separately
Although the induced pain was of muscular origin in all participants, by two reviewers) using content analysis. RESULTS: There were
participants in the ‘muscle’ and ‘nerve group’ responded differently 143 responses (74% response rate) Over 90% of participants
to changes in the length of the nerve bed (p < 0.00001). Participants either ‘agreed’ or ‘strongly agreed’ (that they were competent)
in the ‘muscle group’ demonstrated no change in pain perception for all assessment and treatment items.The mean competence
with the test (p 0.38), whereas pain varied significantly in the score was 91% (median 93.8%). Cronbach’s alpha demonstrated
‘nerve group’ (p 0.001). The increase and decrease in pain in the strong internal consistency between items .965 (assessment)
.976 (treatment) .925 (range) and .909 (confidence). Participants
‘nerve group’ corresponded with an increased and decreased loading
supported the competencies but requested additional items and
of the nervous system. CONCLUSIONS: Previous research has
clearer instructions. The importance of current, regular clinical
demonstrated that, when participants are not aware of the origin of
experience in determining competence was highlighted. Experience,
the induced pain, experimental muscle pain does not change during
self-confidence, and attitude to on-call may affect competence rating,
the neurodynamic test for the median nerve, slump test or straight leg
and therefore the reliance on self-evaluation to assess competence
raising test. Findings of this experiment suggest that the perception was questioned. CONCLUSIONS: Respiratory experts supported
of pain during a clinical provocation test is not only influenced by the development of this tool to help therapists identify their on-
the pathobiological processes in operation, but also by the patient’s call learning needs and facilitate transferability between trusts.
beliefs and expectations. IMPLICATIONS: The findings demonstrate Content validity of scale items was demonstrated through the
that a patient’s beliefs regarding the pathobiological process consistency of responses from senior respiratory clinicians. Further
in operation should be considered when interpreting subjective research is needed to assess repeatability prior to undertaking
responses during clinical tests. It also suggests that misjudgements a national survey. The tool is now ready for use to support
by a patient about his or her condition may hinder accurate diagnosis. reflective practice but further work is needed before recommended
KEYWORDS: Diagnosis; patient’s beliefs, clinical test. FUNDING competence scores can be agreed for summative assessment
ACKNOWLEDGEMENTS: PH is supported by the National Health purpopses. IMPLICATIONS: A national tool is now available for
and Medical Research Council of Australia (NHMRC). CONTACT: therapists to identify their learning needs and support their reflective
[email protected] practice.The items were written for those working mainly with adult
ETHICS COMMITTEE: Medical Research Ethics Committee, The patients and may need adapting for paediatric physiotherapists. The
University of Queensland tool is based on core respiratory competencies and could potentially
be adapted for use with students or staff working in respiratory Research Report Platform Presentation
care. KEYWORDS: Competence, Self-assessment, Emergency 2634 Monday 4 June 11:05
duty physiotherapy. FUNDING ACKNOWLEDGEMENTS: Unfunded. PP Crystal Pavilion B & C
CONTACT: [email protected] NEURAL COORDINATION BETWEEN ANTAGONIST MUSCLES
ETHICS COMMITTEE: Southmead Research Ethics Committee AND THE POSSIBLE CLINICAL IMPLICATIONS
Mattos E, Kohn A; University of São Paulo, IPUSP, Neuroscience
Program
PURPOSE: The motor control of human movements is coordinated
Research Report Platform Presentation by many different neural structures. One of them is the control that
2403 Monday 4 June 11:05 happens in the spinal cord by means of inhibitions and facilitations
PP Crystal Pavilion A between antagonist or synergist muscles. The main pathways
THE EFFECT OF FOOT FUNCTIONS ON BALANCE AND GAIT involved are associated with presynaptic inhibition and reciprocal
IN OLDER PEOPLE inhibition. These may be verified non-invasively in the soleus and
tibialis anterior by conditioning the H reflex with stimulation to a nerve
Ersoy A, Can F to the antagonist muscle (activating Ia fibers). It is also possible to
verify these inhibitions during movements and comprehend better
PURPOSE: Foot problems are commonly seen in older people and the associated motor control. RELEVANCE: A good knowledge of
may lead to foot dysfunction. Foot in a neutral position has been these spinal controls can give more comprehension about different
clinically observed to facilitate ambulation and prevent disability. Gait injuries, as tendonitis, as it could make possible the creation
abnormalities and falls might be resulted from foot problems and of different exercises for therapy. PARTICIPANTS: 16 subjects.
dysfunctions. The aim of this study to investigate the influence of METHODS: The soleus H reflex was obtained by stimulation of
foot functions on balance and gait abnormality which is causative the tibial nerve in the fossa poplitea, and it was conditioned by a
factor for falling in older people. RELEVANCE: The risk factors stimulus to the common fibular nerve in subjects at rest and during
for falling in older people are loss of posture and balance, gait dorsiflexion and plantarflexion. The conditioning stimulus preceded
abnormalities and foot problems. Prevention of falls could be provided the test stimulus by either 15 or 100ms. These differences in the
by restoring balance and gait, and also improving foot functions. time intervals determine which pathway will be evaluated. All the
Detailed evaluation of foot functions which could be correlated with subjects stayed seated with the right foot fixed onto a pedal with
balance and gait must be important for older people. Improving foot a torque meter, and they realized 20% of the maximum voluntary
functions could be an effective prosedure to enhance balance and contraction, with visual feedback. ANALYSIS: The amplitudes of
gait parameters in geriatric rehabilitation. PARTICIPANTS: A total the H reflexes were used to compute the percent of inhibition
of 60 older people (35 females and 25 males) living in Nursing for each pathway, with 15 and 100ms between the stimuli. The
home included in the study. Their mean age was 77.07±6.83 obtained values were compared with one-way ANOVA, using the
ranged between 65-93 years. The subjects who have severe Tukey post-test to compare the three conditions: at rest and during
neurological deficits or ortopaedic and rhematological diseases, the two contractions. RESULTS: The medium latency conditioning
ortopaedic surgery, loss of vision, major foot deformities can cause (15ms) of the H reflex caused similar levels of inhibition in the
limping or disability were excluded of the study. METHODS: Minor resting state (32.73% ±4.18) and during dorsiflexion (31.92% ±5.96),
foot problems such as pes cavus, pes planus, plantar keratosis this difference being not significant (p = 0.84). During plantarflexion
the inhibition was 15.09% (±2.34) while at rest it was 30.01%
were recorded by inspection. Foot deformity Scale and Maryland
(±5.56). This 50% decrease in inhibition was statistically significant
Foot Scoring Scale were used for assesing foot problems and foot
(p < 0.05). The long latency conditioning caused (five subjects) at
functions. Balance and gait were measured using Berg’s Balance
rest 20.22% ±3.83 of inhibition and in dorsiflexion it caused 34.43%
Scale and Gait Abnormality Scale. ANALYSIS: All the datas were
±7.90. This 70.31% increase in inhibition during dorsiflexion was
analized using SPSS for Windows Release 11.5 packed program.
statistically significant (p < 0.05). During plantarflexion the mean level
Pearson’s Correlation Coefficient Test was used to find out the of inhibition was 53.26% (±5.29) while at rest it was 77.63% (±5.50)
relationships between the parameters. The significance level was (p < 0.005). CONCLUSIONS: Neural circuits of the spinal cord are
set at p < 0.05 and p > 0.01. RESULTS: Their foot deformity scale modulated during muscle activation by descending pathways and
was 4.97±2.95 points (1-11 points). 83.3% of hallux valgus, 25% of by afferent inputs from muscle receptors. IMPLICATIONS: These
painful heel, 97% of plantar keratosis and 76.7% of one toe deformity neurophysiological findings are useful for a better understanding
were observed. Their mean foot function score was 85.52±8.9 of mechanisms behind normal and pathologic motor behaviors.
according to Maryland Foot Scale. Their Gait Abnormality Scale More refined therapeutic approaches may rely on such knowledge
was 14.43±6.31 points (between 4 to 28 point). There was a high and provide treatment for different neurological and orthopedic
correlation between foot problems and foot functions (r: −0.496, diseases. KEYWORDS: H reflex, neural inhibition, motor control.
p < 0.01). Foot function was highly correlated with gait abnormality FUNDING ACKNOWLEDGEMENTS: CNPq and Capes. CONTACT:
(r: −0.424, p < 0.01), while there was a positive relationship between [email protected]
foot function and balance (r: 0.317, p < 0.05). CONCLUSIONS: It ETHICS COMMITTEE: Ethics Committee from Psicology Institute of
has been concluded that balance and gait can be influenced by Univesity of São Paulo
foot problems and foot functions. As foot functions improve, balance
and gait parameters could be more stable and get into normal Research Report Platform Presentation
limits in older people. If causative factors like foot problems for 1330 Monday 4 June 11:05
fall could be improved or treated, prevention of fall, gait training VCEC Meeting Rooms 11-12
and effectiviness of rehabilitation may be higher in older people.
EFFECTS OF A PHYSIOTHERAPY PROGRAM ON
IMPLICATIONS: In geriatric rehabilitation, the physical therapist
SYMPTOMS AND FUNCTION IN INDIVIDUALS WITH SEVERE
must be taken account the detailed assesment and treatment of
OSTEOARTHRITIS OF THE KNEE JOINT
foot problems and foot functions before balance and gait training
of older people. KEYWORDS: Balance, Gait, Older People, Foot, McNair P, Simmonds M, Collier J; Physical Rehabilitation Research
Berg’s Balance Scale. FUNDING ACKNOWLEDGEMENTS: None. Centre, AUT University
CONTACT: fi[email protected] PURPOSE: To investigate the effects of a six week physiotherapy
ETHICS COMMITTEE: Hacettepe University Ethics Commitiee program on pain, impairments and function in individuals with
osteoarthritis of the knee joint. RELEVANCE: With a growing June 1, 2006 who experienced no complications during pregnancy or
elderly population, osteoarthritis is becoming an increasing burden childbirth participated in this study. Participants were recruited from
upon health care resources. Limited attention has been given to one hospital in Québec in 2006 with medical charts in the obstetrics
programs that might improve symptoms and function in individuals department. METHODS: A case-control study was conducted. The
with severe osteoarthritis of the knee joint. PARTICIPANTS: Subjects Knowles-Eccersley-Scott Symptom score, sent by mail after delivery,
(N=47, mean age 72 years) who were scheduled to have a total made it possible to identify participants with dyssynergic defecation.
knee joint replacement within six weeks were randomly assigned A review of the medical/obstetric charts revealed the degree of
to physiotherapy and “normal care” groups. METHODS: A single perineal tear as well as other risk factors, such as the mother’s age,
blinded randomized trial design was implemented. Subjects in the gestational age, length of the second stage of labour, use of forceps,
physiotherapy group attended a program three times per week for vacuum extraction, episiotomy, anaesthesia, and newborn’s weight.
six weeks. Each session involved a combination of land and water ANALYSIS: Univariated and multiple logistic regressions were used
based exercises, and included a circuit type design that incorporated for analysis with odds ratio as the association measure. RESULTS:
strengthening, walking and stepping activities. The program was 55 primiparas had a severe perineal-muscle tearing and 262
progressed each week according to performance and symptoms. primiparas had tearing equal to or less than a second-degree tear. 88
Subjects in the “normal care” group received a standardized home participants (28.1%) had constipation and 31 were of the dyssynergic
program. This program was typically prescribed for patients in the six type (9.8%). Of the women with dyssynergic defecation, 10 had
weeks prior to total knee joint replacement. It involved instructions severe perineal tearing. The presence of dyssynergic defecation
concerning exercises that would be beneficial for improving strength triples the risk of a third- or fourth-degree perineal tear (OR: 3.44;
and function. Both groups provided information concerning their 95% CI: 1.29–9.15), median episiotomy doubles it (OR: 2.62; 95% CI:
activity levels during the time of the study. The following variables 1.30–5.30), the use of forceps triples it (OR: 3.61; 95% CI: 1.76–
were examined prior to and after the interventions: quadriceps 7.37) and the newborn’s weight increases it by a factor of 1.50 for
and hamstring muscle strength during a maximal effort isometric each 250 g (OR: 1.50; 95% CI: 1.21–1.86). Pelvic-floor training is a
contraction at 90 degrees of knee flexion, a 6 RM for a dynamic protective factor, reducing the risk of perineal tear by half (OR: 0.46;
leg press exercise; walking performance (timed 10 meter walk and 95% CI: 0.21–0.98). CONCLUSIONS: This exploratory study led to
ascending and descending stairs); pain, stiffness and perceived the hypothesis that the presence of dyssynergic defecation increases
ability to undertake activities of daily living as measured using the the risk of severe perineal tearing. Indeed, it would be important
subsections of the WOMAC Knee and Hip Osteoarthritis Index. to conduct a prospective study with the objective of evaluating the
ANALYSIS: To compare the groups across time, a 2-factor (groups relationship between lack of pelvic-floor muscle coordination with
and time) repeated measures ANOVA was utilised. The alpha level dyssynergic defecation and severe perineal tearing. IMPLICATIONS:
was set at 0.05. RESULTS: The findings showed that muscle strength This study has helped identify a modifiable factor (dyssynergic
was significantly improved (p < 0.05) in the quadriceps muscles of the defecation) in the prevention of severe perineal tearing. In particular,
physiotherapy group only. Furthermore, in this group only, walking physical therapists may develop a specific pelvic-floor exercise
performance was also significantly increased (p < 0.05), as was program for the treatment of dyssynergic defecation and help prevent
perceived ability to undertake activities of daily living (p < 0.05). No discomfort due to urinary incontinence after delivery. KEYWORDS:
significant improvements (p > 0.05) were noted in hamstring muscle’s Severe perineal tear, Dyssynergic defecation, Urinary incontinence.
strength, knee joint pain or stiffness in either group. CONCLUSIONS: FUNDING ACKNOWLEDGEMENTS: This work was funded by the
These findings provide support for a short term physiotherapy Centre de Recherche sur le vieillissement de Sherbrooke.
program in the treatment of severe osteoarthritis of the knee joint. ETHICS COMMITTEE: The ethics committee on human research in
IMPLICATIONS: The findings indicate that even when individuals the Centre Hospitalier Universitaire de Sherbrooke
have severe osteoarthritis of the knee joint, there is potential
for improving strength in quadriceps muscles and also function.
KEYWORDS: Knee,osteoarthritis, exercise, rehabilitation. FUNDING Research Report Platform Presentation
ACKNOWLEDGEMENTS: Arthritis New Zealand; New Zealand 1877 Monday 4 June 11:05
Society of Physiotherapists. CONTACT: [email protected] VCEC Meeting Room 17
ETHICS COMMITTEE: This work was approved by the Northern RESPONSE TO EXERCISE IN PEOPLE WITH BOTH DIABETES
Regional Ethics Committee, Auckland, New Zealand. AND STROKE
Kluding P, Tseng B; University of Kansas Medical Center, Kansas
Research Report Platform Presentation City, KS, US
1479 Monday 4 June 11:05 PURPOSE: This pilot project sought to examine the influence of
VCEC Meeting Room 16 Type 2 diabetes mellitus in people with chronic stroke. We compared
EFFECT OF PELVIC FLOOR MUSCLE DYSSYNERGIA, MET IN body mass index (BMI), measures of function, cardiorespiratory
DYSSYNERGIC DEFECATION, ON SEVERE PERINEAL TEAR fitness, and muscle strength between people with both stroke and
DURING DELIVERY diabetes (SD) and subjects with stroke alone (SA) at baseline and
following an exercise program. RELEVANCE: Diabetes is known to
Marchand M1 , Corriveau H1 , Watier A2 ; 1 University of Sherbrooke;
2 Centre Hospitalier Universitaire de Sherbrooke be a contributing factor to the cause of stroke, but the influence of
diabetes on function after stroke has not been specifically examined.
PURPOSE: The study’s objective was to determine if dyssynergic Although it is generally accepted that physical exercise is beneficial
defecation was associated with an increased risk of third- and fourth- for people who have had a stroke, the presence of diabetes and
degree perineal tear during a first vaginal delivery. RELEVANCE: diabetic complications may limit an individual’s tolerance for exercise
Perineal tearing often occurs during the second stage of labour. and their ability to benefit fully from it. PARTICIPANTS: Ten subjects
These muscular lesions cause some discomfort after childbirth, such (4 SD, 6 SA) have enrolled in this project to date, with a mean age
as urinary incontinence, which is a symptom treated with a perineal of 62.9±8.7 years and mean time since stroke of 53.3±34.7 months.
approach by a physical therapist. Many risks factors are associated Two subjects dropped out during the intervention phase (1 SD, 1
with perineal tearing. Nevertheless, some studies have suggested SA) and 2 subjects have not yet completed the intervention, so only
that lack of coordination of the pelvic floor, present in dyssynergic baseline data are presented for these 4 subjects. METHODS: All
defecation, could be present during the second stage of labour and subjects participated in a supervised program of aerobic and lower
cause perineal tearing. PARTICIPANTS: 317 primiparas (27.72±4.15 extremity muscle strengthening exercise three times each week for
years of age) with a vaginal delivery between May 1, 2005 and 12 weeks. The intensity of aerobic exercise was determined by a
graded maximal exercise test and progressively increased. Outcome temperatures were presented (45ºC and 46ºC, 46ºC and 47ºC, 47ºC
measurements include BMI, functional measures (Stroke Impact and 48ºC). Participants were required to determine the higher of
Scale (SIS), Fugl-meyer, gait velocity), cardiorespiratory fitness the paired temperature using a 6 category confidence rating scale.
(VO2peak, MET level, and duration of exercise test), and muscle ANALYSIS: The sensitivity (da, perceptual accuracy at the task)
strength (measured with a hand-held isometric dynamometer). and response bias (ca, tendency to choose a particular rating) of
ANALYSIS: An independent t-test was used to examine differences the participants were calculated (Macmillan and Creelman, 2005).
in baseline measurements between the SD and SA groups. A paired One way repeated ANOVA with Group (CP vs. PF) as a between-
t-test was used to compare measurements before and after the subject factor was performed on the sensitivity and response bias
exercise program in the 6 subjects who completed the intervention. data. RESULTS: CP were better at discriminating between the paired
Significance level was set at 0.05. RESULTS: At baseline, a noxious temperatures than the PF as noted by their higher sensitivity
significant difference between the groups was found for percent scores (p = .027). There were no significant differences between the
recovery on the SIS (37.5% for SD, 65.83% for SA, p = 0.021). participant’s ability to discriminate for the higher temperatures pairs
The SD subjects also had higher BMI, decreased function (SIS as opposed to the lower temperature pairs (p = .311). No significant
score, Fugl-Meyer), decreased VO2peak, and decreased strength interaction effects between Group and the temperature pair (p = .642).
of all extremities compared to the SA subjects, although none of CP held the same decision criteria compared to PF when asked
these differences were significant. For the 6 subjects who completed to choose the scale ratings (p = .24). CONCLUSIONS: Interestingly,
the intervention (3 SD, 3 SA), significant improvements were found the CP group was better at discriminating noxious thermal stimuli
in VO2peak (11.8 vs 14.5 ml/kg/m, p = 0.046), MET level (3.4 vs than PF. The response biases of both groups were similar. This
4.2, p = 0.41), and duration of test (9.1 vs 12.9 minutes, p = 0.037). finding suggests that the perceptual accuracy of CP, compared to
CONCLUSIONS: Subjects with both stroke and diabetes rated their PF, in performing thermal discriminatory tasks may be enhanced.
level of recovery from stroke lower than subjects with stroke alone, There is a current lack of models explaining this phenomenon and
and demonstrated generally lower levels of function. Following the the relationship between pain threshold and noxious discrimination
intervention, significant improvements in cardiorespiratory fitness ability. However, central sensitisation of the nervous system is
were noted even in this small sample. We have identified feasibility a potential explanatory model. IMPLICATIONS: Elucidating the
issues related to recruitment and a 20% drop out rate that will processes underlying chronic pain may guide healthcare profes-
need to be addressed in future studies. IMPLICATIONS: This sionals in focusing their treatment and rehabilitation strategies
preliminary work indicates a need for future study with a greater (physical, psychological or cognitive). KEYWORDS: Chronic, pain,
number of subjects to determine if there is a difference in outcome psychophysics. FUNDING ACKNOWLEDGEMENTS: This study was
between the two groups. The mechanism behind these hypothesized funded by the Queen Margaret University College PhD studentship
differences will be explored in the future. KEYWORDS: diabetes, programme. CONTACT: [email protected]
stroke, exercise. FUNDING ACKNOWLEDGEMENTS: This work was ETHICS COMMITTEE: Queen Margaret University College Ethics
supported by a Mary Switzer Fellowship award from the National Committee; Lothian Research Ethics Committee (National Health
Institute of Disability and Rehabilitation Research through the US Service, Edinburgh)
Department of Education. CONTACT: [email protected]
ETHICS COMMITTEE: Human Subjects Committee of the University
of Kansas Medical Center
EXPERIENCES OF CAREGIVERS TO PATIENTS WITH
1811 Monday 4 June 11:05 AMYOTROPHIC LATERAL SCLEROSIS REGARDING
VCEC Meeting Room 18 NON-INVASIVE POSITIVE PRESSURE HOME VENTILATION
NOXIOUS HEAT DISCRIMINATION ABILITY IN PERSONS WITH Sundling I1 , Ekman S2 , Weinberg J3 , Klefbeck B4,5 ; 1 Stockholms
CHRONIC PAIN: A PSYCHOPHYSICAL STUDY Sodra Geriatriska Klinik, Sjukgymnastikenheten, Stockholm,
Tan C1 , Roche P1 , Martin D2 , Palmer S3 ; 1 Queen Margaret Sweden; 2 Division of Gerontological Caring Science, Department
University College, School of Health Sciences, Edinburgh, United of Neurobiology, Health Care Sciences and Society, Karolinska
Kingdom; 2 Sheffield Hallam University, Centre for Health & Social Institutet, Stockholm, Sweden; 3 Department of Clinical
Care, Sheffield, United Kingdom; 3 University of the West of Neuroscience, Karolinska University Hospital, Huddinge, Sweden;
England, Faculty of Health & Social Care, United Kingdom 4 Division of Physiotherapy, Department of Neurobiology, Health
Care Sciences and Society, Karolinska Institutet, Stockholm,

PURPOSE: To compare the noxious thermal discriminative ability
Sweden; 5 Department of Physical Therapy, Karolinska University
and decision-making bias of persons with chronic pain to pain-
Hospital, Huddinge, Sweden
free individuals. RELEVANCE: Studies have indicated that persons
with chronic pain (CP) demonstrated higher experimental pain PURPOSE: The purpose of this study was to investigate the
thresholds (pressure and thermal) compared to pain-free individuals experiences of caregivers to patients with Amyotrophic Lateral
(PF). However it has not been clearly established the extent to Sclerosis (ALS), regarding non-invasive positive-pressure ventilation
which physiological and cognitive-decisional influences contribute (NPPV) at home. RELEVANCE: Although strong evidence underlines
to the elevated pain threshold. This information is important for the importance of treating sleep disordered breathing to improve
understanding the effect of chronic pain on behavioural responses quality of life for patients with ALS, most patients underutilize
and the underlying neurophysiological processes of chronic pain. treatment. Research on quality of life during end-of-life care is sparse
In particular, secondary hyperalgesia which is a consequence of and interviews with caregivers may be the only source of information
central sensitisation. PARTICIPANTS: Thirty-three persons with when patients cannot be interviewed. Little is known about the impact
chronic low back pain and twenty-nine pain-free individuals took on the caregiver’s life when a family member is provided with non-
part. They were recruited from an outpatient physiotherapy clinic invasive positive-pressure home ventilation and no study using a
and community centres. The mean age for CP was 54.7 (S.D. = qualitative approach on the experiences of caregivers to patients
13.9) years and PF was 57.8 (S.D. = 16.7) years. The average with ALS on home ventilation was found. PARTICIPANTS: Eight
length of low back pain experienced was 15.1 (S.D. = 10.3) caregivers to patients with ALS were selected for their ability to
years. METHODS: Noxious thermal stimuli were administered to provide information for the study. The caregivers were 40-74 years
the participant’s dominant forearm using a Peltier thermode with a of age. All were spouses to patients with ALS, living at home.
surface area of 25 mm × 50 mm (Somedic AB). Three blocks of paired The patients had been on non-invasive ventilation at home for a
period of 3-15 months using the ventilator daily for 2 hours up at the effects of usual footwear on the balance of frail patients
to 24 hours. METHODS: The research interviews were conducted attending a day hospital and identifies that there is a significant
as conversation about the home ventilation. Each interview started benefit. Further studies should investigate whether particular types
with the open-ended question: Please tell me in what way your of footwear are associated with greater benefit. IMPLICATIONS:
spouse benefits from the home ventilation? Follow up questions An increased understanding of the effect of usual footwear and
were asked to encourage informants to explain or deepen their slippers on balance will allow physiotherapists to advise regarding
stories. Interviews were taped and transcribed in full. ANALYSIS: safe footwear and falls prevention. KEYWORDS: footwear, balance,
The text was analysed for major content themes using a qualitative falls. FUNDING ACKNOWLEDGEMENTS: RCSI Summer student
content analysis method and coded in meaning units in light of the grant (2005). CONTACT: fi[email protected]
purpose of the study. RESULTS: Content emerged that referred to ETHICS COMMITTEE: Beaumont Hospital Ethics (Medical Re-
the three main themes “Getting to know the ventilator”, “Embracing search) Committee.
the ventilator” and “Being on the ventilator on a 20-24hour basis”.
Sub-themes describing the impact on caregiver’s lives, positive and
negative, as well as noted benefits from the use of the ventilator with
the patients are presented. CONCLUSIONS: The results show the 3072 Monday 4 June 11:25
caregiver’s need for active support from a multi-professional team PP Crystal Pavilion B & C
and suggest that the caregiver’s experiences be included in the INVESTIGATION OF CHANGES IN OXYGENATION OF HUMAN
technical development of NPPV equipment. The results also show QUADRICEPS FEMORIS DURING ISCHAEMIA AND FATIGUING
the caregiver’s ability to provide information on how NPPV affects MUSCLE CONTRACTIONS
the quality of life of patient’s with ALS. IMPLICATIONS: This new
Mead D, Culpan J, Cramp M; University of East London, London, UK
information provides the physiotherapist with the knowledge of how
to take an active role in supporting both caregivers and patients. PURPOSE: Near infrared spectroscopy (NIRS) provides a non
It enables the physiotherapist to be “a step ahead” when periods invasive method of analysing muscle metabolism and response to
of more active support will occur. Further studies are suggested to stress in human muscle, normally under ischaemic conditions. This
focus on caregiver’s to patients with ALS need for support during study examines the feasibility of using NIRS during muscle fatigue
the ventilator period and also on how a multi-professional team as a basis to explore tissue oxygenation and muscle performance in
can meet the caregiver’s changing need for support throughout the those with metabolic problems. RELEVANCE: Metabolic problems,
ventilator period. KEYWORDS: Caregivers, Non-invasive ventilation, such as diabetes, are associated with obesity and increased risk
Qualitative content analysis. FUNDING ACKNOWLEDGEMENTS: of significant cardiovascular diseases. Their impact on muscle
The Swedish Association of Persons with Neurological Disabilities performance is an important consideration in the implementation of
provided funding for the study. CONTACT: [email protected] rehabilitation programmes. PARTICIPANTS: A convenient sample of
ETHICS COMMITTEE: The Ethics Committee at Huddinge University 10 healthy adults (5M, 5F) mean age 36 (SD 7) years with no known
Hospital, Stockholm, Sweden metabolic, neurological or musculoskeletal diseases. METHODS:
In this ethically approved study, subjects were seated in isometric
torque chair and NIRS optodes (NIRO-200, Hamamatsu Photonics
Research Report Platform Presentation Deutschland GMBH) were placed over both quadriceps femoris
2643 Monday 4 June 11:25 muscles. Responses of the right limb to (A) proximal limb occlusion
PP Crystal Pavilion A with a thigh cuff pressure of 100 mmHg greater than systolic
SHOE CHARACTERISTICS AND POSTURAL STABILITY IN pressure for 15 minutes, (B) percutaneous stimulation at 40Hz
OLDER WOMEN ATTENDING A GERIATRIC DAY HOSPITAL for 250 ms every second for 3 minutes (modified Burke fatigue
protocol) and (C) proximal limb occlusion for 5 minutes applied
Crehan F1 , Curran M2 , Barrett E3 , Moore A, Donegan C, Horgan F;
1 Royal College of Surgeons in Ireland, Dublin, Ireland; 2 Dept immediately after muscle fatigue were recorded. Anthropometric
details including skinfold thickness were also recorded. ANALYSIS:
of Physiotherapy, Beaumont Hospital, Dublin, Ireland; 3 Dept of
Preliminary analysis of changes in oxyhaemoglobin (DO2Hb) and
Medicine for the Elderly, Beaumont Hospital, Dublin, Ireland
deoxyhaemoglobin (DHHb) during the first 3 minutes of each
PURPOSE: This study examined the effects of footwear on balance condition has been conducted. Repeated measures ANOVA was
in a sample of older women attending a day hospital. RELEVANCE: performed to determine possible significant differences between
The causes of falls in older people are multi-factorial and include conditions A, B, and C and post-hoc t-tests were conducted as
intrinsic factors and environmental hazards such as unsafe footwear. appropriate. The relationship with anthropometric characteristics was
Footwear is a potentially modifiable factor but has been little also examined using Pearson’s correlation coefficients. Statistical
studied to date. PARTICIPANTS: 100 elderly females attending a significance was defined as p < 0.05. Mean ± SEM are reported.
geriatric day hospital took part. Inclusion criteria included being RESULTS: As expected, measures DO2Hb and DHHb were related
over 60 years of age, having an AMTS of 6 or over- being to skin fold thickness (r = −0.677 to −0.783, p < 0.05). For conditions
able to understand simple instructions and being able to stand A, B and C, absolute values for DO2Hb were 133±50 mM, 194±67 mM
independently. METHODS: Demographic data and a brief falls and 214±60 mM respectively and for DHHb were 158±40 mM,
history were recorded. Participant’s footwear was assessed using 260±39 mM and 154±65 mM respectively. Significant differences were
a Footwear Assessment Form. A Berg Balance Score (BBS) was observed in DO2Hb (ANOVA: F2 = 8.975, p < 0.01) and DHHb
completed under two conditions-shoes on and shoes off. Ethical (ANOVA: F2 = 7.448, p < 0.05). Post hoc analysis confirmed that
approval was granted by the hospital Research Ethics Committee. change in DO2Hb levels was significantly less in condition A (p < 0.05)
ANALYSIS: Repeated measures ANOVA for shoe effect and linear whereas change in DHHb levels was significantly greater during
regression for baseline predictors of shoe effect were applied. condition B (p < 0.05). CONCLUSIONS: Differences in the response
RESULTS: Participants’ mean age was 82 years (s.d. 6.5) with a of DO2Hb and DHHb during ischaemia in a fresh and fatigued
mean Abbreviated Mental Test Score of 8.2 (s.d. 1.9). 51% were living state and during fatiguing muscle contraction support the feasibility
alone and 80% had a history of falls. The mean BBS was 39.07 (s.d. of the procedure but unresolved issues include the effectiveness
9.14) with shoes on and 36.54 (s.d. 10.39) with shoes off (p < 0.0001). of lower limb occlusion and potential localised volume changes
Wearing their own footwear significantly improved a participant’s in the lower limb distal to the cuff. The negative correlation
balance compared to being barefoot. The greatest benefit of footwear between skinfold thickness and measures of DO2Hb and DHHb
was seen in participants who were independently mobile with the suggests that skinfold thickness may account for the large observed
poorest balance. CONCLUSIONS: This is the first study to look variability. IMPLICATIONS: Further investigation is required before
application to a population with metabolic problems. KEYWORDS: Randomised placebo controlled studies are currently in progress
Muscle fatigue, Tissue oxygenation, Metabolic diseases. FUNDING to investigate the efficacy of this intervention. IMPLICATIONS: In
ACKNOWLEDGEMENTS: The Wellcome Trust Vacation Scholarship cases of persistent anterior knee pain unresponsive to rehabilitation,
Scheme. CONTACT: [email protected] a single injection of BTXA into the distal third of the Vastus
ETHICS COMMITTEE: School of Health and Bioscience Research Lateralis muscle may confer a temporal opportunity to restore
Ethics Committee, University of East London knee extensor balance and clinically meaningful sustained functional
improvement. KEYWORDS: Botulinum toxin Type-A; Patellofemoral
pain; Rehabilitation. FUNDING ACKNOWLEDGEMENTS: Product
[Dysport® ] was provided to Royal Perth Hospital by IPSEN P/L
1570 Monday 4 June 11:25 Australia. CONTACT: [email protected]
VCEC Meeting Rooms 11-12 ETHICS COMMITTEE: Royal Perth Hospital Ethics C’tee
A NEW APPROACH TO ANTERIOR KNEE PAIN: BOTULINUM
TOXIN TYPE-A INJECTION OF VASTUS LATERALIS TO
RESTORE KNEE EXTENSOR BALANCE Research Report Platform Presentation
Singer K1 , Singer B1 , Silbert P2 , Song S3 ; 1 Centre for 1598 Monday 4 June 11:25
Musculoskeletal Studies, University of Western Australia, Perth, VCEC Meeting Room 16
Australia; 2 Department of Neurology, Royal Perth Hospital, Perth, WHICH WOMEN DO PELVIC FLOOR MUSCLE EXERCISES SIX
Australia; 3 Department of Radiology, Royal Perth Hospital, Perth, MONTHS POSTPARTUM?
Australia
Bø K1 , Owe K1 , Nystad W2 ; 1 Norwegian School of Sport Sciences,
PURPOSE: Persistent anterior knee pain [AKP] is a prevalent Department of Sports Medicine; 2 Norwegian Institute of Public
musculoskeletal disorder, frequently presenting in women, and may Health, Division of Epidemiology
be associated with considerable morbidity and reduced quality of
life. Many interventions for AKP have been investigated, including: PURPOSE: In 1947 Kegel advocated pelvic floor muscle training
taping, biofeedback, muscle stimulation, foot orthoses and specific (PFMT) after childbirth to prevent and treat urinary and fecal
stregthening regimes, often without universal success. Botulinum incontinence and sexual dysfuntion. Todate randomized controlled
toxin Type-A [BTXA] has proven successful in situations where trials have demonstrated that such exercises are effective. However,
moderation of muscle over-activity is indicated. BTXA provides a there is scant knowledge about how many and which women are
localised transient denervation of muscle confering a dose-related doing the exercises. The aim of this study was to estimate the
opportunity to improve function and control of local muscle systems. association between PFMT and several demographic and health
The role of BTXA in cases of chronic AKP has not been established. related factors that may influence PFMT 6 months postpartum.
RELEVANCE: The aim of this original study was to investigate RELEVANCE: Knowledge about which women are performing PFMT
whether selective weakening of the distal third of vastus lateralis may help targeting the health services for postpartum women.
[VL] muscle following BTXA [Dysport® ] intramuscular injection, in PARTICIPANTS: This analyses include the first 17978 women
conjunction with an exercise programme to strengthen the knee enrolled in the Norwegian Mother and Child Cohort Study (Moba)
extensor system, would confer sustained functional improvements who answered questions about PFMT (N= 17744). METHODS:
in subjects with chronic AKP dysfunction. PARTICIPANTS: Eight Pregnant women are recruited to the study through a postal invitation
female subjects were referred into this open-label trial by orthopaedic after they have signed up for the routine ultrasound examination in
surgeons, sports medicine physicians or local physiotherapists. their local hospital.The study has been approved by the regional
The average age was 29 years, all presenting with a history of committee for ethics in medical research and the Data Inspectorate.
symptoms>1 year. Strict entry criteria were met; none had prior ANALYSIS: Logistic regression analyses were used to estimate the
surgery and all had deem to ‘fail’ conservative management, with association between doing regular PFMT 6 months post partum
most being considered for a surgical opinion. All subjects had a and several factors that may influence PFMT. The results are
normal patello-femoral joint according to radiology evaluation from presented in terms of crude and adjusted odds ratios (aOR) with 95%
CT examinations. METHODS: Each subject underwent repeated confidence intervals (95% CI). RESULTS: Six months postpartum,
baseline assessment prior to Dysport® injection into the distal 78.3% reported doing at least occasional PFMT. Of all women, 58.3%
third of Vastus Lateralis muscle, performed by an experienced did PFMT regularly once a week and 27.6% did PFMT 3 times
neurologist under EMG guidance. Quantitative static knee extensor a week. Women doing regular PFMT were more educated, likely to
force production at 30º knee flexion and a timed stair task, participate in general fitness activities and had more children. Women
and qualitative (self reported pain and disability) measures were experiencing urinary leakage and pelvic girdle pain postpartum
performed at baseline and 6 weekly intervals to 24 weeks post- were also more likely to do PFMT (aOR=1.26, 95% CI 1.18-1.35;
injection. Cross sectional area of the knee extensor musculature aOR=1.31, 95% CI 1.23-1.39). Those who smoked daily, or were
from the distal third to joint line was evaluated from computed delivered by cesarean, were less likely to do PFMT (aOR=0.81,
tomography [CT] at baseline and 12 weeks post-injection. During the 95% CI 0.72-0.91; aOR=0.56, 95% CI 0.51-0.61). CONCLUSIONS:
post-injection period, all subjects undertook a home-based daily knee Women that did regular PFMT had more children, were significantly
extensor strengthening programme. ANALYSIS: Repeated measures more educated, and were more likely to participate in general fitness
ANOVA with planned comparisons across time intervals was used activities 3 times a week. Women experiencing urinary leakage
to test for significant changes. RESULTS: No adverse events were and pelvic girdle pain were also more likely to do PFMT regularly. In
encountered. Most subjects reported meaningful improvements in contrast, women that smoked daily or were delivered by cesarean
knee pain and symptoms, and increased participation in sporting and were less likely to do PFMT regularly. IMPLICATIONS: When
daily living activities. Performance on a timed stair task improved in recommending PFMT, special attention should be directed towards
all subjects (p < 0.01). Isometric knee extensor force was improved those less educated KEYWORDS: pelvic floor muscle training,
(p < 0.001) despite localised atrophy of the distal Vastus Lateralis in postpartum, prevention,. FUNDING ACKNOWLEDGEMENTS: The
the treated limb. The greatest change occurred between baseline and study is supported by The Norwegian Ministry of Health, NIH/NIEHS
six weeks post-injection, however improvements were maintained (grant no. N01 – ES – 85433), NIH/NINDS (grant no. 1 UO1
at 24 week and 12 month follow-up. CONCLUSIONS: These data NS 047537-01) and Norwegian Research Council/FUGE (grant no.
provide preliminary evidence for the role of BTXA injection as an 151918/S10). CONTACT: [email protected]
adjunct to rehabilitation of indivduals with chronic AKP dysfunction. ETHICS COMMITTEE: The regional medical ethics committe of
Functional improvements were sustained at longer term follow-up. Norway (RekSør)
DOES HYDROTHERAPY RELIEVE PAIN? A SYSTEMATIC LONG-TERM EFFECTS OF GLOSSOPHARYNGEAL INSUFFLA-
REVIEW OF THE LITERATURE TION IN PERSONS WITH CERVICAL SPINAL CORD INJURY
Swinkels A1 , Hall J2 , Briddon J1 , McCabe C3 ; 1 University of Nygren-Bonnier M1,2 , Wahman K3 , Lindholm P4 , Markström A5 ,
the West of England, Bristol, UK; 2 Royal National Hospital for Westgren N6 , Klefbeck B1,2 ; 1 Division of Physiotherapy,
Rheumatic Diseases, Bath, UK; 3 University of Bath, UK Department of Neurobilogy, Care Sciences and Society, Karolinska
PURPOSE: Pain relief is a common therapeutic aim when refer- Instiutet, Stockholm Sweden; 2 Department of Physical Therapy,
ring patients with neuromusculoskeletal disease for hydrotherapy Karolinska University Hospital, Huddinge, Sweden; 3 Division of
(exercise in warm water). This is based on the popular belief Neurorehabilitation, Department of Neurobiology, Care Sciences
that hydrotherapy relieves pain, but what is the evidence for this? and Society, Karolinska Institutet Stockholm, Sweden; 4 Section
This systematic review considers the question “Does hydrotherapy of Environmental Physiology, Department of Physiology and
relieve sensory pain in adults with neuromusculoskeletal disease”? Pharmacology, Karolinska Institutet, Stockholm, Sweden;
5 Respiratory Unit, Department of Anaesthesia and Intensive
RELEVANCE: The International Association for the Study of Pain
identifies the relief of pain as a priority in the delivery of healthcare Care, Karolinska Institutet, Danderyd Hospital (KIDS), Danderyd,
and this presents a growing challenge in an aging population. Sweden; 6 Spinalis Clinic and Research Unit, Karolinska University
Hydrotherapy is an expensive modality which is under threat in Hospital, Stockholm, Sweden
the current economic climate. Systematic reviews of randomised
controlled trials (RCTs) play a critical role in informing decisions PURPOSE: To evaluate the immediate and long-term effects
on the clinical effectiveness of health care delivery. No previous of glossopharyngeal insufflation (GI) on lung function, ability to
reviews have specifically focused on the question of whether cough and chest expansion in persons with cervical spinal cord
hydrotherapy relieves pain in adults with neuromusculoskeletal injury. RELEVANCE: Persons with cervical spinal cord injury have
disease. PARTICIPANTS: N/A METHODS: Fourteen electronic severe inspiratory and expiratory muscle weakness, which leads to
databases were searched for RCTs on hydrotherapy for patients diminished tidal volumes, sighs, and cough flows, resulting in reduced
with neuromusculoskeletal disease compared to other physiotherapy chest wall and lung expansion. The cause of death for these persons
interventions or no treatment controls. A process of consensus with a reduced vital capacity (VC) is often due to pneumonia as a
was adopted in accepting papers for the review following a tiered
consequence of a decreased ability to cough. Earlier studies have
approach in which titles, abstracts and full papers were screened
shown that GI can help the patient to take deeper breath to improve
independently by two reviewers. ANALYSIS: Papers accepted for
the review were subjected to descriptive data extraction and quality coughing effectiveness and to prevent pneumonia. An important
assessment using a modified Scottish Intercollegiate Guidelines treatment goal for these patients would be to improve ability to cough,
Network (SIGN) checklist and the Cochrane criteria for internal ventilation, and chest wall range of motion. PARTICIPANTS: Twenty-
validity in RCT’s. Within and between group effect sizes for sensory seven subjects, 21 men and six women, mean 47 (range 21-70)
pain outcome measures were calculated. RESULTS: 705 citations years of age, with cervical spinal cord injury, in Stockholm community
were retrieved, of these 19 RCTs were selected for inclusion. These were included. METHODS: The subjects performed 10 repetitions
incorporated 670 patients with rheumatic disease, low back pain, of GI four times a week during eight weeks. Pulmonary function,
multiple sclerosis and fibromyalgia. Patients received between 4-84 peak cough flow (PCF), functional residual capacity (FRC) (measured
hours of hydrotherapy (mean 26.2 hours) over a period ranging from with nitrogen washout) chest expansion and maximal inspiratory and
4-52 weeks. Within group effect sizes following hydrotherapy were expiratory mouth pressure (MIP and MEP) were measured before
equivocal. Between group effect sizes showed little evidence in favour and after the eight weeks. ANALYSIS: Descriptive statistics are
of hydrotherapy versus the control group interventions of immersion presented as mean ± standard deviation (SD) and range. Student’s
and land based exercise. CONCLUSIONS: There is currently little
paired t-test was used, and a value of p < 0.05 was accepted as
substantive evidence that hydrotherapy relieves pain in adults with
being statistically significant. RESULTS: Seven of the 27 subjects had
neuromusculoskeletal disease or that it relieves pain more effectively
difficulty performing GI and were excluded from the analysis. After
than other modalities such as immersion. However, many of the
studies reviewed were methodologically flawed and failed to meet eight weeks of training the subjects had significantly increased their
key criteria for internal validity. In addition, reporting issues such as VC (p < 0.001) with 0.3 l, and FRC 0.7 l (p < 0.0001). The subjects
the omission of information on water temperature and the aim, type inhaled with GI, 0.9 l on top of their VC. Chest expansion increased
and intensity of the exercise intervention detracted from the quality significantly by GI. There was no change in PCF, MIP and MEP.
of some reports. IMPLICATIONS: At present there is little evidence CONCLUSIONS: By using this technique, GI, for a period of eight
to support the use of hydrotherapy in the relief of pain. Further weeks the subjects who could perform GI were able to increase their
randomised controlled studies of good quality are needed to provide VC and FRC. Further studies are needed to investigate if the use
a robust evidence base on pain relief in hydrotherapy. Developments of GI can prevent pulmonary complications. IMPLICATIONS: These
in understanding of the potential mechanisms of pain relief in new results show that it is possible to increase VC and FRC with GI
hydrotherapy may help to target treatment at those populations most in the long-term. This could be of value for physiotherapists to teach
likely to benefit. KEYWORDS: Hydrotherapy, pain, systematic review. patients with cervical spinal cord injury and other neuromuscular
FUNDING ACKNOWLEDGEMENTS: Funding for this systematic disorders, and might slow the progressive decrease in lung volume
review was provided by Donated Funds, Royal National Hospital for
that is caused by the disorders. The technique is easy to perform,
Rheumatic Diseases, Bath, UK and the Faculty of Health and Social
it is not time-consuming, and it may be useful as a complement
Care, University of the West of England, Bristol, UK. CONTACT:
[email protected] to respiratory aids. KEYWORDS: Chest expansion, cough function,
lung function,. FUNDING ACKNOWLEDGEMENTS: The Swedish
Association of Survivors of Traffic Accidents and Polio Health
Care Sciences Postgraduate School. CONTACT: malin.nygren-
[email protected]
ETHICS COMMITTEE: The regional Research Ethics Committee,
Nord, Karolinska Institutet, Stockholm, Sweden, Dnr: 04-1071/1
INTER-RATER RELIABILITY OF FOUR FALLS RISK MULTI LEVEL PREDICTORS OF WOMEN’S PHYSICAL
ASSESSMENT TOOLS FOR RESIDENTIAL AGED CARE ACTIVITY BEHAVIOUR FOLLOWING PARTICIPATION IN AN
Barker A1 , Nitz J1 , Haines T1,2 ; 1 Division of Physiotherapy, The EXERCISE-BASED PRIMARY PREVENTION PROGRAM
University of Queensland, Brisbane, Australia; 2 Princess Alexandra Landry M1 , Brooks D2 , Grace S3 , Thomas S3 ; 1 Women’s College
Hospital, Brisbane, Australia Hospital, Toronto, Ontario, Canada; 2 University of Toronto, Ontario,
PURPOSE: The aim of this study was to undertake the first step Canada; 3 York University, Toronto, Ontario, Canada
towards validating four falls risk assessment tools by determining
PURPOSE: Physical activity is well established as a health promotion
the level of reliability between three raters in the use of the
Peninsula Falls Risk Assessment Tool (PFRAT), Melbourne Falls Risk and cardiovascular disease prevention behavior. Despite this, over
Assessment Tool (MFRAT), Falls Assessment Risk and Management 55% of Canadians do not participate in regular physical activity.
(FARAM) and the Queensland Falls Risk Assessment Tool (QFRAT). Women have lower rates of participation in leisure time physical
Specifically, the reliability of (1) overall scores obtained, (2) risk activity than men and have also been studies to a lesser extent than
factors identified and (3) to define limits for the smallest change men. The predictors of adherence and maintenance to moderate
that indicates real changes in falls risk scoring. RELEVANCE: Falls intensity physical activity have not been thoroughly investigated,
risk assessment tools are widely used by physiotherapists to assess especially in a group of women at risk for cardiovascular disease,
the falls risk of people living in residential aged care, despite a after participation in a primary prevention program. This study will
paucity of evidence to support their efficacy. Investigations into provide important information on the assessment of physical activity
the validity of falls risk assessments have been few, and their among women and the results can be used to help develop more
results poor. The use of instruments which do not have known effective interventions for women at risk for cardiovascular disease.
clinometric properties is an issue of effective resource utilisation. RELEVANCE: Few studies have examined the determinants of
Further investigation into the validity of falls risk assessments used by PA in different contexts. Factors that contribute to maintenance of
physiotherapists is needed. PARTICIPANTS: Twenty-eight residents recommended PA guidelines in women, at moderate-to-high risk
(mean age 83.75 years, SD 8.73) from two residential aged care for CVD, following an exercise based risk modification intervention
facilities in metropolitan Australia were assessed by the three raters. have not yet been explored. PARTICIPANTS: A convenience sample
METHODS: A cross-sectional reliability study involving concurrent, of subjects who have enrolled in the PP program at the Women’s
blind assessment by three raters: a physiotherapist experienced in Cardiovascular Health Initiative (WCHI) was targeted for recruitment.
aged care, a physiotherapist and a final-year physiotherapy student
METHODS: This study is a retrospective cohort study designed to
was conducted. ANALYSIS: The intra-class correlation coefficient
determine predictors of PA maintenance 6 to 36 months following
(ICC; two-way random effects, absolute agreement model) was used
participation in a PP program. Data was collected through database
to assess correlation on overall and item scoring between the three
files and self-administered survey questionnaire. The dependant
raters. The mean and standard deviations (SD) of each rater’s scores
were calculated to detect the presence of systematic differences. variable was PA (via the International Physical Activity Questionnaire
The standard error of measurement (SEM) and minimal detectable (IPAQ), the Duke Activity status Index (DASI) score and the total
change (MDC) were calculated for the total scores to assess the Kaiser Physical Activity Scale (KPAS) score) measured 6 to 36
error in measurement between raters. As the tools had varying months post discharge from the PP program ANALYSIS: Bivariate
total scores the MDC% was calculated to allow for comparisons analysis was conducted using the IPAQ, KPAS, and DASI as
between tools to be made. The MDC% = (MDC/total score) X 100. dependant variables. Independent variables found to have significant
RESULTS: Intra-class correlation coefficients of 0.77, 0.57, 0.75 and correlations the bivariate analysis were put in a regression model to
0.77 for the PFRAT, MFRAT, FARAM and QFRAT were obtained. determine the effect. RESULTS: Of a total of 168 women Information
The MDC was 5.06, 5.05, 7.46 and 4.87 points, representing a letters were sent out in September 2005 to 115 eligible participants.
change of 25.32, 16.82, 37.29 and 13.53 percent of the total scores A total of 73 completed surveys were received for a 74.5% response
before change can be interpreted as a real change in scoring. rate. Approximately 82% of the respondents were categorized on the
Over 50% of items on the PFRAT and QFRAT showed high (0.75- IPAQ as being “sufficiently active” or “health enhancing physically
1.00) ICC scores, compared with 17% or less of individual items active”, with a mean expenditure of 2068 METmin/week. Age and
on the FARAM and MFRAT. CONCLUSIONS: The QFRAT is a HADS score were both found to be significantly inversely related
reliable measure of falls risk. The MFRAT, FARAM and the PRAT to the DASI score(p = 0.02). The SF-36 PCS was also significantly
demonstrated inconsistent levels of reliability. IMPLICATIONS: The correlated with DASI(p < 0.0001). Analysis of the separate indepen-
finding that three out of four commonly used and endorsed falls dent variables in the regression model for the KPAS was significant
risk assessments have poor inter-rater reliability raises questions for employment and PA Plans. Unemployed or retired participants
about the expenditure of often limited resources on completing scoredless on the KPAS total score (p = 0.0004). CONCLUSIONS:
these assessments. KEYWORDS: Accidental falls, risk assess-
Some of the factors that may predict physical activity participation
ment, residential facilities. FUNDING ACKNOWLEDGEMENTS: Nill.
are potentially modifiable, such that improved maintenance rates
could be achieved with a better understanding of PA patterns and
ETHICS COMMITTEE: Ethical clearance was obtained from the
University of Queensland Medical Research Ethics Committee. adherence to established PA guidelines, in those women identified
at risk for CVD. IMPLICATIONS: This is an important step in
the development of effective interventions aimed at increasing PA
patterns, in which physical therapists play a vital role. KEYWORDS:
exercise adherence, cardiovascular disease prevention, women’s
health. FUNDING ACKNOWLEDGEMENTS: Practice-Based Re-
search Award, Sunnybrook & Women’s Health Sciecnes Centre,
Toronto, ON, Canada. CONTACT: [email protected]
ETHICS COMMITTEE: Ethics approval from the Toronto Academic
Health Sciences Council Ethics Review Board and from the University
of Toronto was obtained.
QUADRICEPS ACTIVITY AND MOVEMENT IN RESPONSE TO UN- INDIRECT TRAINING OF THE PELVIC FLOOR MUSCLES VIA
PREDICTABLE SAGITTAL SUPPORT-SURFACE TRANSLATIONS TRANSVERSUS ABDOMINIS FOR FEMALES WITH URINARY
INCONTINENCE: A RANDOMIZED CONTROLLED TRIAL
Stensdotter A1 , Grip H, Hodges P, Häger-Ross C; 1 Department
of Community Medicine and Rehabilitation, Physiotherapy, Umeå Hung H, Tsauo J; School and Graduate Institute of Physical Therapy,
University, Umeå Sweden College of Medicine, National Taiwan University, Taipei, Taiwan
PURPOSE: The treatment effects of pelvic floor muscle training
PURPOSE: The aim of this study was to determine whether for urinary incontinence have been proven by many randomized
activity of vastus medialis obliquus (VMO) is delayed and/or controlled trails. But there is no evidence to describe the effect
reduced in response to unpredictable perturbations in persons with of indirect training of pelvic floor muscles (PFM) via transversus
patellofemoral pain (PFP) and if there is a relationship between whole abdominis (TrA). Does it work for female urinary incontinence? Does
body kinematics and muscle activity. RELEVANCE: PFP may be the treatment effect come from the functional improvement of PFM?
related to unfavorable knee joint loading. Delayed and/or reduced This study aimed to answer these questions. RELEVANCE: This
activity of VMO and altered kinematics have been identified in people study provides information about clinical management of female
with PFP in some studies, whereas others have failed to show a urinary incontinence. PARTICIPANTS: Seventy-one women with
difference compared to healthy individuals. Earlier studies have in urinary incontinence were recruited in this study. METHODS: All
subjects were randomized to intervention (48.6±6.4 y/o) or control
general investigated anticipatory muscle activity in different voluntary
group (48.9±6.4 y/o) and evaluated pre- and post- the 4-month
tasks without reference to movement strategies. No previous study
intervention by a physical therapist blinded to the randomization. The
has investigated both muscle activity and whole body kinematics in
demographic data, related urogynaecological history, self-reported
postural responses to unpredictable balance perturbations in PFP. severity, leaking frequency during 3-days diary, leaking amount
To guide the physiotherapy management of PFP it is important during 1-hr and 20-mins pad test, strength of PFM, vaginal squeeze
to understand the association between quadriceps coordination pressure and time, and quality of life were collected and analyzed.
and movement strategies and to understand why VMO activity is Women in the control group learned correct contraction of PFM in the
sometimes altered in PFP. PARTICIPANTS: 17 women with PFP first evaluation and received customary information of PFM exercise.
(age 27.7±6.6 years) who were pain-free at the time of testing The executer asked them to perform PFM exercise everyday but not
and 17 matched healthy controls (age 26.0±4.6 years) participated. contact with them by phone or other way. The intervention group
METHODS: Whole body three dimensional kinematics and surface followed a specially designed exercise course including diaphrag-
EMG of quadriceps muscles were studied during the postural matic breathing, tonic activation, muscle strengthening, functional
response to unpredictable support surface translations. ANALYSIS: expiratory patterns and impact activities. They were individually
Onset of EMG activity was determined by a computer algorithm trained by a physical therapist for 30-60 minutes eight times during
which served as a guide for manual inspection and correction. Data the intervention period. ANALYSIS: A two-way mixed analysis of
were presented to the examiner without reference to muscle or variance (ANOVA) and Wilcoxon signed-rank test were used to
order of repetition. A six degree of freedom segment model was assess possible differences between pre- and post- intervention and
two groups. The Chi-square and Mann-Whitney rank-sum tests were
created to identify movements. Anterior/posterior linear shift velocity
used to assess the discrete dependent variables. RESULTS: The
of the body’s center of mass (COM) was calculated and angular
self-reported incontinence severity, self-reported stress incontinence
movement and velocity were determined for the trunk, hip and knees
severity, leaking frequency during 3-days diary, leaking amount during
in three dimensions. Statistical analyses were performed with a 1-hr pad test and 20-mins pad test were significantly improved in
three-way repeated-measures- ANOVA with kinetic chain, group and the intervention group (p < 0.0005, p < 0.0005, p = 0.042, p = 0.013,
muscle as factors. RESULTS: Unexpectedly, onset of VMO EMG p = 0.006 respectively) but not in the control group. The self-reported
was earlier relative to the other parts of the quadriceps in PFP. incontinence improvement rate and stress incontinence improvement
This was associated with changes in kinematics including greater rate of the intervention group was significantly better than the control
trunk and hip flexion in response to anterior platform translation in group (p = 0.006–0.002). The quality of life was significantly improved
the PFP subjects. No differences were found between groups for in more items for intervention group compared to control group.
joint angular movement and velocity or linear shift and velocity of There was no difference of change of strength and endurance
COM. No differences between groups were found in response to of PFM between two groups. The endurance was significantly
posterior translations. CONCLUSIONS: The relative timing between improved when the data of two groups were pooled to analyze,
the portions quadriceps muscles may be task specific. The earlier but strength not. CONCLUSIONS: The training of PFM via TrA
activity of VMO and greater trunk flexion (which may reduce the could improve the urinary incontinence, but the treatment effect may
load on the knee by shifting the COM forwards) may be part of not come from improvement of strength of PFM. Further studies
an adapted postural response in attempt to 1, reduce knee joint about the mechanism are needed. IMPLICATIONS: Findings suggest
that the women with urinary incontinence may be trained via TrA.
loading; 2, compensate for reduced quadriceps strength; 3, protect
KEYWORDS: Pelvic floor muscles, Transversus abdominis, Urinary
the affected knee; and/or 4, compensate for reduced balance control.
incontinence. FUNDING ACKNOWLEDGEMENTS: National Science
IMPLICATIONS: Attention should be directed toward task specific
Council of Taiwan. CONTACT: [email protected]
compensatory strategies and that these may persist even in the ETHICS COMMITTEE: Ethics committee of NTUH, No: 9461700665
absence of pain. KEYWORDS: EMG, kinematics, knee. FUNDING
ACKNOWLEDGEMENTS: Funding: Trygg Hansa’s Research Foun-
dation; Kempe Memorial Foundation; The Swedish Research Council
(no. 220-3-302 and project 08667). Acknowledgements: Technical
assistance: Fredrik Öhberg, Biomedical Engineering & Informatics;
Göran Westling, Integrative and Medical Biology Umeå University,
Sweden. CONTACT: [email protected]
ETHICS COMMITTEE: Umeå University Medical Research Ethics
Committee, Umeå Sweden. (§245/01, dnr 01-166)
EXPERIENCES OF MOVING WITH PERSISTENT PAIN-A AN OBSERVATIONAL COHORT STUDY OF PHYSICAL
QUALITATIVE STUDY FROM A PATIENT PERSPECTIVE RECOVERY AT THREE AND SIX MONTHS AFTER A
Lundberg M1 , Styf J1 , Bullington J2 ; 1 Division of Occupational PROLONGED STAY IN INTENSIVE CARE
Orthopaedics, Sahlgrenska University Hospital & Göteborg Salisbury L1 , Walsh T2 , Hope D2 , Bateman A2 ; 1 Centre for
University, Göteborg, Sweden; 2 Ersta & Sköndal University College, Integrated Healthcare Research, School of Health Sciences,
Stockholm, Sweden Edinburgh University, Medical School, Teviot Place, Edinburgh, EH8
PURPOSE: The aim of the present study was to explore how patients 9AG, Scotland; 2 Intensive Care Unit, Edinburgh Royal Infirmary,
with persistent musculoskeletal pain experienced moving with pain. 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
RELEVANCE: For the patient with persistent pain, movement is
PURPOSE: To investigate the physical profile of recovery in persons
often accompanied by pain. During the past decade there has been
focus on the negative impact of fear of movement on the patient who have suffered a prolonged stay in intensive care (>48 hours).
with persistent pain. Physical therapists have a unique position in RELEVANCE: While medical interventions in Intensive Care Units
the health care system, since we focus on achieving health through (ICU) continue to save lives, the long term physical, psychological
movement. We need, however, a language that gives meaning to and nutritional effects are poorly understood or evaluated (Combes et
pain and describes the general bodily experience without resorting al, 2003). Research of physical rehabilitation following intensive care
to terms that indicate disease. One methodology that enables us is limited (Jones et al, 2003). This study investigated the physical
to explore the lived experience is phenomenology, which has been recovery profile of patients following a prolonged stay in intensive
recommended as an “alternate research paradigm” to positivism for care. PARTICIPANTS: A total of 68 persons who had suffered a
physical therapy research. New knowledge can be acquired by asking prolonged stay in intensive care (>48 hours) were recruited into
the patients about their experiences regarding moving with pain. the study. Thirty-five participants completed the study protocol and
PARTICIPANTS: The sample was purposive and consisted of 10 returned at 3 and 6 months post discharge from ICU. Of the remaining
Swedish outpatients with heterogeneous non-malignant persistent 33 participants 9 died, 19 were lost to follow-up and 5 withdrew
musculoskeletal pain. The patients took part in individual rehabilita- from the study. METHODS: This observational cohort study was
tion at two different physical therapy departments. Informed consent carried out at Edinburgh Royal Infirmary, Scotland, with approval of
was obtained prior to participation, and the study was approved by the Multi-Centre Research Ethics Committee. Informed consent was
the Ethics Committee at the University of Göteborg. METHODS: In- obtained from either the participant or their welfare guardian if the
depth interviews were performed by a physical therapy researcher participant was unable to give informed consent. At 3 and 6 months
with many years’ experience with the rehabilitation of patients with post discharge from intensive care participants were assessed using
persistent musculoskeletal pain. The interviews were audio-taped a battery of physical outcome measures including a six minute
and lasted for 1-1.5 hours. All interviews were performed by the same
walk test (6MWT), the SF-36 and SF-36 physical component score,
researcher. Open-ended questions were used in order to stimulate
the Frenchay Activities Index (FAI), the Euroquol thermometer of
detailed accounts of the patients’ experience. The guiding question
health and visual analogue scales (VAS) of fatigue (0 indicating
was “How do you experience moving with pain?” ANALYSIS: The
interviews were analyzed according to a qualitative method known no fatigue to 10 indicating worse fatigue), pain (0 indicating no
as the Empirical Phenomenological Psychological (EPP) method. pain to 10 indicating worse pain), and appetite (0 indicating no
This approach consists of focusing on the individual’s experience appetite to 10 indicating best appetite). ANALYSIS: All data was
of the phenomenon. The EPP-method is a descriptive idiographic tested for normality using a Shapiro-Wilks test. Data demonstrating
qualitative methodology that aims to describe the meaning structure normal distribution was presented using mean ±SD. All other data
of a psychological phenomenon. RESULTS: The experience of was presented with medians and IQR. RESULTS: For all outcome
moving with pain implied much more than pure physical movement. measure two values are presented the first represents the score
Pain was a threatening challenge to the informants’ existence and at 3 months and the second the score at 6 months. Euroquol
identity. The results were coded, analyzed and described in three Thermometer (61±21.56; 64±19.92); FAI (34±10.65; 37±10.06);
typologies; Failed adaptation, Identity restoration and Finding the VAS of fatigue (4.89±2.6; 4.74±2.5); VAS of pain (4(0.5-6); 5(1.5-7));
way out. CONCLUSIONS: In conclusion, to move with persistent VAS of appetite (8(3.5-9.5); 8(5.5-9.5)); SF-36 (42 (28-56); 45(28-
pain was described by the informants as having deep existential 68)); SF-36 Physical Component Score (34(20-45); 38 (23-56)).
impact on the individual’s life. It was also evident that all of Only 17 participants were able to undertake the 6MWT at 3 and
the informants experienced a dramatic change in their identity. 6 months (354±149; 452+174). CONCLUSIONS: At 3 months post
These experiences would most likely affect the patients’ chances discharge from intensive care the participant’s outcome measures
of recovery. IMPLICATIONS: By helping patients to move and by demonstrated ongoing physical deficits. At 6 months the scores
confronting them with their fear of movement we also touch their showed minimal improvement from the 3 month scores with the
feelings and self image. We need to extend our knowledge about exception of the 6MWT. Persons who have undergone a prolonged
what it means to the patient in an existential context to be unable
intensive care stay demonstrate ongoing physical deficits after
to move as before, in order to enable a successful rehabilitation
discharge from ICU. IMPLICATIONS: These physical deficits indicate
process. KEYWORDS: chronic pain, fear of movement, identity,
that this group have ongoing rehabilitation needs that are currently
movement, phenomenology. FUNDING ACKNOWLEDGEMENTS:
not being met. As a result a research study has been developed to
This study was supported by grants from the Health and Medical
Care Executive Board of the Region Västra Götaland. CONTACT: investigate the provision of multi-disciplinary rehabilitation, including
[email protected] physical therapy, immediately after discharge from intensive care
ETHICS COMMITTEE: Göteborg University to address these issues. KEYWORDS: Intensive Care; Recovery;
Rehabilitation. FUNDING ACKNOWLEDGEMENTS: This research
was funded by Edinburgh Royal Infirmary Intensive Care Unit
Research Fund and unrestricted educational grant from Nutricia.
ETHICS COMMITTEE: Multi-Centre Research Ethics Committee,
United Kingdom
PP Crystal Pavilion A VCEC Meeting Rooms 11-12
THE EFFECTS OF AGE AND FALL HISTORY ON THE UNDERSTANDING THE MECHANISMS OF PAIN IN KNEE
STEADINESS OF FORCE GENERATION IN THE QUADRICEPS OSTEOARTHRITIS
Newham D1 , Perry M1,2 , Carville S1,3 ; 1 Division of Applied Maly M1 , Costigan P2 , Olney S3 ; 1 School of Physical Therapy,
Biomedical Research, King’s College London, UK; 2 Current Address: The University of Western Ontario; 2 School of Kinesiology & Health
School of Physiotherapy, Curtin University of Technology, Perth, Sciences, Queen’s University; 3 School of Rehabilitation Therapy,
Australia; 3 Current Address: Aacademic Dept of Rheumatology, Queen’s University
King’s College London School of Medicine, London, UK
PURPOSE: We aimed to identify whether mechanical charac-
PURPOSE: To compare the steadiness of quadriceps force in healthy teristics could explain variance in pain intensity in people with
young and older people and also to investigate whether older knee osteoarthritis (OA). RELEVANCE: We know little about the
people with a history of medically unexplained falls generate less determinants of pain due to knee OA and therefore, our strategies
steady force than those without a history of falling. RELEVANCE: to target pain may not be optimal. Little work has investigated the
A decreased ability to generate smooth and controlled muscle force role of mechanical characteristics though medications change both
(i.e. decreased steadiness) has been reported in older people, mainly pain intensity and knee mechanics. If mechanics are related to
during isometric contractions. This may be a cause of medically pain, mechanical interventions could be useful to pain management.
unexplained falls in older people, but has not been studied. Safe PARTICIPANTS: Participants had physician-diagnosed, radiographic
posture and controlled movement requires the generation of steady knee OA (n=54, age 68.3 ±8.7 years; 32 were women). Participants
forces during dynamic contractions as well as isometric ones and had an average of 2.5 comorbidities (conditions that required
older people often report particular difficulty in controlling movements treatment for>3 months). METHODS: Pain intensity was reported
that predominately involve eccentric contractions. We studied force on the Western Ontario McMaster Universities Osteoarthritis Index
steadiness during static and dynamic contractions of the quadriceps (WOMAC-Pain). Body Mass Index (BMI) was calculated from
in healthy young and older people. The latter group included people measured height and weight. Quadriceps strength was the mean
with and without a history of falls. PARTICIPANTS: We studied 44
peak extensor torque (QUAD) of 5 maximum-effort 60º/s trials
young (aged 18-40 years) and 78 older (aged>70 years) people. In
on an isokinetic dynamometer. Static varus-valgus angle (VAR)
the latter group 34 people had a history of falling (fallers) and 44
was measured from weight-bearing radiographs. Three-dimensional
did not (non-fallers). The study had the approval of the local ethics
gait analysis was conducted to compute the peak knee adduction
committee. METHODS: Steadiness during isometric steadiness was
moment (ADD MOM) and dynamic range of knee motion about
measured during contractions at 10, 25 and 50% maximal voluntary
the sagittal (ADD RNG) and coronal (FLEX RNG) axes. The study
force (MVC). The subjects were given visual targets and asked to
was approved by the Queen’s University Research Ethics Board.
maintain force as steadily as possible for 10s. The coefficient of
ANALYSIS: Pearson Correlation Coefficients (r) were calculated
variation (CoV) of the force trace was measured over the middle
and deemed significant if p < 0.002 (2 tailed Bonferroni correction,
6s. Anisometric steadiness was measured by the standard deviation
6 comparisons, a = 0.01). A step-wise linear regression was
of acceleration during concentric and eccentric contractions against
performed with the WOMAC-Pain as the dependent variable and
two external loads (1 & 5 kg) at the ankle. Subjects were asked
the mechanics as independent variables. RESULTS: Participants
to bend and straighten their knee as smoothly as possible over
reported 30 ±19 (out of 100) on WOMAC-Pain. Data from one
a joint range of 30-90 degrees of flexion. Each contraction lasted
6s. A 1 min rest period elapsed between each of the contractions. participant was removed (n=53) because her pain score was an
ANALYSIS: ANOVA and post hoc t-tests were used. RESULTS: outlier. BMI (28 ±5 kg/m2 ) and VAR (−0.8±4.6º) suggested that
The younger subjects tended to be most steady and the fallers the the 53 participants had mild disease. Peak QUAD was 64 ±29 Nm.
least but the differences were not consistently significant. During Gait analysis included ADD MOM (0.44 ±0.15 Nm/kg), ADD RNG
isometric contractions the fallers were less steady (P < 0.001) than (8.8±3.4º) and FLEX RNG (60±9º). Correlations with the WOMAC-
both the young and non-fallers, who had similar values. Isometric Pain subscale (n=53): BMI (kg/m2 ): 0.41*; QUAD (Nm): −0.03;
steadiness was unaffected by force in all three subject groups. VAR (º): 0.10; ADD MOM (Nm/kg): 0.10; ADD RNG (º): −0.04;
Steadiness during dynamic contractions in all groups steadiness was FLEX RNG (º): −0.41*. A model explaining variance in WOMAC-Pain
similar for both of the two external loads and types of contraction. showed that greater dynamic knee range of flexion-extension related
During concentric and eccentric contractions the older subjects were to a lower pain score (slope coefficient −2.9 ±0.9, Adj R2 0.18). Added
less steady than the younger ones (P < 0.002). The only differences to that, lower BMI related to lower pain intensity (slope coefficient
between the two older groups was that the fallers were less steady 6.4±2.1, Adj R2 0.29). CONCLUSIONS: These findings apply to a
than the non-fallers by 31% (P = 0.013). CONCLUSIONS: These data high functioning group with knee OA. Dynamic range of motion and
indicate ageing affects the steadiness of dynamic contractions more body mass explain variance in pain intensity, providing evidence that
than isometric ones. The decreased steadiness during eccentric mechanical variables are important to understanding pain in people
contractions in the fallers could be an important mechanism of with knee OA. IMPLICATIONS: Because this study does not provide
medically unexplained falls. IMPLICATIONS: These data support insight into cause and effect, future research should investigate
the subjective reports of older people that they have more difficulty whether dynamic knee range of motion and obesity are sources of, or
controlling eccentric force generation. It has been reported that the result of, pain. Interventions aimed at range of motion and obesity
practice improves the steadiness of force generation and this should could address, in part, the causes of pain. Physical therapists can
be considered when working with older people, particularly those at play a critical role in studying and implementing such programs to
risk of falling. KEYWORDS: Ageing, muscle force, steadiness, falls. manage pain due to knee OA. KEYWORDS: arthritis, biomechanics,
FUNDING ACKNOWLEDGEMENTS: We are grateful for support pain. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes for
from the EU Better Ageing project (QLRT 2001 00323) and the Health Research (#99034), Toronto Rehabilitation Institute, Natural
Charitable Foundation of Guy’s and St Thomas’, UK. CONTACT: Sciences and Engineering Research Council of Canada. CONTACT:
[email protected] [email protected]
ETHICS COMMITTEE: King’s college London ETHICS COMMITTEE: Queen’s University Research Ethics Board
Research Report Platform Presentation 4AY,UK: Periform Electrodes. Verity Medical, Lightwater GU18
2564 Monday 4 June 12:05 5WW,UK: Neurotrac 5 EMG. CONTACT: [email protected]
VCEC Meeting Room 16 ETHICS COMMITTEE: Harrow Local Research and Ethics Commit-
EFFECT OF COMPARTMENTAL PELVIC FLOOR MUSCLE tee (LREC) UK. LREC NUMBER:04/QO/405
CONTRACTION ON URETHROVESICAL STRUCTURES USING
REAL-TIME ULTRASOUND – A PILOT STUDY
Crotty K1 , Bartram C1 , Pitkin J2 , Cairns M3 , Taylor P3 , Dorey G4 ; 2251 Monday 4 June 12:05
1 St Mark’s Hospital, Harrow, UK; 2 Northwick Park Hospital, Harrow,
UK; 3 University of Hertfordshire, Hatfield, UK; 4 University of West
of England, Bristol, UK EFFECTS OF ENDURANCE EXERCISE ON MOTOR COORDINA-
TION, AMBULATORY AND STEREOTYPIC BEHAVIOR, AND PAIN
PURPOSE: Pelvic Floor Muscle Contraction (PFMC) can be isolated THRESHOLD IN STREPTOZOTOCIN INDUCED DIABETIC RATS
anterially, posterially or in combination. However, instructions for
Ghosh P1 , Czekajewski J2 ; 1 Maryville University, St. Louis,
PFMC with respect to continence are inconsistent in scientific
Missouri, USA; 2 Columbus Instruments, Columbus, Ohio
and lay publications. Study purpose is to investigate which
compartmental PFMC produces greatest change in urethrovesical PURPOSE: Diabetes mellitus is a worldwide problem and can
structures as seen on 2-D Real-time Ultrasound (2D-RTUS), and gradually affect the whole body system in chronic conditions.
validate 2D-RTUS for this purpose. RELEVANCE: Whilst studies The aim of the present study was to delineate the effects of
have investigated exercise regimes and interventions, none have endurance exercise training on motor coordination, stereotypic
addressed compartmental PFMC. Currently therefore, treatment and ambulatory behavior, pain sensation, and blood glucose
outcomes may be sub-optimal due to this gap in the evidence concentration in streptozotocin-induced diabetic rats RELEVANCE:
base. It is also difficult to compare research studies, and women’s Substantial evidence suggests a decline in neuromuscular junction
health information in lay publications is confusing. PARTICIPANTS: activities and development of neuropathy in patients with diabetes
A convenience sample of 38 continent, nulliparous, pre-menopausal mellitus and these changes affect the quality of life. PARTICIPANTS:
women were recruited from one UK hospital and physiotherapy Twenty male Wister rats (170-200 g) were used for the experiment.
clinic. Twenty completed the study, and 17 sets of 2D-RTUS data METHODS: Diabetes was induced by intravenous injection of
were usable. METHODS: Participants were taught anterior, posterior streptozotocin (6 mg/100 g body wt)through tail vein. Blood glucose
and combined PFMCs by a specialist physiotherapist, practiced levels were monitored by glucose oxidase method 3 days post-
three PFMCs in each compartment twice daily for two weeks, and injection, and the animals with blood glucose exceeding 250 mg/dL
completed an exercise diary. Surface Electromyography confirmed were considered diabetic. Only 16 rats out of 20 fell into this criteria.
ability to distinguish between compartments. Three PFMCs in each They were divided into two groups. One group of rats was used
compartment were imaged in random order using perineal 2D-RTUS for exercise training while the other group of rats remained in the
in supine and standing by a Professor of Radiology, and repeated cage without any exercise. Exercise training consisted of treadmill
after 10 minutes. Measurements of angle of urethral inclination (AUI) running with a horizontal floor moving at a constant speed of
and angle of bladder neck rotation (ABNR) were read twice by 20 meter/min for 30 min twice a day for 5 days a week. Motor
one rater and once by a second rater. ANALYSIS: Best of three coordination, pain threshold, stereotypic and ambulatory behavior,
images in each compartment were used for analysis. Preliminary and blood glucose concentration were assessed at 7-day intervals
analyses are presented (n=17) for average compartmental AUI, for 28 days.- ANALYSIS: The statistical analysis was carried out
where smaller angles correspond to optimal activity. Analyses of using student’s t-test. RESULTS: The results show that endurance
ABNR, repeatability, intra and inter-reader reliability, and image exercise significantly increases both stereotypic and ambulatory
clarity for validity of 2D-RTUS are ongoing. RESULTS: For test behavior, improves pain threshold, and increases motor coordination
one supine, smallest AUI in each compartment was achieved using in diabetic rats when compared with non-exercised diabetic rats.
posterior PFMC in 8/17 (47.05%), [average AUI 47.4º (SD: 9.9)]; CONCLUSIONS: It is concluded that endurance exercise training can
combined PFMC in 6/17 (35.3%) [average AUI 49.0º (SD: 10.3)], prevent the decline in motor coordination, stereotypic and ambulatory
and anterior PFMC in 2/17 (11.8%) [average AUI 50.6º (SD:10.3)]. behavior, and pain threshold in diabetic rats IMPLICATIONS: The
In 1/17 (5.9%) poor image clarity prevented comparison. For test outcome of the study may add to the existing knowledge on the
one standing, smallest AUI in each compartment was achieved using effects of exercise on diabetes. KEYWORDS: Diabetes, endurance
combined PFMC in 7/17 (41.1%) [Average AUI 58.1º (SD: 11.7)]; exercise, motor coordination. FUNDING ACKNOWLEDGEMENTS:
posterior PFMC in 6/17 (35.3%) [Average AUI 56.7º (SD: 11.3)], This work was not supported by research fund.
and anterior PFMC in 0/17 (0%) [average AUI 63.9º (SD: 10.9)]. In
4/17 (23.5%) image quality prevented comparison. Similar patterns
were seen for test two and intra-reader reliability. CONCLUSIONS: Research Report Platform Presentation
The preliminary results from this pilot study suggest that anterior 2385 Monday 4 June 12:05
PFMC instructed as “contract as if stopping the flow of urine” VCEC Meeting Room 18
is less useful than posterior or combined PFMC in respect to LIVING WITH LONG-TERM PAIN: A PHENOMENOLOGICAL
AUI. This is relevant because large AUI is related to incontinence. SEARCH FOR MEANING
Furthermore, anterior PFMC is widely taught by non-specialist
Hassenkamp A; St Georges/University of London and Bournemouth
practitioners and promoted in lay publications. Continued analyses of
University
these results and future studies in non-symptomatic and symptomatic
populations are planned and will inform which compartmental PFMC PURPOSE: Whilst chronic pain has been the focus of much research
effects greatest change in urethrovesical structures. IMPLICATIONS: attention, the experience for the person living with it, remains
Results suggest that standardizing technique to either a posterior predominantly unchanged. Often this group of patients is labelled
or combined PFMC may optimize AUI and thus have potential as difficult, demanding and manipulative. Using a phenomenological
for improving treatment outcomes for incontinent women. Findings approach this study aimed to explore the deeper meaning of what it
may also aid comparison of research studies, and objectively is like to live with long-term pain as an older person. It sought to elicit
inform advice given in lay publications. KEYWORDS: Continence, insights that might enable the therapist to develop new avenues of
Imaging, Pelvic floor muscle. FUNDING ACKNOWLEDGEMENTS: interactions with the patient. RELEVANCE: Physiotherapy’s model
With thanks to the following providers: Visus Medical 44803 Bochum, of practice is based on communication- and movement science.
Germany: JiveX reader software. Neen Health Care, Oldham OL1 Focussing only on these during the assessment and examination
process can miss out on tapping into the the patient’s rich experience were admitted to the hospital for a CVD related diagnosis. Patients
in perceiving the world through an altered body. Rather than who could not understand English, were not cognitively intact, or
bringing meaning to this situation, this may be created from it. had undergone cardiac transplantation or a ventricular assist device
PARTICIPANTS: 12 physiotherapy patients over the age of 60 placement were excluded. METHODS: This prospective descriptive
who had lived with unremitting pain for more than 10 years were study used a sample of convenience recruited from a regional
recruited to the study. All responded to a flyer in a physiotherapy medical center. Patient background and medical information was
department of a large nationally renowned teaching hopsital in the obtained through chart review and interview. Patients completed a
UK. METHODS: A phenomenological paradigm with an embodied questionnaire that included items about what types of resources
life-world perspective based on the philosophy of Merleau-Ponty was for education, self-monitoring, and exercise they had available to
chosen with its emphasis on experiencing the world through the body. them after discharge from the hospital. ANALYSIS: Descriptive
In-depth interviews lasting about 1 hour explored what it is like to live statistics and frequencies were calculated for all of the data collected
with chronic pain. The interviewer sought to elicit rich descriptions in this study. RESULTS: We found that the type of technology
focussed on the participants’ bodily awareness of the world, any equipment most often available was a video-cassette recorder
alterations in these and relevant interactions. Alongside this, memos (93%) and least available was the Internet (58%). Furthermore,
relating to non-verbal observations as well as reflections on the only 42% of study participants had access to and competence
interactions were used. ANALYSIS: All interviews were audiotaped with using both computers and the internet. We found that the
and transcribed. The qualitative analysis was iterative. Meaning units type of health monitoring equipment most often available was
were recognized, themes and finally patterns identified while keeping a thermometer (90%) and least available was a blood pressure
in mind the sense of the whole. The researcher used imaginative monitoring device (59%). We also found that the type of exercise
variation seeing all possible perspectives and finally constructed an equipment most often available at home was an exercise bike (32%).
overall description of the essence of the experience while at the In addition, we found that 88% of the study participants reported
same time taking a reflexive stance throughout the whole process. having easy access to a safe place, most often outside to walk
RESULTS: Inbued with the demands and feedbacks of the scientific regularly. CONCLUSIONS: We found in this population of patients
world from which they had sought help, the participants all identified that less than half could easily participant in an Internet-based
watershed insights leading them to deconstruct their adherence to the education and or monitoring program after hospital discharge. In
biomedical interpretation of their experiences. All participants stated addition, many study participants were not able to self-monitor vital
that only the recognition of dissonance with the accepted concepts signs and did not have home exercise equipment. Taken together
helped them to move on. Pain was described as ‘isolating’, a ‘conduit this data suggests that, although technology-based education and
for hence unknown experiences both enhancing and damaging’ while monitoring may be efficacious and provide optimal remote interaction
the altered bodies were described as ‘a barrier to the ‘normal’ between healthcare providers and patients, it may not be feasible in
world’ and ‘a supertuned instrument’. All reported a ‘before and many practice areas and settings. Although most study participants
after’ (ie the onset of pain) time concept which they linked to a new reported having access to a place for walking outside, depending
vulnerability and at times an enhanced creativity. CONCLUSIONS: on the climate walking may not consistently be an exercise option.
A phenomenological, embodied stance elicited themes in this group IMPLICATIONS: Patient education is a key intervention for facilitating
of needing to unburdening themselves of their assumed and re- secondary prevention of cardiovascular disease through risk factor
inforced biomedical beliefs before being able to make sense of reduction. Use of newer technologies may provide another method
living in their world with altered bodies. IMPLICATIONS: There of delivering information to enhance patient self-management of
might be a need to challenge some of the assumptions of a cardiovascular diseases but access to and competence with these
reductionist, hypothetico-deductive paradigm in physiotherapy and tools may be a limiting factor, especially in less developed and
replace it with a more interpretative stance in this group of patients. rural areas. KEYWORDS: patient education, exercise, cardiovascular
KEYWORDS: phenomenology; Merleau-Ponty; life-world paradigm. disease. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
FUNDING ACKNOWLEDGEMENTS: No funding has been received. [email protected]
CONTACT: [email protected] ETHICS COMMITTEE: Spokane – IRB
ETHICS COMMITTEE: Royal National Orthopaedic Hospital LREC,
London, UK, December 2005
2711 Monday 4 June 12:05 A COMPARISON OF KNEE JOINT LAXITY AMONG
VCEC Meeting Rooms 19-20 SNOWBOARDERS BEFORE AND AFTER SNOWBOARDING
ISSUES THAT INFLUENCE THE FEASIBILITY OF TECHNOLOGY- Wade J, Henderson R; Department of Physical Therapy, Rosalind
BASED EXERCISE EDUCATION AND MONITORING IN PATIENTS Franklin University of Medicine and Science, North Chicago, Illinois,
WITH CARDIOVASCULAR DISEASE USA
LaPier T, Wilson B; Eastern Washington University, Department
PURPOSE: Snowboarding has evolved into one of the world’s most
of Physical Therapy, Spokane, WA, USA
popular winter sports. Little evidence exists to explain injury trends
PURPOSE: The purpose of this study was to describe how often among snowboarders in the recreational setting. The aim of this
patients with cardiovascular disease had access to and comfort with study was first, to evaluate the difference in anterior knee joint
using home technology, health monitoring, and exercise equipment. laxity between the leading and trailing legs of snowboarders before
RELEVANCE: Recently a National Heart, Lung, and Blood Institute and after activity; second, to evaluate the difference in anterior
Working Group recommend that, “Research support should be knee joint laxity within each leg among snowboarders before and
directed to evaluate the effectiveness of advanced interactive after snowboarding activity; and third, to compare anterior knee
technologies and systems that incorporate not only instruction but joint laxity results with various snowboarding habit patterns reported
also ongoing monitoring and corrective feedback.” Several studies on a participant questionnaire. RELEVANCE: Knee injuries are
have reported positive in patients with cardiovascular disease common among snowboarders. The leading leg is injured significantly
using Internet-based instruction technologies. For computer-based more often than the trailing leg. This study investigates how knee
instruction to be used in post-hospital education delivery, patients responds to snowboarding activity, both within and between lower
must have access to and be competent using the necessary limbs. PARTICIPANTS: Twenty-seven male (77.14%) and eight
technology. PARTICIPANTS: This study included 50 patients who female participants (n=35), ranging in age from 18 to 56 years
(mean=22, SD=7.14 years), voluntarily participated in the study at normal or nearly normal survey scores. Peak bilateral lower extremity
Alyeska Ski Resort in Girdwood, Alaska. Participants met criteria joint displacement did not differ at the hip (53.9 ±15º vs. 53.4 ±15º),
for inclusion if they were 1) recreational snowboarders, 2) non- knee (54.9 ±12º vs. 53.8 ±12º) or ankle (20.5 ±6º vs. 20.2 ±5º).
beginners, 3) 18-65 years, and 4) without history of knee injury. Single lower extremity vertical jump height did not differ (31 ±11 cm
METHODS: Participants completed a 13-item questionnaire detailing vs. 31.3 ±11 cm). Vertical ground reaction forces (1.86 ±.23%BW
their snowboarding habit patterns. Participants were instructed to vs. 1.87 ±.21%BW) and power (25.9 ±6 W/kg vs. 25.4 ±5.8 W/kg)
engage in 3-hours of normal recreational snowboarding activity. during propulsion did not differ. Vertical ground reaction forces during
Knee joint laxity was measured using the MEDmetric KT-1000 single leg jump landing were decreased at the surgical side (3.2
Arthrometer before and after activity in both the leading and trailing ±.5%BW vs. 3.3 ±.5%BW, P = 0.009), however power during landing
legs. Approval for this study was obtained from the IRB at Rosalind did not differ (−44.9 ±12 W/kg vs. −46.6 ±14 W/kg). Standardized
Franklin University of Medicine and Science. ANALYSIS: Unpaired EMG amplitudes were decreased at the vastus medialis muscle (1.4
t-tests were used to compare between leg differences before and ±.65%MVIC vs. 1.6±0.85%MVIC, P = 0.03) and increased at the
after snowboarding. Paired t-tests were used to compare within leg gluteus maximus muscle (1.05±0.79%MVIC vs. 0.81±0.38%MVIC,
pre- versus post-snowboarding differences. Participant questionnaire P < 0.0001) of the involved lower extremity during propulsion.
responses were analyzed using paired t-tests, unpaired t-tests Standardized EMG amplitudes were also decreased at the vastus
and the One-Way ANOVA. RESULTS: No statistically significant medialis muscle (1.2±0.63%MVIC vs. 1.31±0.69%MVIC, P = 0.04)
differences (p < 0.05) were found when the leading leg was compared and increased at the gluteus maximus muscle (1.18±1.1%MVIC vs.
to the trailing leg, either before or after snowboarding activity. When 0.88±0.4%MVIC, P < 0.0001) of the involved lower extremity during
Pre-snowboarding was compared to Post-snowboarding, significant single leg jump landing. Medial hamstring and gastrocnemius muscle
differences (p < 0.05) were found in both the leading and trailing standardized EMG amplitudes did not display significant side-to-side
legs. The only snowboarding habit pattern from the participant differences. CONCLUSIONS: Despite predominantly satisfactory
questionnaire to demonstrate significant differences (p < 0.05) was knee survey scores evidence of biomechanical and neuromuscular
stance pattern. CONCLUSIONS: Snowboarding activity does result activation differences at the involved lower extremity were observed.
in an increase in knee joint laxity within both legs; however, this Decreased landing forces, decreased vastus medialis muscle activa-
increase is not different between legs. There is some evidence tion and increased gluteus maximus muscle activation amplitudes
to suggest that the change in knee joint laxity is associated with at the involved lower extremity suggest long-term compensatory
a snowboarders stance pattern. IMPLICATIONS: These findings changes toward a hip joint bias to decrease knee joint loading
suggest that the normal repetitive stresses occurring at the knees forces. IMPLICATIONS: ACL reconstruction corrects ligamentous
are not likely to account for the leading versus trailing leg injury laxity, however compensatory biomechanical and neuromuscular
discrepancy experienced by snowboarders. It is more likely that activation changes still occur. KEYWORDS: ACL Reconstruction,
this discrepancy is attributable to biomechanical forces acting on Patient Outcome, Allograft, Compensatory Changes. FUNDING
the knees during turning, jumping, landing, or falling. KEYWORDS: ACKNOWLEDGEMENTS: Fischer-Owen Fund Educational Grant.
Snowboarding, Knee, Laxity. FUNDING ACKNOWLEDGEMENTS: CONTACT: [email protected]
None. CONTACT: [email protected] ETHICS COMMITTEE: University of Louisville Medical Institutional
ETHICS COMMITTEE: Institutional Review Board at Rosalind Review Board
Franklin University of Medicine and Science
Research Report Platform Presentation 934 Monday 4 June 12:45
897 Monday 4 June 12:45 VCEC Meeting Rooms 11-12
VCEC Ballroom B & C DEVELOPMENT AND EVALUATION OF THE GERMAN VERSION
LOWER EXTREMITY BIOMECHANICAL AND NEUROMUSCULAR OF THE “PAIN ATTITUDES AND BELIEFS SCALE FOR
ACTIVATION COMPENSATIONS FIVE YEARS FOLLOWING ACL PHYSIOTHERAPISTS (PABS-PT)”
RECONSTRUCTION Laekeman M1 , Sitter H2 , Basler H3 ; 1 Physiotherapy, Medical Faculty
Nyland J, Caborn D; Division of Sports Medicine, Dept. of of Philipps-University Marburg, Germany; 2 Institute of Theoretical
Orthopaedic Surgery, University of Louisville, Louisville, KY, USA Surgery, Philipps-University Marburg, Germany; 3 Department of
Medical Psychology, Philipps-University Marburg, Germany
PURPOSE: Bilateral lower extremity biomechanical and neuromus-
cular activation characteristics were compared during maximal effort PURPOSE: Recent studies discussed Fear-Avoidance-Beliefs
single leg jumps. Our hypothesis was that the ACL reconstructed (FABs) as a high risk factor for chronic low back pain. The aim of
lower extremity would display differences compared to the non- this study was to develop and evaluate a scale (German version) for
involved lower extremity. RELEVANCE: Long-term biomechanical the assessment of attitudes and beliefs of physiotherapists towards
and neuromuscular activation changes may remain following ACL the treatment of back pain. RELEVANCE: FABs can be influenced
injury, surgical reconstruction, and rehabilitation. PARTICIPANTS: by the attitudes and beliefs of physical therapists. PARTICIPANTS:
70 subjects with bilaterally equivalent active knee mobility and In a cross-sectional study a questionnaire was sent out, to which 280
laxity within 2 mm of the non-involved knee were evaluated at out of a total of 424 physiotherapists (response rate 66%) answered,
a mean of 5 years (range = 2-10 years) post-unilateral ACL part of them being a representative sample of German physiotherapy
reconstruction. METHODS: Subjects completed the 2000 IKDC practitioners (n = 353), and a smaller sample consisting of students in
Knee Survey. EMG (1000 Hz), vertical ground reaction force (500 a bachelor course for physiotherapy (n= 71) with previous experience
Hz) and two dimensional sagittal plane kinematic (60 Hz) data in physiotherapy practice. METHODS: The questionnaire included
were collected as subjects performed 3 sets of 3 consecutive the “Pain Attitudes and Beliefs Scale” for physiotherapists (PABS-
maximal effort single leg countermovement jumps with each lower PT) (Dutch original version), which has been translated into German
extremity. Gluteus maximus, vastus medialis, medial hamstring and following a forward-backward procedure. Further instruments were
gastrocnemius EMG amplitudes were standardized to levels attained the adapted version of the Tampa Scale of Kinesiophobia (TSK-DE)
during performance of single repetition, maximal volitional effort and a translated version of patient vignettes (originally in English).
isometric contractions (%MVIC) using standard manual muscle tests. ANALYSIS: To determine psychometric properties of the PABS,
Ground reaction force magnitudes were standardized to bodyweight we employed a principal component factor analysis in addition to
(BW). ANALYSIS: Paired t-tests were used to compare mean side- item- and regression analyses. RESULTS: Factor analysis of the
to-side differences (P < 0.05). RESULTS: 66% of subjects displayed German version corroborated the structure of the original version
with a biomedical factor explaining 21.5% of the total variance the sole source of motivation for participation. CONCLUSIONS: The
and a psychosocial factor explaining 3.6% of the variance. The findings revealed the complexity of ways in which women managed
respective subscales depict an internal consistency of Cronbach’s their participation. This supports the notion that rehabilitation efforts
a = 0.77 (scale 1) and 0.58 (scale 2). Retest-reliability in a smaller be multifaceted including the development of social and health
sample of n = 79 amounts to r = 0.83 and r = 0.70 respectively. care support and promotion of policies which promote participation.
Physiotherapy students scored significantly higher on scale 2 after an IMPLICATIONS: The findings highlight the importance of a holistic
introduction into biopsychosocial model of treatment for pain. Validity team approach in the management of HIV related disability.
was supported by substantial correlations between both subscales Although physiotherapy has the potential to assist women with self-
and the scores in the TSK and the patient vignettes, especially management strategies related to the chronic nature of the illness,
with regard to given recommendations for activity and return to this was not a priority in these women’s lives. Physiotherapists
work (r values between 0.72 and 0.37). CONCLUSIONS: The need to work with others to provide consultation and advocacy
German version of the PABS-PT appears to be a reliable and valid so that women can be involved with rehabilitation strategies to
instrument for the assessment of attitudes towards treatment options improve their quality of life. Future work will focus on identifying
for low back pain in physiotherapy. IMPLICATIONS: Reliability of predictors of participation and the physiotherapy role in managing
the psychosocial scale may improve by an increase of the number HIV related disability and promoting participation. KEYWORDS: HIV,
of items. KEYWORDS: low back pain – physiotherapy – treatment participation. FUNDING ACKNOWLEDGEMENTS: This research
orientation. FUNDING ACKNOWLEDGEMENTS: this work was was funded by the Canadian Institutes for Health Research.
unfunded. CONTACT: [email protected] ETHICS COMMITTEE: McMaster University Research Ethics Board
ETHICS COMMITTEE: Ethics commission, Medical Faculty of
Philipps-University, Marburg, Germany.
730 Monday 4 June 12:45 KNEE SPRAIN EFFECTS ON KNEE FUNCTION AFTER AN
VCEC Meeting Room 18 EARLY PHYSIOTHERAPY INTERVENTION
UNDERSTANDING PARTICIPATION ISSUES IN WOMEN LIVING Ylönen J1 , Lundberg M1 , Tollbäck A2 ; 1 Karolinska University
WITH HIV Hospital, Stockholm, Sweden; 2 Karolinska Institute, Stockholm,
Solomon P, Wilkins S; McMaster University, School of Rehabilitation Sweden
Science, Hamilton, Canada
PURPOSE: The aim of this study was to evaluate effects of an
PURPOSE: This study examined the experiences of women living early physiotherapy intervention after knee sprains. RELEVANCE:
with HIV focussing on what helps and hinders women from Knee sprains are one of the most common knee injuries in leisure
participating fully in their community. RELEVANCE: In developed activities and sports. The subsequent discomfort and soft tissue
countries HIV has become an increasingly chronic and episodic damages can lead to negative inactivity effects. It is important
illness. With this shift, the role of rehabilitation in management of HIV that the rehabilitation process is individually adapted and adjusted
related disability has increased. The World Health Organization has to the extent of the injury, the symptoms and to the goal of the
developed the International Classification of Functioning, Disability rehabilitation. This process needs to be started shortly after the
and Health (ICF) to assist in understanding how contextual factors, injury. PARTICIPANTS: 48 patients, 19 women and 29 men, (17-
such as environment and personal factors, relate to leading a 55 years of age), were consecutively recruited from the Emergency
full life. Increased understanding of the barriers and facilitators to Room, at the Karolinska University Hospital, Huddinge. METHODS:
participation will enable physiotherapists to provide care that will The patients were randomly allocated to an intervention- or a control
meet the needs of a vulnerable population. PARTICIPANTS: 23 group. All patients received written instructions including a simple
women (mean age =40) who had been living with HIV for an average training program made by a physical therapist. The patients in the
of 9.5 years. 61% of the women rated their health as very good intervention group were also scheduled for a visit to a physical
to excellent; 13% rated their health as fair to poor. 83% of the therapist... During the visit, the patient received information about
women had children. 65% had an annual income in the range the injury mechanisms and factors that influence injury healing.
of CAN$10,000–19,000. METHODS: This study used qualitative, The patients had the opportunity to ask questions and receive
phenomenological methods. Purposeful recruitment identified diverse answers and explanations and to discuss fears and expectations.
community participants across Canada. Women were interviewed in They were also given an individualized treatment program. The
person or telephone using open-ended, semi-structured questions. patients graded their knee function with KOOS (Knee injury and
Use of the ICF as a framework ensured a variety of environmental Osteoarthritis Outcome Score) two and six weeks after the knee
and personal factors were examined. ANALYSIS: Interviews were injury. Six weeks after the injury, knee range of motion, effusion
audiotaped and transcribed verbatim. Initially both investigators measured as knee girth and thigh girth were measured in all
coded 7 transcripts to develop the coding system. Summaries of patients. Ethical approval for performing the study was obtained
each woman’s story were completed. Categories and overarching by the Ethics Committee at the Karolinska University Hospital in
themes were developed using a qualitative software program (N6). Stockholm. ANALYSIS: Non-parametric statistical methods were
RESULTS: Although women were living with a variety of disabilities used. The Mann Whitney U-test was used to assess differences
and activity limitations these were secondary in importance to the between the groups. The Wilcoxon Sign Rank Test was used to
daily need to cope with multiple life stressors. Overarching themes assess differences within the groups. P < 0.05. RESULTS: Six weeks
related to participation included fearing disclosure, experiencing after the knee injury, the increase in patient estimated knee function
discrimination, managing participation on a daily basis, coping (KOOS) was higher in the intervention group compared to the control
positively with HIV, fostering supportive networks and living in poverty. group. There were no significant differences in active knee range of
One group of women was participating to the extent to which they motion, effusion or thigh girth, between the groups. CONCLUSIONS:
desired; this group was able to identify and mobilize multiple social Patients with knee sprains receiving early treatment intervention
and health supports. A second group was isolated, depressed and with one visit to a physical therapist estimate their knee function
experienced major challenges to participation. Children were a major higher six weeks after injury compared to patients who did not
motivation to participate in all women’s lives. For those participating receive an early physical therapy intervention. Furthermore, in this
fully, children provided a sense of involvement which lead to a study, objective measurements of active knee range of motion,
more fulfilling life. For those experiencing difficulty, children were effusion and thigh girth, did not reflect knee function. Thus, these
results reflect a substantial individual benefit from the visit to the Research Report Platform Presentation
physical therapist. IMPLICATIONS: Early, individualized physical 970 Monday 4 June 13:05
therapy intervention in addition to written information improve patient VCEC Meeting Rooms 11-12
rated knee function to a higher degree than written information only. SELF-REPORT OUTCOME MEASURES FOR LOW BACK
KEYWORDS: Intervention, knee sprain, physical therapy. FUNDING PAIN – SEARCHING FOR INTERNATIONAL CROSS-CULTURAL
ACKNOWLEDGEMENTS: This study was supported by grants from ADAPTATIONS
the Swedish Research Council, Karolinska Univerity Hospital. Costa L, Maher C, Latimer J; Back Pain Research Group, School
ETHICS COMMITTEE: Ethics Commintee at the Karolinska Univer- of Physiotherapy, The University of Sydney, Australia
sity Hospital, Stockholm, Sweden
PURPOSE: To describe the available cross-cultural adaptations
of low back pain (LBP) self report outcome measures and
the psychometric testing that has occurred for each adaptation.
Research Report Platform Presentation RELEVANCE: Self report measures are commonly used in clinical
905 Monday 4 June 13:05 practice and in research studies. Most existing questionnaires were
VCEC Ballroom B & C developed in English and it is not clear how many have been adapted
to other languages. PARTICIPANTS: Not applicable METHODS: Two
KNEE FLEXOR TORQUE DEFICITS TWO YEARS FOLLOWING
different searches on MEDLINE, EMBASE, CINAHL and LILACS
ACL RECONSTRUCTION WITH SEMITENDINOSUS-GRACILIS
were performed. The first search identified questionnaires specifically
AUTOGRAFT: COMPARISON WITH ALLOGRAFT AND
designed for patients with LBP. The second search combined the
NON-IMPAIRED GROUPS
name of the questionnaire with 35 different languages in order to
Nyland J, Elmlinger B, Tillett E, Caborn D; Division of Sports locate cross-cultural adaptations of the questionnaire. ANALYSIS:
Medicine, Department of Orthopaedic Surgery, University of Data on the psychometric testing of the translated questionnaires
Louisville were extracted. Additionally psychometric properties were rated by
PURPOSE: This study compared the isometric knee flexor torque of the Quality Criteria for Psychometric Properties of Health Status
subjects who were two years status-post ACL reconstruction using Questionnaires with the evaluation restricted to the subset of items
autogenous semitendinosus-gracilis (STG) grafts with subjects who relevant to cross-cultural adaptation. RESULTS: 40 questionnaires
were two years status-post ACL reconstruction using allograft tissues were identified of which only 15 had been adapted to a new
language. Only 19 of the 35 different languages we searched for were
and with a non-impaired control group. Our hypothesis was that
represented in the search results. From 1400 possible adaptations,
subjects with autogenous STG grafts would display greater involved
only 61 have been completed. Psychometric testing of the adapted
side knee flexor torque deficits compared to the other groups.
questionnaires was quite variable and in general sub-optimal with
RELEVANCE: The graft that is selected for ACL reconstruction is an
testing usually restricted to an assessment of reliability and construct
important surgical decision since options have differing advantages
validity. CONCLUSIONS: There are insufficient cross-cultural adap-
and disadvantages. Autogenous tissue harvest is known to impair
tations for self-report outcome measures for LBP patients; the pattern
knee joint function during the early stages of rehabilitation following
of results suggests that there is no relationship between the number
ACL reconstruction. PARTICIPANTS: Three groups of 20 subjects
of people who speak a language and the number of adaptations
(STG autograft group = 13 males, 7 females, 27.1 ±7.6 years of
to that language. Major differences in sample sizes, test-retest
age; allograft group = 8 males, 12 females, 31.8 ±11 years of age;
periods, statistical analysis and benchmarks considering reliability
and control group = 13 males, 7 females, 29.4 ±10 years of age)
and validity were found. IMPLICATIONS: There is a clear need for
participated in this study. The STG autograft group was 2.3 ±.4
further cross-cultural adaptation of LBP self report measures and for
years status-post ACL reconstruction with a mean 2000 IKDC Knee greater attention to the quality of psychometric evaluation of adapted
Evaluation Survey score of 86.4 ±11. The allograft group was questionnaires. Without appropriately adapted measures the clinical
2.4 ±.5 years status-post ACL reconstruction with a mean 2000 management of LBP patients who do not speak English is potentially
IKDC Knee Evaluation Survey score of 80.5 ±13. All subjects who compromised. KEYWORDS: Outcome assessment, psychometric
underwent ACL reconstruction were compliant with rehabilitation properties, low back pain. FUNDING ACKNOWLEDGEMENTS:
program recommendations. METHODS: Handheld dynamometry Leonardo Costa is a PhD student supported by CAPES – Ministério
of bilateral knee flexor torque was performed with subjects in da Educação – Brazil; Christopher Maher holds a research fellowship
a prone position with the test knee positioned at 90º flexion. funded by the National Health and Medical Research Council of
Measurements were performed twice and the mean values were Australia. CONTACT: Leonardo Costa – [email protected]
analyzed. Measurements displayed excellent reliability (ICC = 0.94).
Lower extremities were tested in an alternating order. ANALYSIS:
One-way ANOVA and Scheffe post-hoc tests were used to evaluate Research Report Platform Presentation
between group involved – noninvolved side isometric knee flexor 2958 Monday 4 June 13:05
torque differences (P < 0.05). RESULTS: The STG autograft group VCEC Meeting Room 17
displayed greater involved side knee flexor torque deficits (−17±14 A DAILY PHYSICAL ACTIVITY AND DIET INTERVENTION FOR
Nm) compared to the allograft group (−0.81±8.9 Nm) and compared INDIVIDUALS WITH TYPE 2 DIABETES MELLITUS
to the control group (−0.75±14.2 Nm) (P = 0.001). The allograft group
did not display statistically significant differences with the control Van Rooijen A1 , Viviers C2 ; 1 Dept of Physiotherapy, Faculty of
group. CONCLUSIONS: Long-term knee flexor torque deficits exist Health Sciences, University of Pretoria; 2 Div of Human Nutrition,
at two years following ACL reconstruction when autograft STG tissue Faculty of Health Sciences, University of Pretoria
was used despite patient compliance with rehabilitation program PURPOSE: The aim of this study was to establish the efficacy of
recommendations. IMPLICATIONS: A modified rehabilitation pro- a holistic approach: i.e. daily walk and diet intervention program
gram may help to reduce the knee flexor torque deficits observed as well as compliance to medicine use to decrease HbA1c over
among patients who undergo ACL reconstruction using an STG a period of 4 months in subjects with limited financial resources.
autograft. KEYWORDS: Patient Outcome, Allograft, Rehabilitation. Secondary outcomes that were investigated were body mass index,
FUNDING ACKNOWLEDGEMENTS: Fischer Owen Orthopaedic blood pressure, lipid profiles, waist circumference, Health-related
Fund. CONTACT: [email protected] quality of life and walking distance. RELEVANCE: Evidence suggests
ETHICS COMMITTEE: University of Louisville Medical Institutional that populations in Africa develop Type 2 diabetes mellitus (DM) at an
Review Board increasing rate as they reject their traditional lifestyles. Diabetes is the
tenth most common cause for total life years lost in females in South and older) living with HIV/AIDS. METHODS: We conducted focus
Africa. Physical activity is under-used in the management of type groups and interviews with adults who experienced an “episode”
2 DM in South Africa. PARTICIPANTS: The study was conducted of illness attributed to HIV. We asked participants to describe their
at the New Pretoria Academic Hospital, in the Gauteng Province of health-related challenges, the physical, social and psychological
South Africa. The study participants were men and women of all areas of their life affected, and the impact of these challenges on
races between the ages of 40 and 65, with Type 2 DM and a known their health. ANALYSIS: We used grounded theory techniques to
duration of the disease for at least one (1) year and a HbA1c of develop a conceptual framework that described the consequences
>8-9.5%. METHODS: A randomised controlled clinical trial design of living with HIV. Within this framework, we focused on factors that
was used for the study. For the walk program participants in the influenced how these consequences were experienced by adults
experimental group each received a pedometer as a motivational and living with HIV. RESULTS: We recruited 38 participants (21 men,
monitoring tool. The dietary programme provided the participants with 16 women, 1 transgendered person) for 4 focus groups and 15
the knowledge, skills and motivation to incorporate self-management face-to-face interviews. Participants had a median time since HIV
into their daily lifestyles.The control group received the usual care diagnosis of 9 years (interquartile range: 5-9); 25 (66%) were
and was wait-listed for an intervention similar to the experimental taking antiretrovirals and 19 (50%) had a nadir CD4 count <200
group. ANALYSIS: An analysis of repeated co-variance (ANCOVA) cells/mm3 . Participants conceptualized “disability” as episodic in
was used to compare the experimental and control groups with nature, characterized by unpredictable periods of wellness and illness
respect to changes in HbA1c, in BMI, waist circumference, health- due to HIV and its treatments. “Disability” included four dimensions:
related quality of life and lipid profiles using the baseline values as symptoms / impairments, difficulty carrying out day-to-day activities,
covariate. A p-value <0.05 was regarded as statistically significant. uncertainty resulting in worrying about the future and challenges of
RESULTS: The preliminary baseline adjusted mean HbA1c change social inclusion. Four main factors influenced these dimensions of
from baseline in the exercise group after 12 weeks was −0.39% “disability”. Level of support (e.g. practical and emotional support
(95% CI −0.8 to 0.02). The difference in the baseline adjusted mean from friends, family, and partners, support from health care personnel
walking distance change from baseline in the exercise group (36.20 and services, and income support) and stigma were classified as
to 57.32) was significantly different (p < 0.01) from the baseline in extrinsic factors. Living strategies (e.g. seeking social interaction
the control group (12.07 to 33.33).The difference in the change from with others, maintaining sense of control over life and their illness,
baseline health perception in the exercise group (67.9 to 85.19) and attitudes and beliefs) and aging were classified as intrinsic
was not significantly different (p = 0.86) from baseline in the control factors that could exacerbate or alleviate “disability” experienced by
group (69.16 to 85.37). However, the change from baseline within the adults living with HIV/AIDS. CONCLUSIONS: Influential intrinsic and
experimental and the control groups, both with p < 0.01, respectively, extrinsic factors are a key component of the overall conceptualization
was significant. Cronbach’s alpha coefficient (0.74) indicates a good of “episodic disability”. Level of support, stigma, living strategies
internal consistency. CONCLUSIONS: The decrease in HbA1c levels and aging may exacerbate or alleviate dimensions of “disability”.
of 0.39% in this study must be viewed against the decrease of These factors provide a more comprehensive understanding of
1% to 2% with medication, which is seen as clinically significant. how “disability” is experienced by adults living with HIV/AIDS.
IMPLICATIONS: The exercise interventions together with the use IMPLICATIONS: Existing disablement frameworks have not taken
of medication and correct diet may contribute to the achievement into account the episodic nature of “disability”, nor acknowledged
of a HbA1c level of lower than 7.5% and thus reduced morbidity. the factors that can alter experiences of “disability”. These factors
KEYWORDS: Type 2 diabetes mellitus, exercise, nutrition, health- are integral to understanding how “disability” is experienced and
related quality of life. FUNDING ACKNOWLEDGEMENTS: This perceived by adults living with HIV/AIDS. These factors should
study was funded by the Medical Research Council of South be considered by providers in clinical practice and in the future
Africa, and by the South African Sugar Association. CONTACT: measurement of “disability” for adults living with HIV/AIDS. This
[email protected] research also may be applicable to individuals living with other
ETHICS COMMITTEE: Pretoria Academic Hospital Ethics Review episodic and chronic illnesses. KEYWORDS: Disability, HIV/AIDS.
Board FUNDING ACKNOWLEDGEMENTS: Funding for this research was
provided by the Wellesley Institute. Kelly O’Brien is supported by
a Fellowship from the Canadian Institutes of Health Research,
HIV/AIDS Research Program. CONTACT: [email protected]
1390 Monday 4 June 13:05 ETHICS COMMITTEE: Ethics approval was obtained from the St.
VCEC Meeting Room 18 Michael’s Hospital, Research Ethics Board.
PUTTING “DISABILITY” INTO CONTEXT: FACTORS THAT
INFLUENCE THE EXPERIENCES OF “DISABILITY” FOR
ADULTS LIVING WITH HIV/AIDS
O’Brien K1,2 , Davis A2,3 , Bayoumi A1,2 , Strike C4,5 , Young N2,6 ; PP Crystal Pavilion B & C
1 Centre for Research on Inner City Health, St. Michael’s Hospital,
A SURVEY OF CURRENT METHODS OF TREATMENT OF THE
Toronto, ON, Canada; 2 Department of Health Policy, Management
FEMALE ATHLETE TRIAD BY PHYSICAL THERAPISTS IN THE
and Evaluation, University of Toronto, Toronto, ON, Canada;
3 University Health Network, Toronto Western Hospital, Toronto, US
ON, Canada; 4 Centre for Addiction and Mental Health, Toronto, ON, Pantano K; Cleveland State University, Cleveland, Ohio, USA
Canada; 5 Department of Psychiatry, University of Toronto; 6 School
PURPOSE: Restriction of dietary intake and/or over-exercising
of Human Kinetics, Laurentian University, Sudbury, ON, Canada
in young women can lead to athletic amenorrhea and early
PURPOSE: The purpose of this research was to describe factors development of osteoporosis. Known as the Female Athlete Triad,
that influence the experiences of “disability” from the perspective of this condition may be prevalent in sports that emphasize a lean body
adults living with HIV/AIDS within a larger conceptual framework. appearance. Greater opportunities and increased sports participation
RELEVANCE: HIV increasingly is perceived as a chronic illness in for women has lead to greater competition and a need to excel
developed countries. Individuals may be experiencing the long-term for the female athlete. The Female Athlete Triad, as a result, has
health-related consequences of HIV and potentially adverse effects become a growing concern among health professionals. Methods of
of treatment; often termed “disability”. However, the nature and extent prevention and treatment in early stages are necessary if long-term
of these consequences from the perspective of adults living with detrimental effects are to be avoided.The goal of this self-report is
HIV/AIDS are unknown. PARTICIPANTS: Men and women (18 years to describe the current methods of treatment and prevention used
by physical therapists in the U.S for women having symptoms of, or physical activities, including rehabilitation exercises, with the potential
increased susceptibility to, the Female Athlete Triad. RELEVANCE: of adding substantial strain to the knee (i.e. running, jumping, twisting,
Understanding the current methods of treatment and prevention for cutting, pivoting, quick stop/starts, or activities on uneven ground). All
the female ahtlete triad will help others identify the current strategies patients and physical therapists were instructed to follow guidelines
to implement so that the devastating effects of osteoporosis can from a standardized postoperative ACL rehabilitation protocol used
be prevented in the young female athlete. PARTICIPANTS: 500 at this centre. Patients were assessed preoperatively, 6 weeks, 6, 12,
physical therapists currently practicing in the U.S. were randomly 18 and 24 months postoperatively. ANALYSIS: Outcome measures
selected from the Sports or Orthopedic Physical Therapy Sections included disease-specific quality of life (ACL QOL), Knee arthrometry
of the APTA. METHODS: A survey was developed to assess current (KT 1000) and single limb forward hop test administered by a
methods used by physical therapists in the U.S. to treat and/or blinded research assistant. 1 and 2-year outcomes were compared
prevent the Female Athlete Triad. A prototype survey was sent to after adjusting for baseline scores. A priori directional subgroup
a panel of 20 experts to establish content and construct validity hypotheses based on time from injury to surgery, preoperative KT
of the self-report. The revised questionnaire was then randomly 1000 scores, and 1 and 2-year compliance scores for brace or
sent to 500 physical therapists practicing in the U.S. ANALYSIS: sleeve use were evaluated using tests for interactions. Analyses
Descriptive statistics were used to provide demographic information followed the intention-to-treat principle. RESULTS: There were no
about the population studied and to determine the frequencies with significant between-group differences for any of the outcomes
which physical therapists refer to other health care professionals for at 1 and 2-year follow-ups. Mean between-group differences at
treatment of the disorder. Descriptive information about treatment 2 years were: 2.87% (95% CI: −3.85–9.60) for the ACL QOL,
and preventive measures were compiled and described in narrative 0.07mm (95% CI: −0.80–0.93) for KT 1000 side-to-side difference,
form. RESULTS: One hundred and seventy-nine physical therapists and 2.64% (95% CI: −4.57–9.85) for hop limb symmetry index.
responded to the mailed survey (36% response rate). Of the 179 There were no significant subgroup findings and adverse events
participants, 25% (44) stated that they currently employ specific were similar between groups. CONCLUSIONS: Confidence intervals
methods of treatment. Sixteen of those respondents (36%) reported for between-group differences are narrow and exclude clinically
that they currently use preventative strategies, but only 16% (7) important differences. These findings suggest a functional knee brace
are involved athletic screening for the disorder. The methods of does not result in superior outcomes over a neoprene sleeve following
treatment, prevention and frequency at which physical therapists use ACL reconstruction. IMPLICATIONS: There is lack of scientific
a multidisciplinary team approach are described. CONCLUSIONS: evidence to support the recommendation of using an ACL functional
The results suggest that for the population of physical therapists knee brace over a neoprene sleeve after ACL reconstruction.
targeted in this study, more therapists may be knowledgeable in KEYWORDS: Randomized Clinical Trial, Anterior Cruciate Ligament
the treatment of the Female Athlete Triad than in its prevention. Reconstruction, Knee Brace. FUNDING ACKNOWLEDGEMENTS:
A greater focus on education for the treatment and prevention of This research was undertaken thanks to funding from the Canadian
the Female Athlete Triad could assist in decreasing the prevalence Institutes of Health Research, Smith & Nephew Canada, and the
of this disorder. IMPLICATIONS: Understanding and learning more Canada Research Chairs Program. CONTACT: [email protected]
about the prevention of the female athlete triad can empower ETHICS COMMITTEE: University of Western Ontario Research
the physical therapist to be educational leaders to other other Ethics Board for Heath Sciences Research Involving Human Subjects
professional, coaches and parents that are involved in the care
of the female athlete. KEYWORDS: Female athlete, osteoporosis,
exercise. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
[email protected] 2303 Monday 4 June 13:25
ETHICS COMMITTEE: Drexel University IRB VCEC Meeting Rooms 11-12
TWO-DAY REPRODUCIBILITY OF FUNCTIONAL CAPACITY
EVALUATION IN SUBJECTS WITH EARLY OSTEOARTHRITIS
OF HIP AND/OR KNEE
VCEC Ballroom B & C van Ittersum M1 , Bieleman A2 , Groothoff J3 , Oosterveld F2 ,
Reneman M3 , van der Schans C1 ; 1 Hanze University of Applied
A RANDOMIZED CLINICAL TRIAL COMPARING THE Sciences, Groningen, The Netherlands; 2 Saxion University of
EFFECTIVENESS OF FUNCTIONAL KNEE BRACE TO Applied Sciences, Enschede, The Netherlands; 3 University Medical
NEOPRENE SLEEVE USE FOLLOWING ANTERIOR CRUCIATE Centre Groningen, The Netherlands
LIGAMENT RECONSTRUCTION
PURPOSE: In a spin-off study of the Cohort Hip and Cohort Knee
Birmingham T1,2 , Bryant D1,2 , Giffin R1 , Kirkely A1 , Kramer J2 ,
(CHECK) project, functional capacity is evaluated using a protocol
Litchfield R1 , Fowler P1 , Donner A3 ; 1 Fowler Kennedy Sport
based on the Isernhagen Work Systems (IWS). Test-retest reliability
Medicine Clinic, University of Western Ontario; 2 School of
of lifting and carrying was published as good in healthy subjects
Physical Therapy, University of Western Ontario; 3 Department
and in subjects with chronic nonspecific low back pain. However,
of Epidemiology and Biostatistics, University of Western Ontario
no data are available concerning two-day reproducibility in patients
PURPOSE: The primary objective of this study was to compare post- with osteoarthritis (OA). The purpose of this study is to assess
operative outcomes in patients using an anterior cruciate ligament the reproducibility of lifting and carrying of FCE in subjects with
(ACL) functional knee brace and patients using a neoprene knee early OA of the hip and / or the knee on two consecutive days.
sleeve during rehabilitative exercises and physical activities after RELEVANCE: The reliability of FCE as an outcome measurement
ACL reconstruction. RELEVANCE: Various types of knee orthoses instrument for early OA was assessed. PARTICIPANTS: 92 Subjects
are commonly used by patients during rehabilitation and return to with early OA of hip and / or knee were evaluated, of which 86%
physical activities after ACL reconstruction. PARTICIPANTS: 150 were female. Mean age of the patients was 57 years, with 13%
patients who were undergoing ACL reconstruction using a hamstring of the subjects having complaints of hip, 24% complaints of knee
autograft were recruited from a tertiary care sport medicine clinic. and 63% of both joints. METHODS: A two-day protocol based on
METHODS: In this two-group parallel design randomized controlled the IWS FCE was applied. Most tests of this Functional Capacity
trial, patients were randomized to receive an ACL functional Evaluation (FCE) consist of stepwise increments of physical loading.
knee brace (n=76) or a neoprene sleeve (n=74) at their 6 week The tests for lifting low, lifting overhead and carrying were repeated
postoperative visit following primary ACL reconstruction. Patients on the second day. ANALYSIS: Differences between the two days on
were instructed to wear the knee orthosis during participation in all weight lifted and carried were calculated using paired samples t-tests.
Intraclass Correlation Coefficients (ICC) were calculated to analyze Patients with DM had more co-morbid conditions (mean 3.55, SD
association between day 1 and day 2. Bland and Altman analyses 2.0), higher BMI (mean 34.2, SD 6.4), and fewer were discharged
were performed to assess limits of agreement. No criteria for limits home (52%). The mean (SD) baseline WOMAC function was 51.9
of agreement were available. However, smaller limits of agreement (17.4) and 49.1 (17.5) respectively for patients with and without DM
indicate more stability because it indicates that the natural variation (P>0.05). All patients irrespective of diabetes status had significant
is small. RESULTS: Mean (sd) scores of the two days for lifting low, improvement (29%) in WOMAC function (P < 0.001). Function at
lifting overhead and carrying on day 1 and day 2 are as follows: Lifting 6-months was significantly lower for patients with diabetes (mean
low (kg) 19.7(9.2)-19.5(9.4) (p = 0.15); Lifting overhead (kg) 9.8(5.1)- 23.9, SD 17.5) than patients without diabetes (mean 18.5, SD
9.3(4.5) (p = 0.16); Carrying (kg) 20.0(9.2)-20.2(8.9) (p = 0.64). ICC 14.3), but the difference was not clinically meaningful. Diabetes
values were respectively: r = 0.89, r = 0.75 and r = 0.88. Limits status was not significant in explaining 6-month WOMAC function
of agreement for the different tests were: lifting low 6.4 kg; lifting after adjusting for relevant medical characteristics (P = 0.16, R2
overhead 5.2 kg; and carrying 6.4 kg. CONCLUSIONS: There were = 0.12). CONCLUSIONS: Although patients with DM had more
no statistically significant differences between the test performances co-morbid conditions, it did not appear to influence their baseline
on both days. All three tests show good two-day test reproducibility or postoperative function when compared with patients without
based on ICC values. We found acceptable stability for lifting low DM. Diabetes status was not a significant determinant of short-
and carrying. The need for a two-day test protocol could not be term functional outcome after TJA in this community-based cohort.
confirmed. However, the natural variation of lifting overhead should IMPLICATIONS: Diabetes status alone is not a reason to expect
be taken into account when using the test clinically. IMPLICATIONS: poor functional outcomes when planning rehabilitation care after
In the CHECK study a one-day test protocol will be used. However, TJA. KEYWORDS: WOMAC Function, Total Joint Arthroplasty,
the natural variation of lifting overhead should be taken into account Diabetes Mellitus. FUNDING ACKNOWLEDGEMENTS: This study
when using the test clinically. KEYWORDS: FCE; Osteoarthritis; was funded by the Alberta Heritage Foundation for Medical
Reliability. FUNDING ACKNOWLEDGEMENTS: The CHECK cohort Research, Royal Alexandra Foundation, University of Alberta Hospital
is financed by the Dutch Arthritis Association. The study was co- Foundation, and the Edmonton Orthopaedic Research Trust.
financed by the Stichting Nuts-Ohra and the ‘Mobiliteitsfonds van het ETHICS COMMITTEE: Health Research Ethics Board of the
HBO’. CONTACT: [email protected] University of Alberta.Canada.
ETHICS COMMITTEE: Medisch Spectrum Twente, Enschede, The
Netherlands
Research Report Platform Presentation VCEC Meeting Room 18
3295 Monday 4 June 13:25 EXPERIENCES AND PERCEPTIONS OF SEXUALITY AND
VCEC Meeting Room 17 HIV/AIDS AMONG YOUNG PEOPLE WITH PHYSICAL
FUNCTIONAL OUTCOMES AFTER TOTAL JOINT DISABILITIES IN A SOUTH AFRICAN TOWNSHIP
ARTHROPLASTY: COMPARISON OF PATIENTS WITH AND
Wazakili M, Mpofu R, Devlieger P
WITHOUT DIABETES
Amusat N1 , Jones A1 , Beaupre L2 , Scot S3 , Warren S1 ; 1 Faculty PURPOSE: The purpose of this study was to explore the experiences
of Rehabilitation Medicine, University of Alberta; 2 Orthopedic and perceptions of sexuality and HIV/AIDS among 15-24 year-old
Research, Capital Health, Edmonton; 3 Faculty of Pharmacy & young people with physical disabilities in a South African Township
Pharmaceutical Sciences, University of Alberta characterised by high unemployment rates and lack of social
services. RELEVANCE: Disabled young people are a key group that
PURPOSE: Current rates of Total Joint Arthroplasty (TJA) are is being left out the global fight against HIV/AIDS, yet they are as
increasing among the elderly; as is the prevalence of diabetes vulnerable as their non-disabled peers to HIV risk (Groce, 2003).
mellitus (DM). The effect of DM on short-term function after TJA Physiotherapists need to be aware of the HIV prevention needs of
has not been clearly elucidated. The aim of this study was to this population. They also need take an active role as HIV/AIDS
evaluate the effect of DM on 6-month functional outcomes in a educators for the disabled young people with whom they work.
patient population who received TJA. RELEVANCE: Dysfunction is PARTICIPANTS: Ten young people with physical disabilities and ten
one of the primary clinical problems for patients with TJA. Diabetes parents of children with disabilities participated in the study. Parents
has been associated with dysfunction in the general population, were asked to participate because of their experience in looking after
but this relationship has not been established in patients with TJA. children with disabilities as well as to stand in for the young people
PARTICIPANTS: Seven hundred and fifteen patients who received who were not able to pariticipate. METHODS: Qualitative research
primary elective total hip (n = 307) or knee arthroplasty (n = 408). methods were employed for the study. Respondents participated in
METHODS: This is a secondary analysis, which was part of a multiple individual in-depth interviews. They also participated in 4
larger prospective longitudinal study. Patients were evaluated within focus group discussions of 4-10 participants each. Parents signed
a month prior to surgery and 6-months after receiving TJA. Self consent forms for the 15-18 year olds and the 19-24 year olds signed
reported function was measured using the function subscale of the their own after the aim of the study was explained. Demographich
Western Ontario and McMaster Universities (WOMAC) Osteoarthritis data, consent procedures, interviews and focus group discussions
Index. ANALYSIS: Student t-tests (both independent and paired) were all audio-taped and transcribed verbatim. Transcripts were
were used to compare WOMAC 6-month function between patients read back to the participants for verification or additional ideas.
with and without diabetes. Multiple regression analysis was used ANALYSIS: Data analysis involved reading and re-reading transcripts
to assess impact of diabetes status on function controlling for to gain understanding of the subject under study. Transcripts were
relevant medical characteristics (joint pain and function, co-morbidity, then sorted into broad content categories. Each response was
Body Mass Index (BMI), in-hospital complications, depression and summarised and pattern coded. Codes were compiled to record
type of joint operation). RESULTS: The mean age for the 82 the experiences and perceptions of young people with physical
patients who had diabetes was 67 years (SD 9.5) and 53% were disabilities within the context of their environment. RESULTS:
female. There were no differences in demographics, baseline joint The results indicate that young people with physical disabilities
pain and function, and overall post-operative complications between have limited factual knowledge about sexuality and HIV/AIDS.The
patients with and without DM. There were more DM patients with decisions and choices they make about sexual behaviour are not
hypertension (70% vs. 44%), circulatory (20% vs. 13%), heart (26% informed by what they know; rather, they are part of their whole life
vs. 21%), kidney (8.5% vs. 3%) and eyes problem (31% vs. 35%). situation in the township. They consider their need to be loved and
accepted, need for job security and family life, to be more important existed between the CB&M and ABC scores (r = 0.52, p = 0.03).
than practicing safe sex.They likened the threat of HIV/AIDS to having CONCLUSIONS: The CB&M enables the physiotherapist to better
no food and living in shacks, therefore, no need to treat HIV/AIDS evaluate change in the high-functioning individual with TBI than an
differently. CONCLUSIONS: Young peoople with physical disabilities existing clinical balance measure. The strong relationships of the
are at increased risk for every known risk factor for HIV/AIDS. CB&M and gait variability, a marker of postural instability, indicate that
There is need for sexuality and HIV/AIDS programme developers the CB&M evaluates high level dynamic balance. The relationships
to take into account the experiences and perceptions of this target of the CB&M with the ABC and CIQ demonstrate that patients’
population and to include them in mainstream HIV/AIDS prevention perceptions of balance self-efficacy and community integration are
programmes. IMPLICATIONS: Physiotherapists, especially those in aligned with CB&M total scores. IMPLICATIONS: This current phase
Africa need to be equipped with relevant sexuality and HIV/AIDS of research further supports the validity of the CB&M by establishing
information so they can participate in reaching out to young relationships with other measures of dynamic stability, community
people with disabilities with whom they work. KEYWORDS: Young integration and self-efficacy. Therefore, the CB&M is useful for the
people with physical disabilities, sexuality, perceptions, HIV/AIDS, physiotherapist in their clinical practice. This research also suggests
experiences. FUNDING ACKNOWLEDGEMENTS: I am grateful to that for the higher-functioning patient the CB&M may be more
the UWC/VLIR – Dynamics of Building a Better Society (DBBS) sensitive in capturing deficits than the surrogate measure of walking
Programme for sponsoring my PhD studies under the Youth Wellness velocity. KEYWORDS: Outcome measure, High level balance,
Project. CONTACT: [email protected] Traumatic brain injury. FUNDING ACKNOWLEDGEMENTS: Ontario
ETHICS COMMITTEE: The University of the Western Cape Senate Neurotrauma Foundation. CONTACT: [email protected]
ETHICS COMMITTEE: Toronto Rehab Research Ethics Board
(REB), University of Toronto REB
PP Crystal Pavilion A Research Report Platform Presentation
THE COMMUNITY BALANCE AND MOBILITY SCALE: AN 657 Monday 4 June 14:00
OUTCOME MEASURE FOR HIGH FUNCTIONING INDIVIDUALS VCEC Ballroom A
WITH TRAUMATIC BRAIN INJURY ADHERENCE TO LOW BACK PAIN CLINICAL PRACTICE
Howe J1,2 , Inness L1−3 , Niechwiej-Szwedo E3 , Jaglal S1−3 , GUIDELINES AND THE EFFECT OF ADHERENCE ON PATIENT
McIlroy W1−3 , Verrier M1−3 ; 1 Toronto Rehabilitation Institute; OUTCOME
2 University of Toronto, Department of Physical Therapy; 3 University Rutten G, Degen S, Oostendorp R; Centre for Quality of Care
of Toronto, Graduate Department of Rehabilitation Science Research (WOK), Radboud University Nijmegen Medical Centre,
Nijmegen, the Netherlands
PURPOSE: To further examine the validity of the Community Balance
and Mobility Scale (CB&M) building on previous research which PURPOSE: This study assessed both the degree of adherence
explored the measurement properties of the scale. RELEVANCE: of private practice physiotherapists to the Dutch guidelines for the
Problems with balance are reported to be a longstanding concern diagnosis and management of non-specific low back pain and
post-traumatic brain injury (TBI) even for community ambulators. the correlation between this adherence to said guidelines and
Previously existing balance measures were unable to evaluate these patient outcome. RELEVANCE: Patients with non-specific low back
ambulatory individuals without a ceiling effect. The CB&M was pain make up 20% of the patients presenting to private practice
developed to enable physiotherapists to evaluate change in the physiotherapy in the Netherlands. Clinical guidelines potentially
balance and mobility skills of the higher functioning patient with enhance quality and efficacy of care. Adherence to these guidelines
TBI who is re-integrating into the community. PARTICIPANTS: A has appeared to be moderate thereby complicating an evaluation
sample of convenience of ambulatory individuals with TBI was of the impact of these guidelines on the quality and efficacy of the
recruited from in-patient and out-patient settings within Toronto care process. PARTICIPANTS: 442 private practices were invited by
Rehab and two private community clinics. Twenty-three and 27 mail and physiotherapists of 122 practices attended an instructional
patients patients participated in sensitivity and validity studies, session. 233 therapists registered for participation, of which 41% (n =
respectively. METHODS: Sensitivity was evaluated using the CB&M 96) recorded requested patient data. The average age of participating
and Berg Balance Scale (BBS) change scores between admission therapists was 41.2 years (SD = 9.9) and 26.1% were female.
and discharge. Validity was evaluated by examining the relationship of Therapists were encouraged to randomly select their patients by
the CB&M total scores with laboratory measures of postural sway and asking every first appropriate patient that presented for treatment
spatiotemporal characteristics of gait (GAITRite™), the Community each week. METHODS: 96 therapists recorded the diagnostic and
Integration Questionnaire (CIQ) and the Activities-Specific Balance treatment process data on 242 patients with non-specific low back
Confidence Scale (ABC). ANALYSIS: Standardized response means pain by means of a web-based recording system. We used an iterated
(SRMs) of the BBS were compared with the CB&M. Spearman consensus procedure to establish both care process indicators
Rank Correlation Coefficients between CB&M scores and postural and patient outcome measures based on the Dutch physiotherapy
sway, gait measures (velocity, the mean and variability of step guidelines for low back pain. We also formulated algorithms to extract
width, step time, step length) and questionnaires were evaluated. data from the recording system with regard to said indicators and
RESULTS: The SRMs for the BBS and the CB&M were 0.54 and measures. Therapists encouraged their patients to complete outcome
1.26, respectively. Correlations between the CB&M total scores and measures for pain (Visual Analogue Scale – VAS) and function
static measures of postural sway were low and not statistically (Dutch version of the Patient-Specific Functional Scale (PSFS-Dutch)
significant. The majority of correlations with spatiotemporal measures and Quebec Back Pain Disability Scale – QBPDS). In addition, we
of gait were significant and of a moderate to high magnitude. recorded the number of treatment sessions. ANALYSIS: We used
The relationship between the CB&M and preferred walking velocity descriptive statistics to express the degree of adherence both with
was demonstrated by a correlation of r = 0.68 (p < 0.00). Individuals the guidelines overall and for the distinct components of the care
walking at velocities>1.0 m/sec, however, demonstrated a wide process. We used correlation and multiple regression analyses to
range of CB&M scores. Greater variability in step length and time determine the relationship between adherence to the guidelines
was associated with lower CB&M total scores (r=-.51, p = 0.0063 and patient outcome measures. RESULTS: Overall adherence with
and r = −0.68, p < 0.0001, respectively). Pooled data across CB&M the guidelines was 65.7%. Adherence to distinct components of
studies (n=47) demonstrated a significant correlation between CB&M the care process ranged from 1.2% for indicators concerning the
and CIQ scores (r = 0.54, p < 0.0001). A significant correlation also physicians’ prescription to 96.5% for the assessment of the patient
profile. Pre to post-treatment differences in QBPDS-score correlated motivations to using NT where tutor influences, usefulness of material
with the initial QBPDS-score, patient age, therapist adherence to and the VLE structure were important motivators. “Enhancing
the guidelines, and living environment (R2 = 0.187). The number my Blackboard experience” emphasised student endorsement of
of treatment sessions correlated negatively with adherence to the NT benefits by focussing on potential solutions to problems that
guidelines, previous physiotherapy treatment, a previous episode hampered their use. CONCLUSIONS: This rigorous qualitative
of low back pain less than half a year ago and being a (post) study addressed criticisms of current evaluative literature and found
secondary student (R2 = 0.186). CONCLUSIONS: This study showed physiotherapy students strongly endorsed the incorporation of NT
an overall therapist adherence to clinical guidelines for non-specific into a traditionally-taught module, where positive effects on personal
low back pain of 65.7%. Adherence with the guidelines was related well-being, learning and computer skills were indicated. Benefits
to better short-term outcomes with regard to patient function as outweighed drawbacks indicating motivation to utilise NT was high,
measured by the QBPDS and a lesser number of treatment despite access being optional. Further qualitative work is required to
sessions. IMPLICATIONS: The results indicate that a higher degree substantiate these exploratory findings, and to explore their impact
of adherence to the clinical guidelines for non-specific low back on clinical practice. IMPLICATIONS: Such strong student support,
pain may enhance the efficacy of the physiotherapeutic process. coupled with existing sound educational rationale, suggests NT
KEYWORDS: Clinical Guidelines; Therapist Adherence: Patient Out- enhance the academic experience of undergraduate physiotherapy
come. FUNDING ACKNOWLEDGEMENTS: This study was funded students. Removing these opportunities may be detrimental and
by CZ-Actief in Gezondheid. CONTACT: [email protected] therefore unjustifiable in any future T&L developments. Additionally,
benefits need to be considered against development costs for
bespoke activities, which may be non-transferable to other situations.
KEYWORDS: Network technologies; Student perceptions; Online
568 Monday 4 June 14:00 learning. FUNDING ACKNOWLEDGEMENTS: Glasgow Caledonian
VCEC Exhibit Hall A University. CONTACT: j.fi[email protected]
STUDENT PERCEPTIONS OF NETWORK TECHNOLOGIES ETHICS COMMITTEE: School of Health and Social Care Ethics
INCORPORATED INTO A TRADITIONALLY-TAUGHT Committee, Glasgow Caledonian University; Queen Margaret Uni-
PHYSIOTHERAPY MODULE versity College Ethics Committee
Finlay J; Glasgow Caledonian University, Glasgow, Scotland
PURPOSE: Computer advances have fuelled Internet use in Research Report Platform Presentation
Higher Education (HE) so that network technologies (NT) are now 2262 Monday 4 June 14:00
frequently embedded within teaching and learning (T&L) strategies VCEC Meeting Rooms 1-3
of traditionally-taught university modules. Despite a strong educa- THE CLINICAL ENCOUNTER EXPERIENCES OF PATIENTS
tional rationale for their use, evaluation of these blended-learning WITH NASOPHARYNGEAL CARCINOMA
environments is criticised for being predominantly quantitative and
Lee E1 , Twinn S2 , Moore A3 , Jones M4 ; 1 Physiotherapy
tutor-focussed so that the true impact of NT from the student’s
Department, Prince of Wales Hospital, Shatin, Hong Kong SAR;
perspective is unknown. This research was designed to address 2 The Nethersole School of Nursing, Chinese University of Hong
this gap by evaluating physiotherapy student perceptions of optional
Kong, Hong Kong SAR; 3 Clinical Research Centre for Health
bespoke web-based materials (film-clips, quizzes, lecture-notes and
Professions, University of Brighton, United Kingdom; 4 School of
e-mail) on the Blackboard Virtual Learning Environment (VLE),
Engineering, University of Brighton, United Kingdom
which were developed as additional support for classroom-based
instruction in a first-year anatomy/manual therapy module. Generated PURPOSE: Health-care professionals and patients with cancer have
data had the dual purpose of guiding local developments and different perspectives on treatment priorities and clinicians often
providing qualitative evidence for the wider educational debate. underestimate patients’ preferences for care in the treatment. The
RELEVANCE: Government initiatives regarding computer and life- objective of this study was to identify factors that contribute to a
long learning skills, combined with drives from educational or- therapeutic clinical encounter experience from the perspectives of
ganisations have caused a shift towards blended-learning in HE nasopharyngeal carcinoma (NPC) survivors. RELEVANCE: NPC
despite limited evaluative work, which has resulted in an urgent is a commonly occurring cancer among Chinese, especially in
need for rigorous qualitative research of student perspectives of a relatively young population group. Since the disease carries
these changes. PARTICIPANTS: Thirty physiotherapy students were a favourable prognosis, sequelae following treatment become an
recruited through individual written invitations forming one pilot important concern for these patients. In recent decades, the call for
group (n=10 second-year students) and two main groups (n=20 holistic patient focused and patient involvement rehabilitation prevails,
first-year students, representing 26% of this intake), from which which is in contrast to the predominant biomedical model currently
twenty-seven finally participated. A purposeful stratified sampling operating in Hong Kong. PARTICIPANTS: Patients with their cancer
procedure (based principally on Blackboard usage, gender and age) in remission were referred by the oncologists when musculoskeletal
ensured proportional representation of these student characteristics. symptoms in the neck were identified. Those reluctant to express
METHODS: A qualitative research design using a hermeneutical their experiences, or had signs of active metastases were excluded.
phenomenological approach was selected to explore student experi- 32 patients in total were invited to participate and one patient
ences. A moderator (who was unfamiliar to participants) conducted refused. METHODS: The study objective required the adoption
three homogenous focus groups using a semi-structured questioning of a qualitative approach. Semi-structured in-depth audio-taped
route and audio-recording of data. Field-notes were taken by the interviews in Cantonese were conducted in a regional teaching
researcher. ANALYSIS: Data were transcribed verbatim by the hospital in Hong Kong. Sampling was continued until the point of
researcher and analysed using Ritchie and Spencer’s five-stage saturation at which the addition of new data from participants did not
framework. To enhance analytical rigour, debriefing, reflexivity, field- provide additional information about the health-care experiences and
journal completion and person, investor and analysis triangulation expectations of physiotherapy service. ANALYSIS: Data collection
were incorporated. RESULTS: Three themes emerged: “Blackboard and analysis using a grounded theory approach were concurrently
is beneficial to me” encompassed markedly positive attitudes, conducted. Peer review and respondent validation were carried
emphasising NT provide an essential student support system through out to assure the study trustworthiness. RESULTS: Among the 31
their role in communication facilitation and information retrieval. participants, there were 18 males and 13 females with a mean age
Strong emotional benefits emerged here, which were previously of 50.4 years old. Radiotherapy remained the primary treatment
unreported in the literature. “Promoting my Blackboard use” explored and 14 participants had radiotherapy as their sole treatment. Six
participants had experienced a recurrence for their cancer with were obtained prior to data collection. ANALYSIS: Demographic
operative treatment received. Average post radiotherapy completion data were summarised using descriptive statistics.Change in the
time was 64.2 months (range: 6-151 months). The participants developmental status of the two groups over time was assessed using
articulated the context they inhabited was one of illness, rather ANOVA.Step wise multiple regression analysis was used to identify
than health. Patients expressed an un-equal power base between predictors of developmental status as well as factors predictive of
themselves and clinicians and requested clinicians to listen to improvement in developmental status over time. RESULTS: The
them. The patient-clinician relationship was mainly an affective two groups were well matched for all variables at baseline.At
orientation. Therapeutic alliance throughout the rehabilitation process baseline 52% of the children had severe mental delay and 72%
such as setting the treatment goal and fulfilling their functional had severe motor delay.The children in the experimental group
roles was expected. Putting the patient first, value-for-money showed significantly greater improvement in MDI(p = 0.01) and
treatment, and appointment flexibility were key features of a quality PDI (p = 0.02)scores over time. Weight-for-age and CD4 counts
rehabilitation service. CONCLUSIONS: Three main themes were were predictive of developmental status. CONCLUSIONS: Children
identified: patient-clinician relationship, participation in therapeutic infected with HIV in South Africa are at risk of severe developmental
alliance, and quality rehabilitation service provision. These, together delay. A basic home stimulation programme resulted in sinificant
with the identified needs of the participants, contributed to the improvements in mental and motor development in young children
participants’ perceived health-related quality of life. A constructive infected with HIV. IMPLICATIONS: Physiotherapist need to be
clinical experience was perceived when their needs were met. aware of the impact of HIV on the developing central nervous
IMPLICATIONS: The findings highlight the importance of patient- system. Developmental assessment and management should be
centeredness in treatment delivery in order to better meet the needs an integral part of services for children infected with HIV.The long
of patients. A multifaceted role of clinicians exhibiting therapeutic term rehabilitation needs of children infected with HIV need to be
skills, critical appraisal skills, reflective skills, communication shills, investigated. KEYWORDS: HIV, neurodevelopment, encephalopathy,
interpersonal skills, and educational skills is demanded. The findings children. FUNDING ACKNOWLEDGEMENTS: Medical Research
also facilitate the development and prescription of a multimodal Council of South Africa. AIDS Research Institute, University of the
treatment relevant to the multiple realities of the participants. Witwatersrand. CONTACT: [email protected]
KEYWORDS: nasopharyngeal carcinoma; qualitative study; health- ETHICS COMMITTEE: The Committee for Research on Human
care experience. FUNDING ACKNOWLEDGEMENTS: The study Subjects, University of the Witwatersrand. (Certificate no: M03-05-
was funded by Sir Robert Black Trust Fund Postgraduate Scholarship. 68)
ETHICS COMMITTEE: Joint the Chinese University of Hong Kong –
New Territories East Cluster Clinical Research Ethics Committee
HIGH-LEVEL MOBILITY OUTCOMES FOLLOWING TRAUMATIC
1591 Monday 4 June 14:00 BRAIN INJURY AND STROKE
Williams G; Epworth Hospital, Melbourne
THE EFFECT OF A HOME STIMULATION PROGRAMME ON THE
NEURODEVELOPMENTAL STATUS OF CHILDREN INFECTED PURPOSE: To evaluate the effectiveness of a high-level mobility
WITH HIV IN SOWETO, SOUTH AFRICA program for people with traumatic brain injury (TBI) and stroke.
RELEVANCE: High-level mobility is important for many employ-
Potterton J1 , Stewart A2 , Cooper P3 ; 1 University of the
ment, social, leisure and sporting roles, and quality of life in
Witwatersrand, Johannesburg, South Africa; 2 University of the
general, particularly for the younger survivors of TBI and stroke.
Witwatersrand, Johannesburg, South Africa; 3 University of the
PARTICIPANTS: Thirty-four consecutive referrals to the ‘Running
Witwatersrand, Johannesburg, South Africa
Group’. All participants were, or had been, receiving rehabilitation
PURPOSE: The purpose of this study was to establish whether a following a neurological injury. Twenty-eight participants attended
basic home stimulation programme would have an effect on the the program. Sixteen had sustained a TBI, seven had suffered a
neurodevelopmental status of young children infected with HIV living CVA, two were undergoing rehabilitation following neurosurgery for
in Soweto, South Africa. RELEVANCE: Paediatric HIV is a global brain tumours, two had suffered a hypoxic brain injury, and one
health concern. South Africa has more HIV infected children than any participant had multiple sclerosis. Participants were predominantly
other country in the world.HIV is neuropathic and has the potential male (20 males/8 females) and their average age was 33.2 years
to cause a significant encephalopathy with resultant developmental (range 16-72 years). Time post-incident ranged from 4-207 months
delay.All facets of development are affected. Physiotherapists in (median 25 months) for the people with TBI and 1-110 months
South Africa have not been involved in the long term management (median 10 months) for non-TBI. All except two of the participants
of children infected with HIV.No physiotherapy intervention studies had sustained an extremely severe TBI (post-traumatic amnesia >28
have been done on children with HIV and developmental delay. days, range 1-153 days). METHODS: Data were collected from 34
PARTICIPANTS: 122 children under 2.5 years of age were recruited consecutive referrals to the ‘Running Group’. The primary outcome
for this study. All children had a confirmed diagnosis of HIV and measure was the high-level mobility assessment tool (HiMAT), and for
were cared for by a primary, adult caregiver.The caregivers of a smaller number of participants the Illinois Agility Test was also used.
consecutive children attending a paediatric HIV clinic, at Chris Hani Participants were reassessed following participation in a 3 month
Baragwanath hospital in Soweto, who met the inclusion criteria were high-level mobility program conducted twice weekly. ANALYSIS:
asked to participate in the study. METHODS: This study was a To investigate the effectiveness of the high-level mobility program,
longitudinal, randomised clinical trial. 122 children were randomised individual and group change scores on the HiMAT were calculated.
into either the experimental or control group.The children in the The minimal detectable change (MDC) score for improvement on
experimental group received a home stimulation programme which the HiMAT (maximum score 54) has been established at 4 points.
was updated every three months at a routine clinic visit.The children The proportion of participants who exceeded the MDC was also
in the control group received no intervention. All children were calculated. RESULTS: Six participants did not attend following their
assessed using the Bayley Scales of Infant development at baseline, initial assessment or dropped out after only a few weeks. HiMAT
six months and twelve months.The Mental Developmental Index scores for the remaining 28 participants on referral ranged from 6-
(MDI)and Motor Developmental Index (PDI) were calculated for 44 points (mean 20.3). The 3 month follow-up scores ranged from
each child at each visit.Ethical clearance and informed consent 12-51 points (mean 29.2). The mean HiMAT score change ranged
from 2-20 points (mean 8.9). Results also indicated that 92.9% Extended Scope Practitioner and Clinical Specialist roles are usually
(26/28) of participants exceeded the MDC, demonstrating a clinically achieved during the programme which suggests that the taught and
significant change during the 3 month program. CONCLUSIONS: clinical elements provide the essential attributes for these roles, whilst
Significant late-term recovery in high-level mobility was achieved Consultants and Lecturers complete the research project before
during a 3 month program. All except two participants demonstrated attaining their posts. As the first Consultant posts were created
clinically and statistically significant improvements. These results also in 2002, it may be that these posts will be achieved sooner after
demonstrate that the HiMAT is responsive to change in mobility completion of postgraduate programmes in the future. Factors that
limitations in chronic TBI and non-TBI populations. IMPLICATIONS: encourage and discourage progress have been identified and further
High-level mobility is important for many people with neurological work planned using focus group methodology will explore these
impairments. Participation in many employment, social, leisure factors in greater depth. IMPLICATIONS: This research will enable
and sporting activities requires mobility skills beyond independent managers to offer opportunities and adequate support mechanisms
level walking. This study shows that significant high-level mobility for these groundbreaking specialists who value clinical contact.
improvements can be achieved beyond the traditional acute recovery For educationalists, this research provides evidence that clinical
phase. This program assists people with neurological impairments masters’ programmes prepare physiotherapists for advanced clinical
to achieve better rehabilitation outcomes, and positively impacts roles. KEYWORDS: manual therapy, physiotherapy careers, post-
on societal participation and quality of life. KEYWORDS: traumatic graduate education. FUNDING ACKNOWLEDGEMENTS: Centre for
brain injury, mobility, therapy. FUNDING ACKNOWLEDGEMENTS: Higher Education Development at Coventry University. CONTACT:
This work was funded by Epworth Hospital, Melbourne, Australia. [email protected]
CONTACT: [email protected] ETHICS COMMITTEE: Coventry University Ethics Committee

THE INFLUENCE OF A CLINICAL MASTERS COURSE PHYSIOTHERAPY GUIDELINES FOR THE MANAGEMENT OF
IN MANUAL THERAPY ON THE UK CAREERS OF THE OSTEOPOROSIS WHO IS USING THEM AND WHAT ARE THE
PHYSIOTHERAPY POSTGRADUATES BARRIERS TO IMPLEMENTATION?
Green A, Perry J, Harrison K; Physiotherapy & Dietetics Donaghy M1 , Bulley C1 , Dow C2 ; 1 Queen Margaret University
Department, Coventry University, Coventry, UK College Edinburgh UK; 2 Stirling University Stirling UK
PURPOSE: To explore the career pathways of a group of postgrad- PURPOSE: Evidence based clinical guidelines are an important
uate manual therapists and to identify the influence of the Masters’ route to ensuring the transfer of evidence into practice but are
education on those careers. RELEVANCE: Over the last decade in physiotherapists using them? While scientific rigour underpins the
the UK, there has been potential for manual therapists to extend development of clinical guidelines the awareness, use or clinical
their roles and develop their careers in response to the new career impact of physiotherapy clinical guidelines has not been evaluated.
framework that has developed within the National Health Service This study aimed to find answers to the following questions; who has
(NHS). The clinical masters’ programme at Coventry is designed to access to and who is using the Chartered Society of Physiotherapy
enable the development of senior practitioners into specialist roles osteoporosis guideline in the UK? How is it being implemented?
within clinical practice, research and educational environments and What are the perceived barriers to implementation? RELEVANCE:
therefore it is of interest to explore whether they have met their Developing guidelines is costly. This study identifies barriers to their
potential. PARTICIPANTS: All the postgraduates from the masters’ use and makes recommendations for an action-research based
programme from 1994 to 2005 were invited to complete a postal process of implementation and evaluation. PARTICIPANTS: 243
questionnaire (response rate 62.3%,n=48, with representation from physiotherapists working in the National Health Service, independent
each year). METHODS: Survey methodology was used. The first hospitals and private practice across the UK. METHODS: Survey
section of the questionnaire asked about the participants’ current methodology enabled the collection of numerous responses from a
role and career pathway since their initial physiotherapy qualification. wide variety of geographical and clinical contexts. All aspects of the
The second section explored Masters’ education and its influence study were informed by an advisory group including representation
on their current roles. ANALYSIS: Quantitative data was analysed from the National Osteoporosis Society and service users. The 26-
by Statistical Package for Social Scientists software and open ended item questionnaire was developed from the literature and piloted in
questions were categorised and quantified in terms of frequency of three clinical sites. Closed and open questions addressed availability
response by two researchers independently and then consensus was and use of the guideline, implementation strategies and barriers.
reached. RESULTS: All respondents are physiotherapists and the Stratified sampling was conducted from strategic health authorities or
majority remain in clinical practice (83%) with 14.5% within education health boards throughout the UK, and from lists of 31 independent
and 2% in research. Within the NHS career framework 6.2% hospitals and 102 private practitioners. Of a total random sample
achieved Consultant Therapist roles, 14.4% were in Extended Scope of 558 services, 25% responded. ANALYSIS: Descriptive analysis
Practitioner posts and 16.6% were working as Clinical Specialists. was performed using the SPSS version 12 and Excel. RESULTS:
The mean time taken to achieve their current posts since completion 62% of services had access to the guideline but only 35% were
of the MSc., was 8.7 years for the Consultants, 1 year prior to using it. Physiotherapists most frequently using the guideline included
completion for the Clinical Specialists, at completion for the Extended osteoporosis services (65%), specialist older people’s falls services
Scope Practitioners and 2.4 years for Lecturers. Positive contributions (50%) and rheumatology services (45%). Less than 18% of physio-
from Masters’ education were identified and the most frequently therapists working in out-patients, the community, and independent
cited were improved confidence in self and confidence in practice hospitals used the guideline. Implementation strategies were under-
(n=24), the status of the qualification (n=23) and improved clinical used, when employed, the most successful were education, local
skills (n=20). Negative factors that were most frequently cited were opinion leaders and concensus projects. Perceived barriers to
‘less clinical hands on’ within their roles (n=9), more management implementation were lack of resources, training, time involvement,
responsibilities (n=5) and an increase in expectations from others of and inapplicability to individual patients. CONCLUSIONS: Despite
the individual (n=4). CONCLUSIONS: Findings suggest that Masters’ a relatively low response rate, results from 243 sites indicate poor
education has enabled the participants to take on new specialist awareness and use of the osteoporosis guideline throughout the UK.
roles and they are ‘fit for purpose’ in the new career framework. The lack of implementation strategies suggests that physiotherapists
and users need to develop a sense of ownership in their service, CAT FS measures were as precise as FS measures using all items.
with time to discuss and plan adaptations to practice where Data set 2: a CAT FS change score of 7 out of 100 represented
appropriate, and to provide feedback into guideline review processes. clinically important change. CAT FS change scores discriminated
A deeper understanding of the implications of the guideline is patients by acuity, age and surgical history. CONCLUSIONS: Results
required, especially in services such as outpatients where the direct supported: strong psychometric qualities of the item pool and validity
relevance or recommendations to their clients may be less obvious. of CAT FS measures; the CAT process was more efficient than
IMPLICATIONS: This survey has highlighted a problem, but the using all items; the CAT could be implemented in a variety of
information supplied by questionnaire responses are limited in depth, outpatient clinics; and CAT FS measures were responsive to clinical
making it difficult to fully understand the reasons for poor guideline change and had good discriminant validity. IMPLICATIONS: CATs
implementation. An action research approach would enable the are being used to produce precise measures of FS in an efficient
integration of implementation strategies into a cycle of investigation way in busy outpatient clinics. As computer item banks expand,
and change. As guidelines are integrated into practice, discussion more precise measures should evolve. Recognized gain in data
should identify and resolve problems. There should be input from collection efficiency will facilitate assessment of more constructs
both users and non-users of clinical guidelines, and from clients without undo patient burden. KEYWORDS: computerized adaptive
affected by their use. This information could be collected using focus testing, item response theory, functional status, patient-reported
groups and individual interviews. KEYWORDS: Clinical guideline, outcomes. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
osteoporosis, physiotherapy. FUNDING ACKNOWLEDGEMENTS: [email protected]
This study was funded by the Chartered Society of Physiotherapy ETHICS COMMITTEE: Focus On Therapeutic Outcomes, Inc.
UK. CONTACT: [email protected]
ETHICS COMMITTEE: The study was approved by the Multiple Site
LYMPHEDEMA THERAPY IN BREAST CANCER PATIENTS WITH
826 Monday 4 June 14:20 LYMPHEDEMA; A SYSTEMATIC REVIEW
VCEC Exhibit Hall A
Kärki A1 , Anttila H2 , Rautakorpi U2 ; 1 Satakunta University of Applied
USING COMPUTERIZED ADAPTIVE TESTING TO IMPROVE THE
Sciences, Pori, Finalnd; 2 National Research and Development
EFFICIENCY OF OUTCOMES DATA COLLECTION
Centre for Welfare and Health (STAKES)/Finnish Office for Health
Hart D1 , Mioduski J1 , Werneke M2 , Stratford P3 ; 1 Focus On Technology Assessment (Finohta), Helsinki, Finland
Therapeutic Outcomes, Inc.; 2 CentraState Medical Center;
3 McMaster University PURPOSE: To review systematically the effects of lymphedema
therapy. RELEVANCE: Breast cancer treatments may disturb the
PURPOSE: To describe development of a computerized adaptive lymphatic drainage of the upper limb causing lymphedema. Lym-
test (CAT) for patients with lumbar spine syndromes, determine phedema therapy methods are various, and national guidelines are
precision, discriminant validity and sensitivity to change of CAT needed to support the use of the effective methods. PARTICIPANTS:
measures of functional status (FS), and compare efficiency of CAT Operated breast cancer patients with upper limb lymphedema.
administration with an instrument containing all items. RELEVANCE: METHODS: Medline, Cinahl, DARE, HTA database, PEDro and the
Collecting outcomes data in a busy clinic can be time-consuming and Cochrane Library were searched for systematic reviews, guidelines
costly, but advances in computer technology have reduced patient or HTA reports. We updated the latest review by a literature
burden with little loss of measurement precision. PARTICIPANTS: search from January 2004 to May 2006 for controlled trials with
To develop the CAT, we analyzed retrospective data from 1,285 or without randomization. ANALYSIS: Two authors selected the
patients (46±16 yrs, min 14, max 100, 41% male) who were treated trials, three performed the final selection and two extracted the
for their lumbar syndromes in 56 outpatient clinics in 18 US states data. Three authors assessed the methodological quality for studies.
and who completed 16 physical functioning (PF) items and 12 Back Disagreements were solved by consensus. We used a list developed
Pain Functional Scale (BPFS) items. We implemented the CAT and by van Tulder (2003), 11 equally weighted criteria (yes=1, no=0,
analyzed retrospective data from 5,971 patients (48±17 yrs, min 18, don‘t know=0), resulting 0-11 points. From studies that had been
max 92, 40% male) who were treated for their lumbar syndromes in assessed in the earlier high quality reviews (Pecino 2004, Kärki
275 outpatient clinics in 30 US states and who routinely completed 2001) we adopted the quality assessments. We also aimed to pool
the CAT during treatment. Project had formal IRB approval. All clinics the data of the trials. Synthesis: We were not able to pool any
participated with Focus On Therapeutic Outcomes, Inc. METHODS: studies because of clinical heterogeneity and lacking data. We made
In both data sets, patients entered FS data at intake and discharge a qualitative synthesis taking into account the methodological quality
(self-report surveys). Data set 1: items were computer administered of the studies, number of studies, type of design (RCR, CT), type
in the same format as paper surveys. Data set 2: items were of outcome measure, statistical significance and consistency of the
administered using the CAT. ANALYSIS: Data set 1: intake data findings. We applied a rating with five levels of evidence by van
were analyzed using Item Response Theory methods employing Tulder (2000): 1. Strong evidence: generally consistent findings in
a rating scale model (RSM) to test item unidimensionality, local multiple (2) high quality RCTs. 2. Moderate evidence: generally
independence, differential item functioning (DIF) and fit. A CAT was consistent findings in one high quality RCT and multiple (>2) low
developed that selected items with maximum information given the quality RCTs. 3. Limited evidence: one RCT or generally consistent
patient’s estimated level of FS and stopped when measurement findings in multiple RCTs or CTs. 4. Conflicting evidence: inconsistent
precision was high. Data set 2: intake and discharge CAT generated findings in multiple RCTs or CTs. 5. No evidence: no RCTs found
FS measures were analyzed using: 1) global rating of change data or just one CT. RESULTS: We identified 10 systematic reviews
and receiver operating characteristic analyses to assess CAT FS and 18 trials (12 randomized). One high quality RCT compared
measure sensitivity to change; 2) ANCOVAs to test CAT FS measures manual lymph drainage (MLD) with compression garments (CG)
ability to discriminate patients by symptom acuity, gender, age to CG alone, and reported similar reduction of lymphedema in
and surgical history. RESULTS: Data set 1: unidimensionality, local both groups after 4 weeks, the greatest reduction in the first 2
independence and negligible DIF of 25 items were supported. RSM weeks. Other studies were moderate to low quality, compared MLD
fit the data well. The lumbar specific CAT used on average 7 items vs. simplified MLD (3 studies), MLD vs. compression sleeve (CS)
(72% more efficient than using all items) to estimate FS measures. (2 studies), MLD vs. compression pump (3 studies), CS vs. no
Intake CAT FS measures discriminated patients by surgical history. treatment (1 study), CG vs. CS (1 study), resisted training vs. no
training (1 study), and 3 studies on devices (mechanical pressure demands, mobility, domestic life and in life areas involving society
device, lower-level laser and ultrasound compared to self massage and community life. Associations between the different categories
and CS, placebo, and compression pump, respectively). CG or CS of health related states were found. Pain, respiratory functions,
was used as an add-on treatment in 14 studies. These studies functions of the digestive system, and neuromuscular and movement
reported no differences between groups, but a 4-60% reduction of related functions showed strong association with various activity
lymphedema was found in all groups. MLD or compression pump and participation restrictions. Some examples in brief are pain and
alone, lower-level laser or ultrasound had no effects on lymphedema. general tasks (p = 0.00), pain and mobility (p = 0.001), respiratory and
CONCLUSIONS: CG are effective in reducing lymphedema. MLD general tasks (p = 0.00), neuromuscular and domestic life (p = 0.02)
seems to have no additional effects when combined with CG Strong associations are evident between impairments of mental
(2=Moderate evidence). Evidence of the effectiveness of other functions as a barrier to environmental factors such as support
lymphedema therapy methods was insufficient (5=No evidence). and relationship in general (p = 0.04) with acquaintances (p = 0.007)
IMPLICATIONS: CG or CS should be introduced to daily use and to attitudes with various players such as health workers friends
immediately in case of post-treatment lymphedema in breast cancer and family (p = 0.05). CONCLUSIONS: Impairments related structural
patients. KEYWORDS: breast cancer, lymphedema, lymph ther- changes and activity and participation limitations have been outlined.
apy, systematic review. FUNDING ACKNOWLEDGEMENTS: The Associations between the different domains are evident and can
research project was funded by National Research and Development be used to determine different support services and rehabilitation
Centre for Welfare and Health (STAKES)/Finnish Office for Health programmes for PLWA IMPLICATIONS: A clear picture of the
Technology Assessment (Finohta). CONTACT: anne.karki@samk.fi functional limitations that PLWA present with has implications for
ETHICS COMMITTEE: Ethical committee in National Research and physiotherapists in service delivery and education. KEYWORDS:
Development Centre for Welfare and Health (STAKES)have approved HIV/AIDS, ICF, impairments, activity limitations and participation
our study in 2006. restrictions. FUNDING ACKNOWLEDGEMENTS: Medical research
Council of South Africa (MRC); Carnegie Foundation. CONTACT:
[email protected]
ETHICS COMMITTEE: Human research Ethical Committee (Medi-
1787 Monday 4 June 14:20 cal) University of Witwatersrand
DISABILITY PREVALENCE AMONG A COHORT OF INPATIENTS
ADMITTED TO CHRIS HANI BARAGWANATH HOSPITAL SOUTH
AFRICA 2071 Monday 4 June 14:40
Myezwa H1,2 ,
Stewart A1,2 ,
Nesara P1,2 ; 1 University
of the
Witwatersrand,Johannesburg, South Africa; 2 Chris hani THE EFFICACY OF TWO COMMUNITY-BASED EXERCISE
Baragwanath Hospital, Johannesburg, South Africa PROGRAMS IN ADULTS WITH A TRAUMATIC BRAIN INJURY:
A RANDOMIZED CONTROLLED TRIAL
PURPOSE: This study was conducted to gain insight and under-
Hassett L1,2 , Moseley A2 , Tate R3 , Harmer A2 , Fairbairn T4 ,
standing of the prevalence of disability among people with HIV
Leung J5 ; 1 Brain Injury Rehabilitation Unit, Liverpool Health
using the ICF checklist with the overall aim to obtain a relevant
Service, Sydney, Australia; 2 School of Physiotherapy, University of
functional and participation picture of people living with HIV/AIDS
Sydney, Sydney, Australia; 3 Rehabilitation Studies Unit, University
in South Africa RELEVANCE: In south Africa, HIV/AIDS places
of Sydney, Sydney, Australia; 4 Brain Injury Rehabilitation Unit,
a major burden on the health services. Physiotherapists already
Westmead Hospital, Sydney, Australia; 5 Brain Injury Rehabilitation
treat people living with HIV/AIDS.The interventions thus far not
Unit, Royal Rehabilitation Centre Sydney, Australia
been informed by a relevant analysis of the impairments,activity
limitations and participation problems experienced by this population PURPOSE: The primary objective of this study was to compare
of patients. PARTICIPANTS: A cohort of eighty in-patients admitted the effectiveness of a supervised fitness centre-based exercise
to Chris Hani Baragwanath Hospital South were approached by program to an unsupervised home-based exercise program on
the clinical team and assessed by the research team. Fifty seven cardiorespiratory and psychosocial outcomes in adults who have
female patients were assessed and 23 male patients. METHODS: A sustained a traumatic brain injury (TBI). The secondary objective
cross sectional study was conducted. On admission and confirmation was to compare the compliance rates between groups to determine if
of HIV status patients were approached by the clinical team. one program is superior in increasing physical activity. RELEVANCE:
Patients who consented were assessed using the ICF Checklist TBI is the leading cause of long-term disability in children and
with sub assessments using goniometry, dynamometry, and mini young adults. Previous research has shown that people who have
mental test questions. ANALYSIS: Data was entered into the EPI sustained a TBI are less physically active and more deconditioned
info programme. univariate analysis was conducted for frequencies than the normal population. Exercise programs are prescribed
and bivariate analysis was conducted to determine associations. by physiotherapists to reverse deconditioning; however there is
RESULTS: The patient assessments presented a varied picture of uncertainty about the effectiveness of these exercise programs. The
the different domains. The impairments of body functions showed results of this study will provide physiotherapists with high-level
mild to complete impairments in the mental functions-73% (n=58) external evidence to guide the prescription of exercise programs
with high numbers in the sub domains of emotion 61% (n=49), for people with TBI. It will also allow funding bodies to fund
energy 75% (n=60), disturbed sleep 71% (n=57). Eighty four percent interventions that have been rigorously examined. PARTICIPANTS:
(n=66) had problems with sensory functions with the most problems Sixty two participants were recruited from three Sydney metropolitan
in the sub category of pain 81% (n=65). Impairments were also brain injury rehabilitation units. Inclusion criteria were: very severe
high in the domains of cardiovascular, haematological, immunological or extremely severe TBI; ability to walk at a speed exceeding
83% (n=67) and respiratory function domains-73% (n=58). Seventy 1m/s; and hospitalisation for at least 1-month. Participants were
four percent (n=59) had impairments in neuro-musculoskeletal and predominantly young (mean age=34yr), deconditioned (mean level
movement related functions with muscle power presenting as the achieved on modified 20-metre shuttle test=6), males (85%) who
domain with the most problems 76% (n=61). Structural changes were had sustained extremely severe injuries (mean length posttraumatic
high in the respiratory structures 66% (n=53) and in structures of amnesia=43 days) an average of 3-months before entry into the
the nervous system 49% (n=39). Other categories assessed were study. Almost half of the participants sustained their injury from a
the activity and participation in a number of life areas. Difficulties road traffic accident (48%). METHODS: A multi-centre, assessor-
were evident in over 60% of patients assessed in general tasks and blinded, parallel group, randomized controlled trial was conducted.
Participants were randomly allocated to one of two groups: the (i.e., “aware”). Multiple linear regression analyses determined the
experimental group participating in a 12-week supervised fitness factors related to adherence for all respondents, and, separately,
centre-based exercise program, and the control group participating in for physiotherapists with realistic perceptions of adherence. Similar
a 12-week unsupervised home-based exercise program. ANALYSIS: regression analyses established the determinants associated with
Analysis of covariance was used to analyze the difference between this awareness of adherence. RESULTS: The average guideline
groups. The primary outcome was a measure of cardiorespiratory adherence rate was 50.4% (SD = 16.8). Only 38.5% of the physio-
fitness, the modified 20-metre walk/run shuttle test. Compliance therapists held realistic perceptions of their personal adherence. For
rates were determined by the number of sessions completed in all respondents, adherence was related to the amount of attention
accordance with training logs. Paired t-tests were used to analyze paid to the guidelines and to the perceived relative advantage
factors influencing compliance. RESULTS: The fitness centre-based (R2 = 0.06). For physiotherapists with realistic perceptions (i.e.,
group was significantly more compliant than the home-based group in who were “aware”), adherence was again related to the amount of
completing the 12-week exercise program. Participants in the home- attention paid and to a greater extent to the relative advantage,
based group were more likely to be compliant if they were more but also to the presence of so-called facilitators (R2 = 0.31). In
physically impaired, had slower processing speed or had a history turn, awareness of adherence was most strongly associated with the
of exercising in the home environment. CONCLUSIONS: People perceived social norm. CONCLUSIONS: This study illustrates the
who have sustained a TBI are likely to be more physically active benefits of the application of a theoretical framework in guideline
if prescribed a fitness centre-based exercise program rather than a adherence studies. From the differences in explained variance of
home-based exercise program on discharge from hospital. Future adherence between all physiotherapists and those who were “aware”
research is needed to examine if a fitness centre-based program (D = 25%), we conclude that awareness of adherence is a key
increases physical activity in other domains (e.g. occupational) factor in guideline implementation. More realistic perceptions may
in the short and long-term. IMPLICATIONS: TBI rehabilitation be achieved by influencing the physiotherapists’ response to the
services should develop links with local fitness centres to facilitate opinions of others (social norm). However, the interpretation of
effective community-based exercise programs. Physiotherapists can our findings may be limited because of the cross-sectional design
play an active role in establishing these programs through edu- and the moderate response rate. IMPLICATIONS: To enhance the
cation and liaison with personal trainers and fitness centre staff. implementation of guidelines, interventions should first of all take
KEYWORDS: Fitness Exercise; Traumatic Brain Injury. FUNDING into account physiotherapists’ awareness of personal adherence.
ACKNOWLEDGEMENTS: Motor Accidents Authority of NSW; Sir Suggestions for future implementation studies include using a
Robert Menzies Memorial Scholarship in Allied Health. CONTACT: longitudinal design to ascertain the determinants that actually predict
[email protected] adherence. In doing so, the use of an extended theoretical framework
ETHICS COMMITTEE: Sydney South West, Western Sydney, the is strongly recommended. KEYWORDS: clinical guidelines; guideline
University of Sydney and Royal Rehabilitation Centre Sydney Human adherence; awareness. FUNDING ACKNOWLEDGEMENTS: The
Research Ethics Committees work was unfunded. CONTACT: [email protected]

VCEC Ballroom A VCEC Meeting Rooms 8&15
AWARENESS: A KEY DETERMINANT OF GUIDELINE THE EXTENT OF DELAY OF LANGUAGE, MOTOR AND
IMPLEMENTATION? RESULTS OF A THEORY-BASED COGNITIVE DEVELOPMENT IN HIV POSITIVE INFANTS
CROSS-SECTIONAL SURVEY IN THE NETHERLANDS Baillieu N, Potterton J; University of the Witwatersrand
Rutten G, Rutten S, Kremers S, Harting J; Faculty of Health
Sciences, Department of Health Promotion and Health Education, PURPOSE: To determine the extent of delay in acquisition of lan-
Maastricht University, the Netherlands guage, cognitive and motor skills in HIV positive infants. Secondary
objective: to determine the skill which is most adversely affected by
PURPOSE: This study aimed to assess physiotherapists’ adherence HIV. RELEVANCE: It has been found world-wide, that HIV-positive
to the Dutch guidelines for non-specific low back pain, ascer- children have significantly greater neurological dysfunction than their
taining which determinants were related to guideline adherence, HIV negative counterparts. There has been very little research
and analysing the role of physiotherapists’ awareness of their carried out on this subject in Africa and developing countries, where
performance in this relationship. RELEVANCE: Guideline adherence the HIV pandemic is critical, and intervention is greatly needed. It
has been found to be only moderate. This may negatively influence is necessary for education regarding the developmental problems of
the quality of care. Interventions to enhance adherence have been HIV, and therefore the structuring of policy regarding management of
found to be of limited effectiveness. This might be due to the absence such patients. PARTICIPANTS: A power calculation revealed that a
of a theoretical framework. Such a framework should at least include sample of 40 infants was needed. The infants were aged between 18
“awareness”, as for other complex behaviours this determinant has and 30 months, and were antiretroviral naive. The sample was one of
been shown to be a major influence. PARTICIPANTS: At random, convenience from a paediatric HIV clinic at Chris Hani Baragwanath
1,500 primary care physiotherapists were invited to participate Hospital in Soweto, Johannesburg. METHODS: The infants were
(response rate 31.5%). Respondents’ mean age was 42.3 years (SD assessed using the Bayley Scales of Infant Development II (BSID
= 8.9), 49.3% were female, and years of working experience ranged II). The facet scores of the BSID II were used for descriptive analysis
from under five to over 30 years (median category 16-25 years). of language, cognitive and gross and fine motor function. The mental
METHODS: Through a cross-sectional survey, guideline adherence and psychomotor indices of the BSID II were used to determine the
was objectively measured by means of validated clinical vignettes extent of delay of mental and motor development. A standardized
and subjectively by asking about the physiotherapists’ perceived socioeconomic questionnaire was administered to evaluate the
level of adherence. A theoretical framework combining Rogers’ socioeconomic backgrounds of the infants. ANALYSIS: A T-test was
Innovation Decision Process and Weinstein’s Precaution Adoption used to compare chronological age and developmental age (as
Process Model guided the measurement of adherence determinants, determined by the BSID II) in both mental and motor development.
which resulted in internally consistent scales. ANALYSIS: Descriptive Descriptive analysis of gross and fine motor development, as well as
statistics were used to express objective and perceived guideline global language development was carried out. The BSID II mental
adherence. Cross-tabulations of both measures showed whether and motor scale scores were used to determine the severity of mental
or not physiotherapists’ perceptions of adherence were realistic and motor delay. Socioeconomic questionnaires were descriptively
analysed. RESULTS: Both cognitive and motor development were prolonged stretches and motor training after casting are probably
found to be significantly delayed, with motor development being required to maintain these gains. KEYWORDS: traumatic brain
the skill most adversely affected by HIV, and more specifically injury, stretching, contracture. FUNDING ACKNOWLEDGEMENTS:
gross motor function. Global language development was delayed Motor Accidents Authority of New South Wales, Australia. CONTACT:
in 82.5% of the sample. The socioeconomic status of the sample [email protected]
was low, which has an added negative effect on neurodevelopment. ETHICS COMMITTEE: University of Sydney, South Western Sydney
CONCLUSIONS: Neurodevelopment is affected in infants with HIV. and Western Sydney Area Health Services, Royal Rehabilitation
Motor development is the skill most adversely affected by the disease, Centre Sydney and Princess Alexandra Hospital
and more specifically, gross motor development, most likely due to
a loss of physical strength. Cognitive development is significantly
affected, as well as global language development. IMPLICATIONS:
These infants and children need specific management and follow 1862 Monday 4 June 15:00
up once a diagnosis has been made. They may benefit from early PP Crystal Pavilion B & C
intervention, specifically by physiotherapists with regards to their COMMENCING TAUGHT POST-QUALIFYING EDUCATION:
delay in gross motor function. KEYWORDS: HIV, Neurodevelopment, BARRIERS FACING PHYSIOTHERAPISTS
Infants. FUNDING ACKNOWLEDGEMENTS: Medical Research Glover P1, , Bulley C2 ; 1 NHS Lanarkshire, Glasgow, Scotland,
Council of South Africa; Aids Research Institute, University of the United Kingdom; 2 Queen Margaret Uiversity College, Edinburgh,
Witwatersrand. CONTACT: [email protected] Scotland, United Kingdom
ETHICS COMMITTEE: Obtained from the Human Ethics Research
Committee of the University of the Witwatersrand PURPOSE: The aim of this study was to explore the personal
perspectives of physiotherapists regarding their perceived barriers
to commencing taught physiotherapy-related Master’s level study
Research Report Platform Presentation (MLS). RELEVANCE: With rapidly increasing knowledge there is
2276 Monday 4 June 15:00 a requirement for continuing professional development to enable
PP Crystal Pavilion A evidence-based practice. Taught MLS provides guidance in this
SERIAL CASTING FOR THE TREATMENT OF ELBOW development; greater understanding of barriers facing physiother-
CONTRACTURES IN ADULTS WITH TRAUMATIC BRAIN apists in undertaking MLS will enable facilitation in clinical and
INJURY: A RANDOMIZED CONTROLLED TRIAL educational environments. PARTICIPANTS: A purposive sample of
9 volunteers (8 female, 1 male, mean age: 36 ±7.29) was recruited.
Moseley A1 , Hassett L1,2 , Leung J3 , Clare J4 , Herbert R1 ,
Participants were: engaged in part-time taught MLS; registered with
Harvey L5 ; 1 School of Physiotherapy, University of Sydney,
the United Kingdom’s professional regulatory body; working within
Sydney, Australia; 2 Brain Injury Rehabilitation Unit, Liverpool
the National Health Service, and possessed a minimum of four
Health Service, Sydney, Australia; 3 Brain Injury Rehabilitation
years clinical experience. METHODS: A qualitative, interpretative,
Unit, Royal Rehabilitation Centre Sydney, Sydney, Australia; 4 Brain
phenomenological study was undertaken with the assumption that
Injury Rehabilitation Unit, Westmead Hospital, Sydney, Australia;
5 Rehabilitation Studies Unit, Northern Clinical School, Faculty reality is individual and all viewpoints are valid. Following ethical
approval, individual, semi-structured interviews (mean time: 67 min-
of Medicine, University of Sydney, Sydney, Australia
utes) were conducted using an interview schedule. Questions were
PURPOSE: The aim of this randomized controlled trial was to derived from a literature review and two developmental interviews
compare serial casting with 1 hour of daily stretch for the treatment with Master’s graduates. ANALYSIS: Interviews were transcribed
of elbow flexion contracture after traumatic brain injury (TBI). verbatim and a summary was member-checked to ensure that
RELEVANCE: Contracture, or loss of joint mobility, is a common initial interpretations were appropriate. Data analysis was conducted
problem after TBI. Physical therapists treat contracture with passive using the framework of interpretative phenomenological analysis.
stretch. The effects of stretch have been investigated in two This focuses on analysis and interpretation of the participants’
systematic reviews and a modest number of randomized controlled words in context to gain deeper understanding of their experiences.
trials, but the results of these trials and reviews are not conclusive. Quotations that communicated similar meanings and ideas were
Serial casting has not been compared to stretch of shorter duration. grouped to form themes. Where conceptual links were identified, key
This comparison is of importance because physical therapists are themes emerged. Peer verification of this analysis was conducted
often faced with a choice between these two treatment alternatives. to increase rigour and involved reflexive discussions with an
PARTICIPANTS: Twenty-six adults with elbow flexion contracture experienced qualitative researcher. RESULTS: Three key themes
after TBI participating in multidisciplinary inpatient rehabilitation. emerged that described the barriers to MLS in different environments:
All subjects completed the study. METHODS: Participants were educational, working, and social. There were several barriers
randomized to receive either serial casting or a program of 1 hour associated with the educational environment; participants frequently
of daily stretch for 2 weeks. Outcomes were measured at baseline, expressed self-doubt regarding academic abilities, often related
after 2 weeks, then 1 day and 4 weeks later. The primary outcome to past educational experiences. They also described negative
was passive elbow extension using a torque-controlled procedure. emotions due to unfamiliarity with the environment and content of
ANALYSIS: All analyses were by intention-to-treat. Between-group MLS. These seemed particularly strong amongst participants who
differences were examined with analysis of covariance using a linear were only qualified to diploma level, as they felt their previous
regression approach. RESULTS: At 2 weeks, serial casting reduced education did not prepare them for MLS. Barriers associated with the
contracture by an average of 22 degrees (95% CI 13 to 31) compared working context included a lack of professional support, especially in
to the stretch group. One day later this effect had decreased to 11 relation to funding and study leave. These led to social barriers as
degrees (95% CI 0 to 21 degrees). The effect had almost completely clinicians were anxious about having insufficient time and finances
disappeared at the 4-week follow-up (mean 2 degrees, 95% CI −13 to fulfil their social roles. CONCLUSIONS: The experiences of this
to 17). CONCLUSIONS: Serial casting produces greater short-term group of post-qualifying students suggest that clinicians who have
reductions in elbow flexion contracture than a program of 1 hour of not previously studied at degree level may face greater barriers to
stretch per day in adults with TBI. These effects are not sustained. commencing MLS than those with a degree, due to self-doubt and
Future research could determine if administration of a more unfamiliarity with higher education. Prior to commencing their study
aggressive stretching protocol in the period following cast removal participants had perceived the experience of MLS as potentially
could maintain the increase in joint range. IMPLICATIONS: Serial threatening, and were concerned about the time and financial
casting induces transient increases in range of motion. Intensive resource implications. Further exploratory research into how to
effectively address the barriers highlighted in this study is required. approach for subacute LBP, however trials in this area are limited and
IMPLICATIONS: The perceived barriers to MLS communicated by generally of poor quality. Given that the effectiveness of treatment for
this group of physiotherapists may be reduced by improving links subacute symptoms can directly influence the likelihood of chronicity,
between clinical and educational environments, thereby increasing these results would suggest that education and awareness of the
familiarity and enabling discussion of the resources required for MLS. causes and consequences of back pain may be a valuable treatment
This may lead to greater professional and financial support for qual- component for this patient subgroup. For chronic LBP there is strong
ified physiotherapists who wish to commence MLS. KEYWORDS: evidence to support the use of advice to remain active in addition to
Barriers, Master’s Education. FUNDING ACKNOWLEDGEMENTS: individually tailored advice relating to the most appropriate exercise,
Unfunded. CONTACT: [email protected] and/or functional activities to promote active self-management.
ETHICS COMMITTEE: Queen Margaret University College Research KEYWORDS: Advice, low back pain, randomised controlled trials.
Ethics Committee, Edinburgh, Scotland, United Kingdom. NHS FUNDING ACKNOWLEDGEMENTS: This project was funded as
Lanarkshire Research Ethics Committee, Scotland, United Kingdom. part of a PhD studentship by the Department for Employment and
Learning (Northern Ireland). CONTACT: [email protected]
1357 Monday 4 June 15:00 Research Report Platform Presentation
VCEC Ballroom A 1208 Monday 4 June 15:00
ADVICE FOR THE MANAGEMENT OF LOW BACK PAIN: DO VCEC Exhibit Hall A
RANDOMISED CONTROLLED TRIALS REFLECT CURRENT IMPLEMENTING AN INTEGRATED ELECTRONIC OUTCOMES
CLINICAL GUIDELINES? AND ELECTRONIC HEALTH RECORD PROCESS TO CREATE
Liddle S1 , Gracey J2 , Baxter D3 ; 1 Health and Rehabilitation A FOUNDATION FOR CLINICAL PRACTICE IMPROVEMENT
Sciences Research Institute, University of Ulster, Shore Road Deutscher D1 , Hart D2 , Horn S3 , Dickstein R4 , Gutvirtz M1 ;
Newtownabbey, Co. Antrim, BT37 0QB, Northern Ireland; 2 School 1 Maccabi Healthcare Services – HMO, Tel-Aviv, Israel; 2 Focus On
of Physiotherapy, University of Ulster, Shore Road Newtownabbey, Therapeutic Outcomes, Inc., White Stone, VA, USA; 3 Institute for
Co. Antrim, BT37 0QB, Northern Ireland; 3 School of Physiotherapy, Clinical Outcomes Research, Salt Lake City, Utah, USA; 4 University
University of Otago, Dunedin, New Zealand of Haifa, Mount Carmel, Haifa, 31905, Israel
PURPOSE: To synthesise evidence from randomised controlled trials PURPOSE: Clinical practice improvement (CPI) processes are
(RCTs) relating to the effectiveness of advice for low back pain dependent on routine collection of clinical outcomes, process and
(LBP), to compare the advice being offered to people with acute, patient characteristics. Our purposes were to 1) describe the
subacute and chronic LBP, and to evaluate the extent to which this integration of electronic functional status (FS) outcomes into an
is congruent with current clinical guidelines. RELEVANCE: Advice electronic health record (EHR); 2) examine the applicability of on-
is one of the principal ways that physiotherapists communicate going outcomes data collection in a large physical therapy service in
with patients, and is recognised as playing an important role in relation to patient and clinic burden; and 3) examine the potential
the management of LBP. More information is needed about the for using the FS/EHR database in CPI projects. RELEVANCE:
effectiveness of advice as it is given, and how this is reflected The conceptualization of functioning as described in the Guide to
in current clinical guidelines. PARTICIPANTS: Thirty-nine RCTs, Physical Therapist Practice appears consistent with ICF’s definition
involving 7,347 participants, qualified for inclusion based on their of activities and participation. Therefore, functioning, as described
methodological quality. METHODS: Systematic review of RCTs using by a patient’s ability to perform activities, appears important when
advice, either alone or with another intervention, in accordance establishing treatment goals in physical therapy. However, for
with the QUOROM guidelines and the Cochrane Collaboration Back patients with neuro-musculoskeletal disorders, integration of routine
Review Group Guidelines for Systematic Reviews (1997; 2003): measures of FS and EHR data in physical therapy settings are
methodological assessment identified RCTs of ‘high’ or ‘medium’ uncommon. PARTICIPANTS: Data were examined from 21,523
methodological quality, based on their inclusion of at least 50% consecutive adult patients (mean age=50.6, SD=16.3, range=18-99,
of the specified internal validity criteria. Outcome measures were 58.9% women) referred to physical therapy for treatment of functional
analysed based on five recommended core outcome domains. deficits secondary to neuro-musculoskeletal disorders. METHODS:
ANALYSIS: Statistical pooling of results was not appropriate due Process and patient characteristic data were entered into the EHR.
to the heterogeneity of trials. An intervention was considered Outcomes data were collected using computerized adaptive testing
positive if there was a significant difference (p < 0.05), in one of technology in 11 outpatient clinics and were integrated into the EHR.
the recommended categories of outcome measure post-treatment, Participation rate (percent of all episodes of care entered into the
when compared to other interventions provided in the trial. For EHR with FS intake data) and completion rate (percent of episodes
those trials using no outcome measures within the recommended with FS intake data that also had FS discharge data) were calculated.
categories, a significant difference in two other outcome measures Time required to enter FS data by the patient and administrative
was stipulated. RESULTS: Twenty three percent of trials investigating time required to manage the patient during FS data collection per
acute LBP had a positive outcome, compared to 86% and 74% of episode were collected. ANALYSIS: Descriptive statistics were used
subacute and chronic LBP trials respectively. Advice as an adjunct for analyses. RESULTS: After one year, average participation rate per
to exercise was the most common form of treatment for acute and clinic reached 79.8% (range=52.7%-100%) and average completion
chronic LBP. Advice as part of a back school was most commonly rate per clinic reached 45.1% (range=19.3%-64.7%). Average survey
used for subacute LBP; these trials generally demonstrated long- entry time per patient was 03:37 minutes (SD=02:19). Maximum
term positive results. A wide variety of outcome measures were estimate of average administrative time per patient was 9.6% of
used, making comparisons between treatment outcomes difficult. overall episode time. The integrated FS/EHR database contained
CONCLUSIONS: The type pf advice provided to people with LBP data from 5,039 episodes of care for 4,845 patients with both intake
within RCTs varies considerably depending on symptom duration. and discharge FS data including EHR patient demographic and
This has important implications for clinical practice, and for the design treatment process data. CONCLUSIONS: The results indicate that
of further clinical trials in this area. Findings from this review support the collection of routine outcomes measurements in a large public
current recommendations that advice to stay active is sufficient for physical therapy service is realistic. Participation and completion
acute LBP; however it appears that RCTs do not commonly reflect rate goals of 90% and 65%, respectively, appeared feasible.
these recommendations. IMPLICATIONS: The results of this review Improving completion rates through clinician’s education of clinical
tentatively support the use of advice as part of a back school use of outcomes, and if needed, by linking outcomes and provider
payment, seems promising. Integrated EHR/outcomes data produced Motor Accidents Authority of New South Wales, Australia. CONTACT:
a valuable CPI platform for service evaluation and outcomes [email protected]
research. Additional variables needed for more comprehensive ETHICS COMMITTEE: University of Sydney Human Research
CPI analyses were identified. IMPLICATIONS: The electronic Ethics Committee and South Western Sydney Area Health Service
environment used to register health records and measure outcomes Research Ethics Committee
enables comprehensive investigations into the best ways to treat
different patient populations. Actual clinical practice improvement will
depend on our ability to continuously analyze the clinical evidence
accumulating in the generated database, and translate it into 2645 Monday 4 June 15:20
practice, so educational processes can be applied to improve clinical
outcomes. KEYWORDS: Clinical Practice Improvement, Outcomes, FACTORS FACILITATING PHYSIOTHERAPISTS TO UNDERTAKE
Functional Status, Electronic Health Record, Computerized Adaptive TAUGHT MASTER’S EDUCATION
Testing. FUNDING ACKNOWLEDGEMENTS: The work not funded. Glover P1 , Bulley C2 ; 1 NHS Lanarkshire, Glasgow, Scotland,
CONTACT: [email protected] United Kingdom; 2 Queen MArgaret University College, Edinburgh,
ETHICS COMMITTEE: IRB, Maccabi Health Care Services – HMO, Scotland, United Kingdom
Tel-Aviv, Israel
PURPOSE: To explore the personal perspectives of physiotherapists
regarding the factors that facilitated them to commence their taught
Research Report Platform Presentation physiotherapy-related Master’s Level Study (MLS). RELEVANCE:
There is a lack of contemporary research into the factors that
encourage physiotherapists to undertake formal post-qualifying study.
With rapidly increasing knowledge there is a requirement for
ECOLOGICAL VALIDITY OF CLINICAL GAIT ASSESSMENT IN continuing professional development (CPD) to enable evidence-
ADULTS WITH TRAUMATIC BRAIN INJURY based practice. Taught MLS provides guidance in this development.
Moseley A1 , Canning C1 , Tate R2 , Wong D3 ; 1 School of Greater understanding of the factors assisting clinicians to undertake
Physiotherapy, University of Sydney, Sydney, Australia; MLS will enable more effective facilitation in clinical and educational
2 Rehabilitation Studies Unit, Northern Clinical School, Faculty environments. PARTICIPANTS: A purposive sample of 9 volunteers
of Medicine, University of Sydney, Sydney, Australia; 3 Brain Injury (8 female, 1 male, mean age: 36 ±7.29) was recruited. Participants
Rehabilitation Unit, Liverpool Health Service, Sydney, Australia were: engaged in part-time taught MLS; registered with the
United Kingdom’s professional regulatory body; working within
PURPOSE: To evaluate the ecological validity of clinical gait the National Health Service, and possessed a minimum of four
assessments that use a dual-task performance paradigm in adults years clinical experience. METHODS: A qualitative, interpretative,
with traumatic brain injury (TBI). RELEVANCE: After TBI, walking is phenomenological study was undertaken with the assumption that
generally slower than in the able-bodied population. An important reality is individual and all viewpoints are valid. Following ethical
focus of physiotherapy intervention is to re-establish a more approval, individual, semi-structured interviews (mean time: 67
efficient gait that can meet the demands of everyday environments. minutes) were conducted using an interview schedule. Questions
Physiotherapists need ecologically valid gait tests that can predict were derived from a literature review, two developmental interviews,
and provide information about a person’s ability to walk in a and two pilot interviews. ANALYSIS: Interviews were transcribed
real-life environment. Agreement between three commonly used verbatim and a summary was member-checked to ensure that
gait tests (comfortable and fast pace over a 10-m distance and initial interpretations were appropriate. Data analysis was conducted
a 6-min walk test) and walking in real-life environments has using the framework of interpretative phenomenological analysis.
previously been reported to be poor. PARTICIPANTS: Forty-eight This focuses on analysis and interpretation of the participants’
adults with traumatic brain injury participating in multidisciplinary words in context to gain deeper understanding of their experiences.
inpatient rehabilitation, including physiotherapy gait training and an Quotations that communicated similar meanings and ideas were
occupational therapy shopping group. METHODS: Walking speed grouped to form themes. Where conceptual links were identified,
was measured in the clinic using four comfortable 10-m walk tests key themes emerged. Peer verification of this analysis was
(walking alone, walking while performing a concurrent cognitive conducted to increase rigour and involved reflexive discussions
task, walking while performing a concurrent manual task, and with an experienced qualitative researcher. RESULTS: Four key
walking while performing both the cognitive and manual tasks themes emerged that described the facilitating factors in different
concurrently). Walking speed was also measured covertly in three environments: social, educational, clinical, and working. Within the
real-life environments (ie, a corridor in the rehabilitation unit, a car Social Environment, participants commented that a settled home
park of a metropolitan shopping centre, and inside a metropolitan life and future domestic plans influenced their MLS commencement.
shopping centre). ANALYSIS: A matrix of intraclass correlation There were several facilitators associated with the Educational
coefficients (ICC; type 1, 1) was calculated to determine the Environment; some individuals expressed positive emotions towards
agreement between the speed in the clinical gait tests and in the real- learning, while others were seeking the challenge of MLS. Also, the
life environments. RESULTS: Highest agreement occurred between content of the Master’s programmes being clinically relevant and
walking while performing a concurrent cognitive task and walking accredited, and the flexibility of the modular structure were motivating
in the real-life environments (ICC 0.50 to 0.71). CONCLUSIONS: factors for some participants. Regarding the Clinical Environment;
Clinical gait tests that involve walking while performing concurrent some individuals indicated a desire to develop their skills within
tasks have higher ecological validity than walking alone. These tests their professional role, or for career progression. Finally, Working
may better mimic the processing demands of walking in real-life Environment facilitation came from the provision of professional
environments, where the person with TBI needs to monitor and support, the expectation for CPD, and interactions with colleagues
respond to the movement of other people and objects in addition with experience of MLS. CONCLUSIONS: The experiences of this
to attending to their walking. IMPLICATIONS: Clinical gait testing group of post-qualifying students suggest that the factors facilitating
should include a concurrent task component as this may better them to undertake MLS were varied and individualised. Their
simulate the requirements needed in functional walking. Furthermore, facilitators could be practical, personal or professional in nature.
practice in real-life environments should be incorporated into a Further research into the facilitators to undertake various types of
walking training program for people with TBI. KEYWORDS: traumatic post-qualifying education is required to generate a body of evidence
brain injury, walking, validity. FUNDING ACKNOWLEDGEMENTS: to help develop effective mechanisms for supporting clinicians in
their formal CPD. IMPLICATIONS: Educational institutions may need the study were the small and predominantly non-adhering sample
to consider promoting the professional and personal benefits of and an emphasis on individual determinants. IMPLICATIONS: The
undertaking their programmes to encourage clinician enrolment. determinants associated with physiotherapists’ guideline adherence
Whereas employers offering practical professional support may in this study may be used in further research to determine whether
also aid facilitation. KEYWORDS: Facilitation, Master’s Education. they indeed explain and predict guideline implementation. In future
FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT: pe- implementation studies, Rogers’ Diffusion of Innovation theory could
[email protected] very well serve as the foundation for a more coherent theoretical
ETHICS COMMITTEE: Queen Margaret University COllege Re- framework. For that purpose, we suggest to consider the addition
search Ethics Committee; Lanarkshire Research Ethics Committee of theories of behavioral and organisational change. KEYWORDS:
clinical guidelines, Diffusion of innovations theory, focus group
interviews. FUNDING ACKNOWLEDGEMENTS: This project was
unfunded. CONTACT: [email protected]
VCEC Ballroom A
A THEORY-BASED QUALITATIVE STUDY TO EXPLORE
POSSIBLE DETERMINANTS OF GUIDELINE ADHERENCE 3026 Monday 4 June 15:20
AMONG DUTCH PHYSIOTHERAPISTS VCEC Meeting Rooms 8&15
Harting J1 , Rutten S2 , Rutten G3 , Kremers S1 ; 1 Department of THE EFFECT OF EXERCISE TRAINING ON METABOLIC
Health Education and Promotion, Maastricht University, Maastricht, FUNCTION AND LIPODYSTROPHY IN HAART-TREATED
the Netherlands; 2 Praxis für Physiotherapie und Manuelle Therapie, ADULTS WITH HIV INFECTION IN RWANDA
Aachen, Germany; 3 Centre for Quality of Care Research (WOK), Mutimura E1 , Stewart A2 , Crowther J3 ; 1 Kigali Health Institute,
UMC St Radboud Nijmegen, Nijmegen, the Netherlands Practice Department of Physiotherapy, P. O. BOX 3286 Kigali, RWANDA, Tel:
for Physiotherapy and Manual Therapy, Uden, the Netherlands +250 08769615 Fax: +250 57 17 87 e-mail: [email protected];
2 University of the Witwatersrand, School of Therapeutic Sciences,
PURPOSE: The studies primary goal was to explore possible
Johannesburg, Republic of South Africa; 3 University of the
determinants of physiotherapists’ adherence to the guidelines for
Witwatersrand, Department of Chemical Pathology, National Health
low back pain in the Netherlands. This should yield the information
Laboratory Service, Johannesburg, Republic of South Africa
necessary for a subsequent quantitative determinant study. A
secondary goal was to investigate the applicability and value of PURPOSE: To assess the effect of exercise training on serum
Rogers’ Diffusion of Innovations theory in implementation research. metabolic variables and lipodystrophy in a population of HIV-infected
RELEVANCE: Various studies indicate that the implementation of African subjects taking HAART. RELEVANCE: As an increased num-
clinical guidelines is far from optimal. Interventions to enhance ber of HIV-infected adults access HAART in developing countries, the
guideline adherence have been found to be of limited effectiveness. task is how to manage HAART-associated metabolic abnormalities.
This has been attributed to the absence of a coherent theoretical In Rwanda, lipodystrophy is present in approximately one-third of
framework. In addition, determinant studies of guideline adherence subjects receiving WHO-recommended HAART. PARTICIPANTS:
are lacking. This study presents a first but important step to A random sample of 100 HIV-positive adults with moderate to
close these gaps. PARTICIPANTS: Three physiotherapy educational severe lipodystrophy was selected. METHODS: The presence of
cooperatives, of 12, 10, and 8 physiotherapists, respectively, were lipodystrophy was determined by a waist-to-hip ratio (WHR) 1.0
found to be willing to participate. The total sample consisted of (men) and 0.90 (women). Participants were randomly assigned
both men and women and covered a wide range in age and years to a 24-week intervention of moderate aerobic exercise (90-
of working experience. METHODS: Focus group interviews were min/day, 3-days/week) (HIV+LIPO+EXS, n=50, 30 women, 37.7±6.2
arranged to discuss the guidelines. The interview routing was based years) or non-intervention control group (HIV+LIPOnoEXS, n=50,
on Rogers’ theory. According to this theory, physiotherapists perceive 30 women, 37.7±6.3 years). The exercise program comprised
guidelines as an innovation. The theory predicts that the diffusion of 15 minutes brisk walk warm up and stretching, 60 minutes
process of guidelines evolves through five succeeding stages: of jogging, running and abdominal exercises and 15 minutes of
knowledge, persuasion, decision, implementation, and confirmation. cool down and stretching exercises. Skin folds, WHR and fasting
The first two are called dissemination, the latter three adoption. For total cholesterol, LDL-, HDL- and triglyceride, glucose and insulin
each of the stages, different determinants are assumed to be of levels were measured at baseline and following the 24-week
influence. ANALYSIS: The interviews were recorded on audio tape, exercise program or control period. ANALYSIS: Changes over
transcribed verbatim, and qualitatively analysed within the computer the 24 week period were compared between the exercise and
program NVivo 2.0. The structured analysis technique reflected the non-exercise group using the Mann-Whitney U test, expressing it
most salient aspects of Rogers’ five diffusion stages. RESULTS: as a percentage of the baseline value. The Wilcoxon matched
The common stance towards the guidelines was rather negative. All pairs test was used to compare mean values for variables at
physiotherapists knew about the guidelines, but most of them did baseline and after the 24 week period. The relationship between
not pay much attention to them, nor did they take a warm interest level of attendance at the exercise sessions and anthropometric
in them (knowledge). They expressed serious doubts concerning and metabolic variables were analysed using Pearson correla-
the guidelines’ fidelity, advantages, compatibility and complexity tions. RESULTS: BMI significantly decreased following exercise
(persuasion). Their motivation to gather further information was low. training in HIV+LIPO+EXS subjects from 24.0±2.9 to 23.4±2.7,
Most participants had not even partially tried out the guidelines, p = 0.0001) compared to no change in HIV+LIPOnoEXS subjects
nor had they noticed many such trials by others (decision). They (24.4±2.2 to 24.5±2.7, p=NS). WHR decreased in HIV+LIPO+EXS
used the guidelines neither regulary nor entirely, for instance subjects (0.99±0.05 to 0.89±0.03, p = 0.0001) compared to no
because of perceived social influences and operational problems change in HIV+LIPOnoEXS subjects (0.98±0.05 to 0.99±0.03,
(implementation). Finally, they showed only little commitment to the p=NS). The percentage change in tricep (−8.73±11.73% vs.
guidelines (confirmation). CONCLUSIONS: Among the participating −1.44±5.10%; p = 0.0001), bicep (−4.57±10.48% vs. −0.57±2.94%;
physiotherapists, the diffusion of the guidelines for low back pain p = 0.01), subscapular (−9.22±14.20% vs. −2.34±6.81%; p = 0.003)
remained mainly restricted to the level of dissemination. For only and suprailiac (−9.03±13.97% vs. −1.73±5.37%; p = 0.005) skin
some of them, the level of adoption had been reached. Rogers’ folds were significantly greater in the HIV+LIPO+EXS than
theory appeared to be applicable as well as valuable in exploring the HIV+LIPOnoEXS group. Serum glucose levels changed by
the determinants of guideline adherence. The main limitations of −2.93±13.63% in the HIV+LIPO+EXS group and by +10.34±27.52
(p = 0.02) in the HIV+LIPOnoEXS cohort. Fasting triglyceride levels in the hemiplegic limbs. In Group A (n=9) a small reduction in PPRT
were 1.34±0.40mmol/l at baseline in the intervention group and was evident between baseline and one minute with a non-significant
1.12±0.28mmol/l (p = 0.004) after the 24 week exercise programme. decrease at three minutes. In group B (n=8) PPRT progressively
No significant change in triglyceride levels was observed in the non- decreased over the three minutes of cyclic stretching (p < 0.001).
exercise group. The level of attendance at the exercise sessions was Marked velocity dependent stiffness was evident in Group B subjects
significantly associated with WHR at the end (r=−0.52, p = 0.0001) when comparing PPRT at slow stretches (5º/sec-1) with faster stretch
but not at the beginning (r=−0.24, p = 0.10) of the intervention. velocities (25º/sec-1). CONCLUSIONS: Velocity dependent passive
CONCLUSIONS: Exercise decreases serum triglyceride levels and stiffness was demonstrated in the affected limb of some hemiplegic
WHR and blocks increases in serum glucose levels in HIV-infected subjects. The potential for cyclic stretching to have a short-term
Africans with HAART-associated lipodystrophy. IMPLICATIONS: influence on passive stiffness in a subset of individuals with acquired
Exercise can be an important treatment strategy for HIV-positive in- brain injury is supported by these data. IMPLICATIONS: Further
dividuals suffering from HAART-associated lipodystrophy, particularly investigation is required to identify the clinical characteristics of
in countries with minimal resources to manage HAART-associated those who might benefit from this intervention. It is anticipated that
metabolic complications. These results highlight the role of physical reduced PPRT would increase the available range of dorsiflexion
therapists in the multidisciplinary care of an HAART-treated, HIV- during functional mobility tasks with the potential to impact on the
positive population. KEYWORDS: Exercise training, HIV Lipodys- risk of falls due to tripping. KEYWORDS: Calf muscle hypertonia;
trophy, metabolic function. FUNDING ACKNOWLEDGEMENTS: We Cyclic stretching; Hemiplegia. FUNDING ACKNOWLEDGEMENTS:
thank the Commission Nationale de Lutte Contre le SIDA and Multi- None. CONTACT: [email protected]
Sectorial AIDS Program (MAP), RWANDA for sponsoring this study. ETHICS COMMITTEE: Ethics c’tee at Royal Perth Hospital, Western
ETHICS COMMITTEE: National Ethics Committee (Rwanda), Australia
and the University of the Witwatersrand (Johannesburg) Human
Research Ethics Committee for human subjects
Research Report Platform Presentation VCEC Ballroom A
2370 Monday 4 June 15:40 EXPERT CONSENSUS EVIDENCE WAS COMBINED WITH
PP Crystal Pavilion A RESEARCH EVIDENCE TO DEVELOP CLINICALLY USEFUL
THE EFFECT OF REPEATED PASSIVE ANKLE MOTION ON GUIDELINES FOR PEOPLE WITH PERSISTENT LOW BACK PAIN
INCREASED CALF MUSCLE STIFFNESS AFTER ACQUIRED Jackson A1 , Barlos P2 , Ferguson S3 , Harding V4 , Hettinga D1 ,
BRAIN INJURY Klaber Moffett J5 , Martin D6 , May S6 , Mercer C7 , Monteath J8 ,
Singer B1 , Cawley D1,2 , Dunne J3 , Singer K1 ; 1 Centre for Roberts L9 , Taylor N10 , Woby S11 ; 1 The Chartered Society of
Musculoskeletal Studies, The University of Western Australia, Physiotherapy, London, UK; 2 Keele University, Newcastle-under-
Nedlands 6009, Australia; 2 Neurosurgical Rehabilitation, Royal Lyme, UK; 3 Royal United Hospital, Bath, UK; 4 St. Thomas’ Hospital,
Perth Hospital, Perth 6000, Australia; 3 Department of Neurology, London, UK; 5 University of Hull, Hull, UK; 6 Sheffield Hallam
Royal Perth Hospital, Perth 6000, Australia University, Sheffield, UK; 7 Worthing & Southlands Hospitals NHS
Trust, Worthing, UK; 8 Barnet & Chase Farm Hospitals Trust, London,
PURPOSE: Increased calf muscle stiffness is a common impairment
UK; 9 University of Southampton, Southampton, UK; 10 BackCare,
following acquired brain injury which can severely compromise
London, UK; 11 North Manchester General Hospital, Manchester, UK
functional mobility. The effect of passive cyclic stretching on
hypertonic muscle has not been extensively studied. RELEVANCE: PURPOSE: To generate expert consensus evidence, where the
The aim of the study was to compare the effect of cyclic ankle research evidence was incomplete, in order to develop clinical
stretching on peak plantarflexor resistive torque (PPRT) in individuals guidelines that were as complete as possible. These guidelines
with hemiplegia and control subjects. A secondary aim was to sought to address 24 clinical questions about the effectiveness (in
compare the effect of different stretch velocities. PARTICIPANTS: A reducing pain, improving function and improving psychological status)
sample of convenience of subjects with hemiplegia following stroke of different types of exercise for people with persistent low back
or traumatic brain injury (n=17, mean age = 45, range 22-76, time pain (LBP). The systematic review of the literature found research
since injury mean = 11.4, range 6–36 months, nine females) and evidence to answer just seven of these questions. RELEVANCE:
age and gender matched control subjects (n=11) were included Persistent LBP is expensive because of its prevalence is high;
in the trial. METHODS: Cyclic stretches were applied for three treatment must be as effective as possible. Clinical guidelines are
minutes at two stretch velocities (25º/sec-1 versus 5º/sec-1) using a recommendations for practice that are based on the best available
purpose-built dynamometer under Labview control (Labview, National evidence. PARTICIPANTS: An expert group (n=23) including a
Instruments). The stretch excursion was 20º plantarflexion to 80% of representative of the patient perspective, and back pain specialists
each subject’s maximal dorsiflexion range. Surface electromyography working in a range of settings (clinical practice, research and
from the medial soleus and tibialis anterior muscles was sampled management) throughout the UK. METHODS: Using a nominal
to ensure stretches were passive. ANALYSIS: Torque-angle curves group technique the experts completed a questionnaire (using a
were derived from the data. PPRT was represented by the torque three-point Likert scale) giving their opinion to the 17 questions
(N.m) at 80% of maximal passive range of ankle dorsiflexion. unanswered by the systematic review. On a first round of this
Baseline PPRT data were compared using paired and unpaired t- questionnaire, consensus (defined as 75% agreement) was achieved
tests with data at one, two and three minutes, and also between for five questions and these were removed from the questionnaire.
stretch velocities for each time point, for hemiplegic and control The remaining 12 questions were discussed over a two-week period
subjects and between limbs in the former group, respectively. using electronic conferencing. After this a second round of the
Acceptable test re-test reliability was demonstrated from control consensus questionnaire was carried out. All communication was
data. RESULTS: PPRT during initial slow stretches (5º/sec-1) in the by electronic methods and took place over a six-week time period.
hemiplegic limb was significantly greater than the less affected limb ANALYSIS: After each round, the questionnaire responses were
(p = 0.001), and control limbs (p= 0.001). Control subjects showed recorded on an Excel spreadsheet and the percentage agreement
a small decrease in PPRT which stabilised during the first minute for each question calculated. RESULTS: On the second round
of cyclic stretching. No effect of stretch velocity was identified. A of the questionnaire, consensus was achieved for a further nine
similar response pattern was noted in the less affected limb of questions. CONCLUSIONS: This process lead to 14 consensus
hemiplegic subjects. Post hoc analysis revealed two distinct trends evidence statements (for example, mobilising and hydrotherapy
exercises reduce pain) on which recommendations for practice were were associated with level of participation. Balance, usual gait
formulated. The consensus questions are the recommendations for speed, lower extremity strength (ankle dorsiflexor and plantarflexor
future research. When the guidelines are updated, if the research muscle groups) and hamstring flexibility were important determinants
evidence is more complete, there will be less reliance on consensus of level of participation, while spasticity and sensation were not.
evidence. IMPLICATIONS: The expert consensus evidence enabled IMPLICATIONS: An improved understanding of the factors impacting
the guideline developers to produce more clinically useful recommen- recovery of the ability to walk safely and independently in the
dations for practice than would have been possible using the research community will assist therapists in developing effective clinical
evidence alone. It also raised awareness of gaps in the literature strategies for retraining community mobility. KEYWORDS: stroke,
and generated discussion about these. KEYWORDS: consensus participation, mobility. FUNDING ACKNOWLEDGEMENTS: This
evidence; evidence based recommendations; effective practice. study was supported with funding from the Walter Stolov Research
FUNDING ACKNOWLEDGEMENTS: This work was commissioned Fund, University of Washington, Seattle, Washington. CONTACT:
by the Chartered Society of Physiotherapy, London, UK. CONTACT: [email protected]
[email protected] ETHICS COMMITTEE: Institutional Review Board, Human Subjects
Division, University of Washington, Seattle, Washington.
PP Crystal Pavilion B & C 989 Monday 4 June 16:15
CLINICAL FACTORS IMPACTING PARTICIPATION IN VCEC Ballroom B & C
COMMUNITY MOBILITY FOLLOWING STROKE INTRA-TESTER RELIABILITY OF TWO CLINICAL TESTS OF
Robinson C, Shumway Cook A, Matsuda P, Ciol M, Beaverson J, TRANSVERSUS ABDOMINIS MUSCLE RECRUITMENT
Soine S, Flemming A; Department of Rehabilitation Medicine, Menezes L1 , Costa L1,2 , Cançado R1 , Oliveira W1,3 , Ferreira P3 ;
University of Washington 1 Pontifı́cia Universidade Católica de Minas Gerais, Belo Horizonte,
Brazil; 2 Back Pain Research Group, School of Physiotherapy, The

PURPOSE: Limited participation in community mobility is a common
University of Sydney, Australia; 3 Universidade Federal de Minas
occurrence following stroke, however the skills and clinical factors
Gerais, Belo Horizonte, Brazil
affecting participation are largely unknown. This study measured
participation in community mobility among adults with and without PURPOSE: The objective of this pilot study was to check the
stroke, and examined the relationship between clinical measures intra-tester reliability of the Pressure Biofeedback Unit (PBU) and
of sensation, strength, range of motion, balance, and gait to the palpation test in assessing TrA recruitment. RELEVANCE: It
participation in community mobility in order to identify clinical factors is widely accepted that the gold standard methods for measuring
impacting participation. RELEVANCE: In the United States, stroke recruitment of the transversus adbominis muscle (TrA) are needle
is the leading cause of disability, and limited mobility is a major electromyography (EMG) and real time ultrasound (US). However,
factor contributing to disablement among adult survivors of stroke. these tools have limitations, EMG is an invasive method where
Recovery of participation in mobility is an important goal in the pain and infection are possible adverse side effects, and both
rehabilitation of survivors of stroke. PARTICIPANTS: The sample EMG and US are costly, limiting the use of these tools in clinical
was composed of 25 adults diagnosed with stroke (mean age practice. In clinical practice TrA recruitment is normally assessed
68±9; mean time since stroke 40 mos, able to walk without the by palpation or by using the Pressure Biofeedback Unit (PBU).
assistance of another) and 25 adults (mean age 68±11) without PARTICIPANTS: Twenty-nine physiotherapy students participated in
stroke. METHODS: Level of participation in community mobility the study. Inclusion criteria: Absence of low back pain during the
was determined by self-reported number of trips and walking- last 12 months and aged between 18-30 years. Exclusion criteria:
related activities performed over a 12-day period (72 hour recall Pregnancy, previous spinal or abdominal surgery and menstruation
trip activity log completed once a week for four weeks). Clinical at the time of the tests. METHODS: A test-retest reliability study
factors tested included balance (Berg Balance Test (BBT)), usual was performed, with a seven-day interval between tests. The PBU
gait speed (10m gait), lower extremity strength (dynamometer), range test was done with the volunteer in a prone position with the bags
of motion (goniometry), sensation (light touch and proprioception), positioned under the abdominal wall with the PBU being inflated to
and spasticity (modified Ashworth scale). ANALYSIS: Comparisons 70mmHg. The volunteer was asked to draw in their abdominal wall
between the two groups were performed using Mann-Whitney for 10 seconds without pelvic movements while breathing normally.
and Chi-square tests for continuous and categorical variables, This procedure was repeated 3 times and we collected the maximum
respectively. In the stroke group, the relationship between clinical pressure value attained over a 2 second period of time. The palpation
measures and total number of trips and walking-related activities test was performed with the volunteer positioned in a supine position
were analyzed using negative binomial regression, while linear and the rater placed her fingers medially 2 centimeters from the
regression was used for the ratio of activities per trip. RESULTS: iliac crests. The rater asked the patient to draw in the abdominal
Compared to adults without stroke, participation in community wall again for 10 seconds and classified the contraction into four
mobility in adults with stroke was characterized by significantly fewer different categories. ANALYSIS: To evaluate the reliability of the PBU
trips (p = 0.001), fewer walking-related activities (p < 0.001), and a assessments, we performed an Intraclass Correlation Coefficient
lower ratio of walking-related activities per trip (p = 0.005). In addition, (ICC 2,1). To evaluate the reliability of the palpation test we used
adults with stroke reported a lower level of satisfaction with their level the Kappa coefficient. RESULTS: Both tests achieved a moderate
of participation in community mobility (p < 0.001) compared to those reliability according to the benchmarks of Fleiss (1986). A Kappa of
without stroke. Adults with stroke were significantly (<0.05) more 0.52 (95% CI) (0.29 to 0.75)was obtained for the palpation test while
impaired on all clinical measures compared to non-stroke. Among an ICC (2,1) of 0.58 (95% CI) (0.28 to 0.78) was obtained for the PBU
adults with stroke, after adjusting for age and sex, the clinical factors test. CONCLUSIONS: This is the first study to assess the reliability
affecting participation (number of walking-related activities performed of the palpation test. Our results demonstrate that both PBU and
per trip) included strength (dorsiflexors and plantarflexors), hamstring palpation tests have sufficient reliability for assessing TrA recruitment
muscle length, balance, and usual gait speed. CONCLUSIONS: in clinical practice however it would be useful to consider whether
Results confirm that participation in community mobility is limited modifications to the test protocol may enhance reliability. For research
following stroke, and this is a source of dissatisfaction among purposes, where precision is important, the EMG and US tests are
adult survivors of stroke. While adults with stroke were significantly clearly better options to assess TrA recruitment. IMPLICATIONS:
more impaired on all clinical measures, not all clinical measures These clinical tests are reliable, safe and low cost options for using in
clinical practice. KEYWORDS: Clinical tests, transversus abdominis, main study in order to identify the future role of physiotherapy in
reliability. FUNDING ACKNOWLEDGEMENTS: Leonardo Costa is their rehabilitation. KEYWORDS: critical illness; physical limitations.
a PhD student supported by CAPES – Brazil. CONTACT: Luciola FUNDING ACKNOWLEDGEMENTS: National Research Foundation
Menezes – [email protected] of South Africa Thuthuka Researchers in Training Programme;
ETHICS COMMITTEE: This study has ethics approval from Pontifı́cia Medical Faculty Research Endowment Fund of the University of the
Universidade Católica de Minas Gerais Ethics Committee. Witwatersrand. CONTACT: [email protected]
ETHICS COMMITTEE: Committee for Research on Human Subjects
(Medical) of the University of the Witwatersrand, Johannesburg.
VCEC Exhibit Hall A Research Report Platform Presentation
THE EFFECT OF PENETRATING TRUNK TRAUMA ON THE 1535 Monday 4 June 16:15
RECOVERY OF ADULT SURVIVORS:A PILOT STUDY VCEC Meeting Rooms 11-12
Van Aswegen H1 , Eales C1 , Richards G2 , Goosen J3 , Mudzi W1 ; TOURNAMENT-RELATED ANXIETY IN PROFESSIONAL FEMALE
1 Physiotherapy department, School of Therapeutic Sciences, TENNIS PLAYERS: AN APPLICATION OF THE TRANSACTIONAL
University of the Witwatersrand, Johannesburg, South Africa; MODEL OF STRESS AND COPING
2 Pulmonology department, Johannesburg General Hospital,
Ortega C1 , Bartholomew J2 , Owen S1 ; 1 University of Texas Health
Johannesburg, South Africa; 3 Trauma Intensive Care Unit, Science Center at San Antonio; 2 University of Texas at Austin
Johannesburg General Hospital, Johannesburg, South Africa
PURPOSE: Structural Equation Modeling (SEM) was used to
PURPOSE: Gunshot and stab wounds to the trunk are common investigate this elite, under-studied population. A conceptual model
injuries seen in South African hospitals. These injuries necessitate was constructed that describes the extent to which individual
exploratory surgical intervention to manage injuries to internal differences in athlete’s social support, coping skills and tennis
organs. Patients are managed in intensive care and often undergo ability, singly and in combination are related to the manifestation
prolonged mechanical ventilation. Immobilization results in some of cognitive state anxiety. RELEVANCE: Physical therapists must
degree of muscle dysfunction. No database exists in South Africa have an understanding of the cognitive processes that impact
to reflect the recovery rate of these patients after hospital discharge. stress in order to impact wellness and assist patients to manage
RELEVANCE: Prolonged recovery and slow return to work rate after stress. This investigation provides insight into an understudied
critical illness may impact negatively on South African economy. population in a high performance, stressful situatin. PARTICIPANTS:
It is not known whether a rehabilitation programme is indicated During the US OPEN, 94 professional female tennis players (18-
to enhance recovery of these patients. PARTICIPANTS: Twelve 47 years) responded to a Competition Questionnaire. METHODS:
consecutive adults with penetrating trunk trauma and prolonged Factor analysis was used to test the validity structure of the scales
mechanical ventilation were recruited from the trauma intensive within this measurement instrument. The scales used addressed
care units of three hospitals in Johannesburg between February dispositional coping strategies, cognitive appraisal, current coping
2004 and June 2005. METHODS: Aims: a)Establish the feasibility strategies, competitive state anxiety and perceived sense of social
of carrying out longitudinal research for this population, b) identify support. ANALYSIS: Factor loadings for items were obtained to
limitations posed for the main study, c) determine differences in identify the relevant indicators of the latent variables to be used
lung function, muscle strength, exercise capacity and quality of life within the measurement models. Items loading <0.3 were discarded.
between survivors and an age and sex-matched control population. Goodness of fit for the constructed measurement models was tested.
A prospective observational pilot study was conducted. Patients were A CFI value greater than 0.90 was considered indicative of acceptable
evaluated at one, three and six months following hospital discharge. fit with a value greater than 0.95 indicative of close fit (Bentler &
Demographic data, lung function tests, muscle strength, exercise Bonnett,1980). A RMSEA below 0.08 was considered a “reasonable
capacity tests and quality of life tests were recorded. ANALYSIS: fit” with <0.05 a “close fit” (Browne & Cudeck, 1993). The Chi-square
Data collected were expressed as means and standard deviations. statistic was also reported as a goodness of fit index. From the
A correlation coefficient was calculated for distance walked on the measurement models, a larger model was constructed, goodness
6-minute walk test versus that of the peak oxygen uptake test. of fit assessed and standardized path scores were reviewed for level
Two tailed t-tests were used to compare subject data with the of significance (p < 0.05). Effect size was also determined with <0.2
control group data. A p < 0.05 was significant. RESULTS: Distance considered small (Cohen, 1988). RESULTS: Retained paths included
walked (6MWT)was significantly reduced comparing subjects to those between primary appraisal and avoidance coping, (path score
the control group over 6-months (p = 0.0025-0.0355). At 1-month = 0.98, p < 0.05), primary appraisal and state anxiety (path score
there was significant difference in triceps and quadriceps strength = 0.99, p < 0.05), avoidance coping to state anxiety (path score =
between the subjects and control group (p = 0.0089 quadriceps; 0.59, p= 0.04) and social support to approach coping (path score
p = 0.0246 triceps). No difference in muscle strength detected =0.53, p < 0.05). The final model has an acceptable goodness of
between groups at 6-months. At 1-month there was significant fit with c2(65) = 82.4 (p = 0.07), CFI=.93 and an acceptable fit of
difference between actual (mean = 2.23L) and predicted (mean = RMSEA=0.05 (CI low = 0.00 and CI high = 0.08). CONCLUSIONS:
1.56L) residual lung volumes for study subjects (p = 0.0034). This Results demonstrate that elite athletes within this population differ
remained significant at 6-months (p = 0.0157). Below average peak from the general population with regard to their experience and
VO2 results were found in study subjects. Physical function, general management of stress. Findings suggest that use of avoidance
health and physical summary scores (SF-36) were significantly strategies increases competitive state anxiety and that as an
different between groups at 1-month (p < 0.0001), 3-months (p athlete perceives greater social support they will be more likely
0.0001-0.0003) and 6-months (p 0.0001-0.013). CONCLUSIONS: to use approach coping strategies. Outcomes of this investigation
Longitudinal research is possible as the drop out rate was relatively enhance measurement of the stress process and suggest that it is
low. Survivors of penetrating trunk trauma and prolonged mechanical inappropriate to use standard coping and appraisal measurements
ventilation have limitations in muscle strength up to 3-months without validation for this group. IMPLICATIONS: This model can
after discharge. They also present with limitations in exercise guide interventions and future investigations. Specifically, health
capacity, lung function and physical quality of life at 6-months after care providers, such as physical therapists who understand the
discharge compared to a control group. IMPLICATIONS: A trend components of the TA model are in an ideal position to help patients
of physical limitations was detected in this group up to 6-months and athletes manage stress. The social support provided and the
after discharge. These findings support the continuation of the ability to impact appraisal can help to diminish state anxiety and
enhance wellness and performance. KEYWORDS: stress, coping, trunk muscle,velocity,. FUNDING ACKNOWLEDGEMENTS: This
appraisal, performance. FUNDING ACKNOWLEDGEMENTS: This study was supported by a grant from the Social Insurance Institution
investigation was undertaken without funding provided by any entity. of Finland. CONTACT: jukka.surakka@arcada.fi
CONTACT: [email protected] ETHICS COMMITTEE: Study was approved by the Ethical Commit-
ETHICS COMMITTEE: Both University of Texas at Austin IRB and tee of the Research and Development Centre of the Social Insurance
Univ. of Tx. Health Science Center at San Antonio Institution of Finland

COMPARISON OF TWO DIFFERENT TRUNK MUSCLE TRAINING CLINICAL REASONING IN THE BOBATH CONCEPT-A
PROGRAMS IN MIDDLE-AGED HEALTHY MEN THEORETICAL MODEL OUTLINING THE PARAMETERS OF
QUALITY OF MOVEMENT
Surakka J1 , Aunola S2 , Ailanto P3 , Alanen E2 , Kylliainen A2 ,
Karppi S4 ; 1 Arcada polytechnic; 2 National Public Health Institute; Meadows L; Leeds Metroplitan University, Leeds, United Kingdom
3 Finnish Back Association; 4 Social Insurance Institution of Finland
PURPOSE: Explicit knowledge of the implicit skills of the Bobath
PURPOSE: Decreased strength and power of the lower trunk therapist are sparse and so this study sets out to identify
muscles is a potential risk factor for low-back disorders, therefore parameters of quality of movement used as a basis for clinical
it is important to find feasible methods for improving the trunk reasoning. RELEVANCE: It is vital that the clinical application of
muscle strength and power. The heterogeneity of the contents of the Bobath Concept is systematically researched to achieve best
low-back training interventions make it difficult to evaluate which practice. PARTICIPANTS: 13 members of the British Bobath Tutors
training duration, frequency and training type are the most effective. Association(BBTA)took part in this study. They play a key role in
This study aimed to compare the efficacy of two different trunk the teaching of the Bobath Concept predominantly in the UK, and
muscle training programs in healthy middle-aged men. RELEVANCE: worldwide. METHODS: Focus group methodology was chosen in
To find a feasible training type, duration and frequency in trunk order to generate qualitative data by capitalising on the interaction
muscle training in preventing low-back disorders. PARTICIPANTS: that occurs within a group discussion. Three homogeneous groups
Fifty-one healthy male exercisers and 18 non-exercising controls were used. Each session was moderated by the researcher and the
(43±9 years) paricipated in the study.The exercisers trained in taped discussions transcribed. These were verified by a nominated
two groups with different training methods and durations; a 54- group member. The funnel approach was used for questions, which
week training group (W54, n=23, 44±5 years) and the 22-week were gathered from available evidence. ANALYSIS: Content analysis
training group (W22, n=28, 45±6 years). METHODS: The 54-week was carried out using the model proposed by Kreuger(1998). This
training group participated in controlled, individually planned basic involved unitising the data to code discussion on specific topics
strength and power training using resistance machines and weights. including aspects such as frequency, extensiveness and intensity
The 22-week group (W22, n=28, 45±6 years) participated in a of comments. The data was verified by two independent assessors.
power and velocity training program carried out as supervised group RESULTS: Three main themes were identified: 1)An understanding
gymnastics, without external loads. The study was a controlled of the term quality of movement 2)Parameters of quality of movement
intervention study Muscle torque and velocity in flexion and extension 3)Clinical reasoning The parameters of quality of movement were
were measured by using an isoinertial dynamometer before and incorporated into a theoretical model. The five main themes
after the intervention. A questionnaire was used at the baseline to being: 1) Postural alignment; 2) Patterns/sequences of movement;
obtain information about low-back, hip, shoulder and neck symptoms 3) Speed/effort; 4) Functional range of movement; 5) Goal orientated
and the type of present physical activity. Perceived health and movement. The Bobath Concept was described as working towards
fitness were inquired before and after the intervention by means efficient movement, rather than normal movement, in order to explore
of a questionnaire. ANALYSIS: The chi-square test was applied and access the potential of the individual. An understanding of how
to examine the distribution of musculoskeletal symptoms, physical the parameters of quality of movement interconnect was identified
activity and self-rated health and fitness. The difference t-tests for as being the basis for the clinical reasoning process using the
equality of means were applied. The one-way analysis of variance Bobath Concept. The Bobath Concept is described as always linking
was used for testing equality of means between the groups. Tukey- qualitative performance to function. Exploring the inherent plasticity
Kramer method was applied in paired comparisons. RESULTS: Men of the central nervous system, based on an understanding of the
in the W54 group(25%) improved their maximal isometric flexion individual’s impairment, is aknowledged as crucial. CONCLUSIONS:
torque to a significantly larger extent than men in the W22 group (7%) The theoretical model developed in this study is a unique insight
(p < 0.05), whereas the W22 group(16-20%) achieved significantly into the implicit knowledge of the experienced Bobath therapist and
(p < 0.001) greater changes than W54 group (5-9%) did in the clarifies some of the underlying principles related to the clinical
trunk muscle flexion and extension velocities. No significant changes reasoning process. This study identifies that a key principle of
were observed in controls. Perceived health improved significanly in the Bobath Concept is the link between movement performance
the W54 group during the exercise intervention (p < 0.03)compared and function. The importance of implicit learning of motor skills by
with the other groups. CONCLUSIONS: Training with resistance the neurolgically impaired patient through the development of the
machines and weights was superior in improving maximal trunk individual’s body schema is seen as vital in developing improved
flexion strength, while group gymnastics with power and velocity functional performance. This study has produced a foundation of
training without external loads was superior in improving the flexion descriptive information that could be used as a basis for further
and extension velocities. 54 weeks of exercising seemed also to research. In part it could be used to develop questions and
have a positive impact on subjective health. The results indicate gather opinions from a larger population of therapists. The use of,
that the training-induced gains are specific to the exercise method for example, single subject experimental designs would enable a
used, and varying training modes are needed for multifaceted comparison between percieved and actual practice. IMPLICATIONS:
improvement of the trunk muscles. IMPLICATIONS: Both training Clinically, the Bobath Concept is used by many therapists throughout
modes are needed; strength gain is essential for stabilizing and the world. In order to move forwards and progress with a sound
strengthening the trunk muscles, and power and velocity training are scientific basis, appropriate research questions need to be asked.
necessary for enhancing muscle coordination and ability to react to This can only be achieved by having a clear understanding of
sudden loadings. KEYWORDS: resistance training,strength,power, the principles underpinning the concept and the clinical reasoning
process. KEYWORDS: Bobath Concept; Quality of Movement; women with ACL reconstruction to assess physical performance
Clinical Reasoning. FUNDING ACKNOWLEDGEMENTS: The British is warranted. KEYWORDS: ACL, landing, drop jump. FUNDING
Bobath Tutors Association funded 50% of my Masters programme. ACKNOWLEDGEMENTS: This work was supported in part by
CONTACT: [email protected] an institutional grant from Texas Woman’s University (Research
ETHICS COMMITTEE: Leeds Metropolitan University, United Enhancement Program). CONTACT: [email protected]
Kingdom. ETHICS COMMITTEE: Texas Woman’s University Institutional
Review Board
VCEC Meeting Room 18 1183 Monday 4 June 16:15
LANDING MECHANICS BETWEEN NON-INJURED YOUNG VCEC Meeting Rooms 19-20
WOMEN AND WOMEN WITH ACL RECONSTRUCTION DURING DEVELOPMENT OF AN OBJECTIVE EVALUATION TOOL OF
A 40-CM DROP JUMP SHOULDER FUNCTION USING 3D KINEMATIC SENSORS
Ortiz A1 , Libby C2 , Bartlett W2 , Etnyre B3 , Kwon Y4 , Olson S2 ; Pichonnaz C1,2 , Farron A1 , Bourgeois A1 , Coley B3 , Aminian K3 ,
1 School of Physical Therapy, University of Puerto Rico; 2 School Jolles B1 ; 1 Hôpital Orthopédique de la Suisse Romande, Lausanne,
of Physical Therapy, Texas Woman’s University; 3 Department of Suisse; 2 HECVSanté-filière physiothérapeutes, Lausanne, Suisse;
3 Ecole Polytechnique Fédérale de Lausanne, Suisse
Kinesiology, Rice University; 4 Department of Kinesiology, Texas
Woman’s University
PURPOSE: The objectives of this research were to test the
PURPOSE: The purpose of this study was to compare landing applicability of a portable device using 3D kinematic sensors
mechanics during a 40-cm drop jump between women with (Physilog® ) for functional evaluation of the patient’s shoulder,
anterior cruciate ligament reconstruction and non-injured women. and to develop objective evaluation tools of function based on
RELEVANCE: Women with anterior cruciate ligament reconstruction this device RELEVANCE: Several functional shoulder scores are
present with neuromuscular deficits that could predispose them to fur- commonly used but none of them is unanimously recognized as an
ther injuries during sports participation compared to women without objective reference. Our purpose was to develop a score specifically
knee injury even after successful reconstruction and rehabilitation. based on objective criteria. Movement recording by a body fixed
PARTICIPANTS: Fourteen physically active young women with ACL sensors (combination of accelerometers and gyroscopes) provides
reconstruction (mean age ± SD: 25.4±3.1, mean height: 167.5±5.6 objective and accurate parameters which are meaningful for shoulder
cm, mean weight: 63.2±6.7 kg) and fifteen healthy non-injured young function evaluation. The recent development of portable devices has
women (mean ± SD age: 24.6±2.6; height: 164.6 cm; weight: made this process more accessible to researchers and clinicians.
58.4 kg) participated in this study. METHODS: Each participant PARTICIPANTS: 25 patients with unilateral shoulder pathology (18
had 12 retro-reflective markers attached over bony prominences on had rotator cuff tear/7 had total shoulder arthroplasty, 9 women, 12
the dominant lower extremity. Additionally, surface electromyography men, 59 years old +/−10) and 30 healthy participants (10 women, 30
(EMG) was recorded from the gluteus maximus, quadriceps, and men, 36 years old +/−7) have been included. All participants signed
hamstrings. Each participant performed a warm-up protocol followed a written informed consent and their surgery was performed in our
by five drop jump task trials. The drop jump consisted of standing on a department by the same senior surgeon. METHODS: One sensor
40-cm platform and performing a maximal vertical jump after landing was fixed on the dorsal side of distal humerus and another one on the
onto a force plate. Peak joint angles, peak ground reaction forces, sternum. Each sensor was connected to a portable data logger. Nine
peak knee joint moments, dynamically normalized rectified surface movements corresponding to daily activities were carried out. Signals
electromyography and quadriceps/hamstrings co-contraction ratio were digitized and analysed to measure acceleration, angular speed
were analyzed. ANALYSIS: All kinematic, kinetic and electromyo- and angles in three dimensions. Based on the results we defined
graphic data were screened for normality assumptions and outliers three scores to analyse differences between healthy and pathological
using the Kolmogorov-Smirnov Test and histograms. Multivariate patient’s shoulder: the 3D shoulder range of angular velocity score
analyses of variance, with follow-up univariate analyses of variance (RAV), the arm power score (P) and the humerus moment score
(ANOVA), were used for comparisons of kinematics, kinetics and (M). The SST (Simple Shoulder test) and the Disabilities of the
EMG data between groups. RESULTS: No statistically significant Arm, Shoulder and Hand Score (DASH) questionnaires were also
differences between groups were found for peak hip and knee joint completed. Healthy participants underwent the procedure twice at
angles. However, significant differences between groups were found one year interval. The patients had a follow up at 3 and 6 months.
for the kinetic and EMG variables. Follow-up ANOVA on each kinetic ANALYSIS: Means and SD were calculated. Non-parametric tests
variable showed significantly lower peak anterior-posterior shear were applied to assess differences between healthy participants
forces, greater peak knee extension moments and greater peak and patients, as well as improvement at 3 and 6 months after
knee valgus joint moments in the group with ACL reconstruction. surgery. (a 0.05). RESULTS: The healthy subjects’ RAV, P and
Follow-up ANOVA on each EMG variable showed significantly greater M scores were significantly different from the patients’ scores at
quadriceps/hamstrings co-contraction ratios, and normalized rectified baseline (before surgery) (p = 0.0009), at 3 months (p = 0.005) and
gluteus maximus and rectus femoris EMG in the group with ACL at 6 months (p = 0.0196). The patients’ scores were significantly
reconstruction. CONCLUSIONS: This investigation demonstrated different between baseline vs. 3 and 6 months (p < 0.015). However,
that landing mechanics represented by peak hip and knee joint the clinical scores showed no differences between baseline and
angles in all three planes of motion were similar between healthy, 3 months, the differences becoming significant only at 6 months.
non-injured women and women more than one year after ACL The tests on healthy participants showed a variability of the mean
reconstruction. Electromyographic measures suggested neuromus- of 0.4% +/−7.2 (RAV), −0.9% +/−8.9 (P) and 1.3 +/−9.3 (M).The
cular compensation strategies in women with ACL reconstruction that measurement method based on body fixed sensors had good
could explain the similarities in landing peak joint angles. However, applicability. CONCLUSIONS: Three scores were developed with
differences for the kinetic measures suggested differences in landing very encouraging results for the objective evaluation of the shoulder
strategies that could predispose women with ACL reconstruction to function. They allow the analysis of shoulder evolution after a surgical
further injury. IMPLICATIONS: This investigation found that young procedure with more precision and sensitivity to change than regular
women with ACL reconstruction exhibited different neuromuscular clinical scores. IMPLICATIONS: The newly developed scores could
and kinetic landing strategies than non-injured females during a be a good a contribution to outcome evaluation in physical therapy,
drop jump. The need for further research and rehabilitation of young rehabilitation and surgery. The good applicability of the system
opens perspectives for precise measurement of shoulder function a problem, and best-practice assessments and interventions are un-
during daily activities. KEYWORDS: body fixed sensors, shoulder, derutilized. IMPLICATIONS: Knowledge transfer strategies aimed at
assessment. FUNDING ACKNOWLEDGEMENTS: Swiss National undergraduate students and practicing clinicians are recommended
Foundation (PNR 53) Grant nº 405340-104752/1. CONTACT: to increase the use of UI related best practices post-stroke and
[email protected] close the gab between actual and best practice. KEYWORDS:
ETHICS COMMITTEE: Université de Lausanne, Faculté de Biologie stroke, urinary incontinence, evidence-based practice, rehabilitation.
et de Médecine, Commission d’éthique de la recherche clinique FUNDING ACKNOWLEDGEMENTS: C. Dumoulin was funded by
a post-doctoral award, N Korner-Bitensky and C. Tannenbaum by
career awards from the Fond de la Recherche en Santé du Québec.
This project was funded by the Canadian Stroke Network, the Réseau
1384 Monday 4 June 16:35 Provincial de recherche en adaptation réadaptation (REPAR), and the
PP Crystal Pavilion B & C Centre de recherche interdisciplinaire en réadaptation du Montréal
DO CANADIAN PHYSIOTHERAPISTS IDENTIFY, ASSESS AND Métropolitain. CONTACT: [email protected]
TREAT URINARY INCONTINENCE AFTER STROKE? ETHICS COMMITTEE: Institutional Review Board, Faculty of
Dumoulin C1 , Korner-Bitensky N2 , Tannenbaum C3 ; 1 School of Medicine, McGill University, in Montreal, Quebec, Canada
Rehabilitation, Faculty of Medicine, University of Montreal; 2 School
of Physical and Occupational Therapy, Faculty of Medicine, McGill Research Report Platform Presentation
University; 3 Faculty of Medicine, University of Montreal 928 Monday 4 June 16:35
PURPOSE: This study identify: the extent to which rehabilitation VCEC Ballroom A
professionals identify UI post-stroke as a problem in those affected; CONTENT VALIDITY OF THE FIRST VERSION OF
the use of best practice assessments and interventions to manage INTERVENTION CATEGORIES FOR PHYSICAL THERAPISTS
UI post-stroke and; the relationship between clinician, client, and BASED ON THE ICF: MUSCULOSKELETAL DOMAIN
environmental variables and variations in UI problem identification,
Allet L1 , Cieza A2 , Bürge E3 , Finger M4 , Stucki G2 ,
assessment, and intervention practices. RELEVANCE: UI is a
Huber E5 ; 1 University hospital of Geneva, Switzerland;
common and distressing problem post-stroke. Although recent 2 Ludwig-Maximilians-University Munich, Germany; 3 Haute Ecole
evidence suggests effective UI rehabilitation interventions, it is
de Sante, Geneva, Switzerland; 4 Rehaklinik Bellikon, Switzerland;
unknown whether physiotherapists’ actual practices reflect best 5 University hospital of Zürich, Switzerland
practices. PARTICIPANTS: A total of 656 physiotherapists, (76 men,
560 women) with a mean age of 40.46 + 9.79 years, working PURPOSE: The International Classification of Functioning, Disability
across the continuum of stroke care in Canada, participated in this and Health (ICF) holds great promise for providing the rehabilitation
study. METHODS: Participants were interviewed using a telephone- disciplines, including physical therapy, with a universal language with
administered questionnaire. Each responded to a series of open- which to discuss human functioning. A first version of intervention
ended questions related to a generated clinical scenario of a typical goals for physical therapists treating patients with musculoskeletal
client with UI post-stroke corresponding to the clinician’s practice (MS) conditions in acute, rehabilitation and community health-care
setting – acute care (n=202), in-patient rehabilitation (n=223), situations based on the ICF has been developed based on a
community care (n=231). ANALYSIS: Descriptive statistics were methodologically sound process including Delphi-exercises and a
used to indicate the prevalence of ‘UI problem identification’, ‘best consensus conference. However, its content validity has not yet
practice UI assessment’ and ‘best practice UI intervention’ by setting, been studied. The aim of this study was therefore to investigate
as defined by existing practice guidelines. Univariate analyses were the content validity of the ICF intervention categories for physical
used to examine the association between 29 potential explanatory therapists treating patients with MS conditions. RELEVANCE: The
variables related to the clinician, client, and environment, and being ICF, containing a list of 1454 categories which constitute the units
a ‘UI problem identifier’, ‘best practice UI assessment user’ and ‘best of the classification, is hierarchically organized and very exhaustive.
practice intervention user’. Logistic regression models, with stepwise It thus becomes highly complex for daily use. In order to initiate its
backward elimination of variables, determined the combination of use in clinical practice it has to be transformed into a user-friendly
variables that predicted being a ‘UI problem identifier’ and ‘best tool. PARTICIPANTS: The study was performed with convenience
practice UI assessment user’. RESULTS: In all, 40.5% of the samples of 300 physical therapy clinical records of patients with MS
physiotherapists identified UI post-stroke as a problem. Less than conditions, treated in 3 health-care situations: acute, rehabilitation
15% indicated using best-practice UI assessments, and only 3% and community. Clinical records written in German, French or
used best-practice UI interventions. Univaritely ‘having answered Italian were included in the study if the patients to whom they
an acute vignette’ and ‘being in a inpatient work setting’ were the corresponded were at least 18 years old and had been treated
2 only variable significantly associated with In all, 40.5% of the at any time from January 2003 to November 2005. METHODS:
physiotherapists identified UI post-stroke as a problem. Less than The study was conducted as a retrospective cross-sectional multi-
15% indicated using best-practice UI assessments, and only 3% center study in the three different language regions of Switzerland.
used best-practice UI interventions. Univaritely ‘having answered The heads of the physical therapy departments of 62 health-care
an acute vignette’ and ‘being in a inpatient work setting’ were the institutions were asked to send a pre-defined number of clinical
2 only variable significantly associated with being a UI problem records to the study leader. The study leader extracted all treatment
identifier, c2: 14.697, p < 0.001 and c2: 9.155, p = 0.01 respectively. goals and all interventions contained in the records and linked
Those spending a greater amount of time treating daily (OR: 1.187; them to ICF categories. The inter-rater agreement of this linking
95% CI:1.051 to 1.341; p = 0.006), having time allocated for learning process was established. ANALYSIS: Descriptive statistics were
(OR:1.441; 95% CI:1.016 to 2.043; p = 0.040) and having a social used to describe the study population and to analyse how often
worker in the workplace (OR:2.010; 95% CI:1.298 to 3.113; p = 0.002) a goal, intervention or technique had been named in the clinical
increased the likelihood of being a UI problem identifier. For the records. A cutoff point of a frequency of 5% was chosen in
outcome best practice UI assessessment user ‘treating longer hours order to include the category in the checklists. RESULTS: Kappa
daily’, ‘seeing more stroke patients daily’ and ‘having answered a re- coefficients and nonparametric bootstrapped confidence intervals
habilitation vignette’ were the 3 only variables significantly associated showed that linker agreement exceeds chance (Kappa value 0.71-
with being a best practice UI assessor, t:3.734, p < 0.001, X2:19.528, 0.9). Most of the ICF categories contained in the first version of
p < 0.001 and X2:15.930, p = 0.001 respectively. CONCLUSIONS: ICF intervention categories for physical therapists working in these
Canadian physiotherapists do not routinely identify UI post-stroke as health-care situations have been confirmed and three checklists
with 38 second-level intervention categories for the acute, 46 for results suggest that a four week training program of isolated voluntary
the rehabilitation and 38 for the community health-care situation contractions of TrA is associated with consistent changes in motor
are proposed. CONCLUSIONS: This study represents the first control of this muscle during functional tasks. IMPLICATIONS: The
step towards the validation of intervention categories for physical findings suggest that changes in motor control may help to explain
therapists treating patients with MS conditions. These three checklists the improvements in self-reported symptoms that have been reported
have now to be applied in clinical practice and their usefulness from previous clinical trials. Future randomised and controlled
assessed. The data provide a promising approach for future research. clinical trials are required to confirm the changes in coordination
IMPLICATIONS: These lists form a user-friendly tool and may of the trunk muscles and their association with pain and functional
also have wider implications by contributing to the definition of outcomes. KEYWORDS: motor training, low back pain, feedforward
the scope of the physical therapy profession and by providing the postural adjustments. FUNDING ACKNOWLEDGEMENTS: Funding
transparency increasingly demanded of health-care providers in the was provided by the National Health and Medical Research Council
current political climate. KEYWORDS: International Classification of Australia. CONTACT: [email protected]
of Functioning, Disability and Health, Intervention, physical therapy, ETHICS COMMITTEE: Medical Research Ethics Committee of the
musculoskeletal. FUNDING ACKNOWLEDGEMENTS: We gratefully University of Queensland, Brisbane, Australia
acknowledge the Swiss Physiotherapy Association for its financial
support and the cooperation of all participants in this study.
ETHICS COMMITTEE: The study was approved by the local ethics 1593 Monday 4 June 16:35
committees: University hospital of GENEVA and ZURICH VCEC Exhibit Hall A
EFFECTS OF MOBILIZATION ON ARTERIAL BLOOD GASES
(ABG) POST CORONARY ARTERY BYPASS SURGERY (CABG)
Nambiar V, Roberts K, Ravindra S; Department of Physiotherapy,
MSRMC, Bangalore, India
VCEC Ballroom B & C
TRAINING OF REPEATED VOLUNTARY CONTRACTIONS PURPOSE: Early Mobilization has been a key word for aggressive
LEADS TO PERSISTENT CHANGES IN POSTURAL CONTROL post operative rehabilitation. ABG being an important parameter used
IN PEOPLE WITH RECURRENT LOW BACK PAIN in the critical care units in the weaning process. Few studies have
been done to study the effects of mobilization as an add on effect to
Tsao H, Hodges P; Division of Physiotherapy, The University of
chest physiotherapy on ABG. The purpose of the study is to measure
Queensland, Brisbane, Australia
the effects of mobilization on ABG values as an outcome measure
PURPOSE: Deficits in control of the trunk muscles have been RELEVANCE: Cardiopulmonary dysfunction is seen in patients post
demonstrated in people with recurrent low back pain (LBP). These cardiac surgery. Immobility is said to have a lot of disadvantages.
changes continue to be present despite the resolution of symptoms Chest Physiotherapy and mobilization are the most common treat-
and are thought to be associated with recurrence and chronicity. One ment techniques used by physiotherapist to prevent and treat post op-
approach that has been shown to reduce symptoms and prevent erative pulmonary complications. PARTICIPANTS: 30 Subjects who
recurrence involves rehabilitation of trunk muscle control. Although underwent CABG and were haemodynamically stable between 35-65
we have recently shown that this rehabilitation strategy induces years of age group. The subjects were selected by convenient sam-
immediate changes in coordination of the trunk muscles, no study pling technique. METHODS: The study design is prospective inter-
has investigated whether improvement can be maintained. Using ventional cross over design. On the 1st post-op day after extubation
the model of changes in control of the deep abdominal muscle, a pre-intervention ABG was taken. The patient was given chest phys-
transversus abdominis (TrA), in people with LBP, this study aimed iotherapy (CPT) followed by mobilization to a chair. The patient was
to investigate whether four weeks of training of repeated voluntary made to sit for ten minutes and then mobilized back to bed. Post inter-
TrA contractions could induce persistent improvements in control of vention ABG was taken. This was considered as intervention I. After
the trunk muscles. RELEVANCE: Understanding of motor control four hours a pre-intervention ABG was taken again. The patient was
changes with motor training will help to explain the efficacy of given CPT only. A post intervention ABG was taken. This was con-
this type of intervention for improvements in pain, function and sidered as intervention II. PH, PO2 and PCo2 measurements taken
recurrence rates. PARTICIPANTS: Nine volunteers with recurrent from ABG samples were the main outcome measures. ANALYSIS:
LBP lasting longer than 3 months were recruited for this study. The statistical software namely SPSS 11.0 and Systat 8.0 were used
METHODS: Subjects trained isolated voluntary TrA contractions for data analysis and Microsoft word and excel to generate graphs,
twice per day for four weeks. Coordination of the abdominal muscles tables, etc. Student paired t test has been used to find significance
was assessed during single rapid arm movements and self-paced of mean difference of ABG parameters for CPT and mobilization.
walking. Recordings of electromyographic activity (EMG) were made The Cohen effect size has been computed to find the effect of CPT
from trunk and deltoid muscles. Measures were made before and and mobilization on ABG parameters. RESULTS: On analyzing the
after initial training, before and after training at week two, at week results of intervention I, there was no change in the PH following
four, and at six months. Feedback of contraction during training was mobilization, while there was 13.05% increase in the PO2 (significant
provided at the initial session, and during the session at two weeks at 1%) and 5.60% decrease in the PCo2 (significant at 1%). Cohen
with real-time ultrasound imaging. TrA EMG was maintained at 5% of effect size showed a mild effect of mobilization on PO2 and a moder-
the maximum root-mean-square EMG amplitude. ANALYSIS: Onsets ate effect on PCo2. On analyzing the changes following intervention
of trunk muscle EMG was identified during arm movement and the II, it was noted that the ABG values showed no change in the PH,
coefficient of EMG variation (CV) was calculated during walking. while there was a 7.24% increase in the PO2 (Significant at 1%) and
RESULTS: Onset of TrA EMG was earlier during arm flexion and a 3.09% decrease in the PCo2 (Significant at 5%). Cohen effect size
extension immediately after a single session of training, and was showed a mild effect of CPT on PO2 and PCo2. CONCLUSIONS:
further improved with four weeks of training. The CV of the TrA EMG Our study showed a significant improvement in the ABG when mobi-
during walking was reduced (indicating more sustained activity) over lization was used as an add on to chest physiotherapy in post opera-
four weeks of training. Changes in timing and CV after one month tive CABG patients. A similar kind of study can be done on patients,
were retained at the six month follow-up despite cessation of training. post valvular heart surgeries and on post operative patients with lung
Changes in other trunk muscles were not significant. Consistent pathologies. IMPLICATIONS: Early mobilization may be considered
with previous studies, significant improvements in self-reported pain as a treatment of choice in the rehabilitation of haemodynamically
and function were also observed (p<0.05). CONCLUSIONS: The stable patients post CABG. This in turn could reduce the need for
supplement oxygen therapy and thus reducing the duration of stay the risk of further, and perhaps more serious injury.The neurological
in Critical care due to respiratory complications and improving cost screening items studied are stable motor performance measures
effectiveness. KEYWORDS: Chest Physiotherapy, mobilization, coro- and can be administered immediately after moderate intensity
nary artery bypass surgery. FUNDING ACKNOWLEDGEMENTS: exercise. KEYWORDS: Motor performance, Balance, Coordination,
Unfunded. CONTACT: [email protected] Concussion. FUNDING ACKNOWLEDGEMENTS: The authors wish
ETHICS COMMITTEE: Ethical Committee of MSRMC, Bangalore to thank The New Zealand Centre for Physiotherapy Research for
India and Narayana Hrudhayalaya of Cardiac Sciences. support with this project. CONTACT: [email protected]
ETHICS COMMITTEE: University of Otago Human Ethics Committee
VCEC Meeting Rooms 11-12 Research Report Platform Presentation
DOES EXERCISE AFFECT THE PERFORMANCE OF SELECTED 1323 Monday 4 June 16:35
NEUROLOGICAL SCREENING TEST ITEMS FOR SPORTS VCEC Meeting Room 16
RELATED CONCUSSION? ARE THE APPARENT EFFECTS OF STRETCH ON TISSUE
Schneiders A1 , Sullivan S1 , McCrory P2 ; 1 School of Physiotherapy, EXTENSIBILITY SOLELY EXPLAINED BY CHANGES IN
University of Otago; 2 Centre for Health, Exercise & Sports STRETCH TOLERANCE? A RANDOMISED CONTROLLED TRIAL
Medicine, University of Melbourne Flopp H1 , Deall S1 , Harvey L2 , Gwinn T3 ; 1 School of Physiotherapy,
PURPOSE: To determine the effect of moderate intensity exercise University of Sydney, Sydney, Australia; 2 Rehabilitation Studies
on three selected measures of motor performance used in sports- Unit, Northern Clinical School, Faculty of Medicine, University of
concussion screening. RELEVANCE: Sport-related concussion Sydney, Sydney, Australia; 3 School of Exercise and Sports Science,
(SRC) is a common injury associated with contact and collision Faculty of Health Science, University of Sydney, Sydney, Australian
sports and represents a major worldwide public health concern. PURPOSE: It is widely believed that regular stretch induces lasting
Players who are suspected of having sustained a concussion require changes in tissue extensibility reflected by increases in passive
medical screening to determine the presence and extent of injury joint range of motion. However, the results of recent trials provide
and to guide return to play decisions. Commonly reported physical
conflicting results. Some indicate that regular stretch does increase
signs of concussion include gait unsteadiness, poor balance and
joint range of motion and others indicate that it does not. One possible
coordination. Recently an international consensus document, termed
explanation for these conflicting results, that we sought to explore, is
the “Sport Concussion Assessment Tool” (SCAT), was developed
that investigators fail to distinguish between changes in tissue ex-
that included a sideline/pre-hospital screen for SRC. While many
tensibility (joint angle corresponding with a standardised torque) and
aspects of the SCAT are well researched, reliability and validity
changes in subjects’ tolerance to an uncomfortable stretch sensation
of the motor performance components designated the “Neurologic
(joint angle corresponding with maximal torque tolerated). The pur-
Screening Protocol”, have not been assessed. Exercise and sport
pose of this study was to determine whether the apparent increases
participation have been shown to effect some measures of motor
in joint range of motion observed with stretch programs can be solely
performance and for the SCAT to be reliable at detecting a SRC
explained by changes in subjects’ tolerance to an uncomfortable
the effect of exercise on neurological screening items needs to be
stretch sensation RELEVANCE: Stretch is commonly administered
established. PARTICIPANTS: Thirty subjects (18-25 years) with no
by physiotherapists to induce lasting changes in muscle extensibility.
known neurological, musculoskeletal or cardiovascular conditions.
Participants were screened using the Physical Activity Readiness PARTICIPANTS: Twenty healthy able-bodied individuals. METHODS:
Questionnaire (PAR-Q) screening test. METHODS: Finger-to-Nose A within-subjects design was used whereby one leg of each subject
(FTN), Tandem Gait (TG) and Single Leg Stance (SLS) tests were was randomly allocated to the experimental condition and the other
administered four times (T1-4) at 15-minute intervals. Measures were leg was allocated to the control condition. The hamstring muscles of
taken twice before and twice after 15-minutes of exercise at 75-85% each subject’s experimental leg was stretched daily for 20 minutes
of age predicted maximum heart rate. The type of exercise interven- over four weeks. Hamstring muscle extensibility (hip flexion with
tion simulated workloads associated with playing rugby-union, a sport a standardised torque) and stretch tolerance (hip flexion with the
with a high incidence of concussion in New Zealand. A repeated mea- highest torque subjects would tolerate) were assessed on both legs at
sures within subjects design was used. ANALYSIS: Comparisons of the beginning and end of the study by blinded assessors. ANALYSIS:
performances across trials were made using mixed models (SAS Mean changes from initial to final measures were calculated for
9.1.2) with direct product covariance structures to account for the both experimental and control legs and 95% confidence intervals
within-trial (replicates) and between-trial covariances and a random for between-leg differences in change scores were calculated.
subject effect. Kenward-Rogers approximation for the denominator RESULTS: The intervention did not increase the extensibility of the
degrees of freedom was used in all cases. Trial, gender, and ordering hamstring muscles (mean change in hip flexion with a standardised
effects were treated as fixed and were compared using least-square torque was −1 degree, 95% CI −4 to 3 degrees) but did increase
means. Mixed model analyses and Intra Correlation Coefficients subjects’ tolerance to an uncomfortable stretch sensation (mean
(ICC) were calculated. RESULTS: When mean ICC values were used change in hip flexion with the highest torque subjects could tolerate
the reliability was “almost perfect” for FTN (ICC = 0.935) and TG was 8 degrees, 95% CI 5 to 12 degrees). CONCLUSIONS: Regular
(ICC = 0.983). TG also had an “almost perfect” score for the single stretch changes subjects’ tolerance to an uncomfortable stretch
measures (ICC = 0.827). When the mean values were used SLS sensation. This leads to an apparent, but not real, increase in muscle
scores were less reliable, but still acceptable with an “almost perfect” extensibility. IMPLICATIONS: These results highlight the importance
score at T-1 (ICC = 0.85) and a “moderate” score at T-2 (ICC = 0.562). of distinguishing between real and apparent increases in muscle
CONCLUSIONS: The FTN, TG and, to a lesser extent, the SLS are extensibility when assessing the effectiveness of stretch, and indicate
reliable measures of motor performance in healthy individuals with that whilst a four-week stretch program increases subjects’ tolerance
the FTN and TG tests demonstrating a facilitatory effect immediately to an uncomfortable stretch sensation it does not increase hamstring
following moderate intensity exercise. There was no evidence that muscle extensibility. The results also help explain the inconsistent
measures taken immediately after exercise were different from those results of recent clinical trials. KEYWORDS: stretch; contracture;
taken after resting for 15 minutes. IMPLICATIONS: This project is extensibility; range of motion. FUNDING ACKNOWLEDGEMENTS:
directed at improving the health and safety of athletes by adding pre- nil. CONTACT: [email protected]
cision in the identification of possible concussions and thus reducing ETHICS COMMITTEE: University of Sydney, Sydney, Australia
FACTORS AFFECTING STIFF-LEGGED GAIT IN HEREDITARY EXPLORATION OF VOLUNTARY ACTIVATION OF QUADRICEPS
AND SPONTANEOUS SPASTIC PARAPARESIS FEMORIS IN PATIENTS WITH ACUTE ANTERIOR CRUCIATE
Marsden J1 , Ramdharry G1 , Wood N2 , Thompson A2 ; 1 Sobell LIGAMENT RUPTURE
Department of Motor Neuroscience and Movement Disorders. Trees A1 , Howe T2 , Dixon J1 ; 1 Teesside Centre for Rehabilitation
Institute of Neurology London UK; 2 Department of Molecular Science, University of Teesside, Middlesbrough, United Kingdom;
Neuroscience Institute of Neurology London UK; 3 Department 2 HealthQWest, Glasgow Caledonia University, Glasgow, United
of Headache, Brain Injury and Rehabilitation Institute of Neurology Kingdom
London UK
PURPOSE: A slow, stiff legged gait is commonly seen in people PURPOSE: Following injury to the anterior cruciate ligament (ACL),
with spontaneous and hereditary spastic paraparesis (SP). The it is accepted that a weakness of quadriceps femoris is due not
cause of reduced walking speed and knee flexion velocity during only to disuse atrophy but to a decrease in voluntary activation,
swing phase is unclear and may be related to weakness; hypertonia caused by arthrogenic muscle inhibition. The purpose of this study
or inappropriately timed antagonist activity. This study aims to was to investigate the degree of maximal voluntary activation (MVA)
investigate the factors affecting stiff-legged gait. RELEVANCE: in patients with acute ACL ruptures and the relationship with strength
People with spastic paraparesis present with multiple impairments and function. RELEVANCE: Unimpaired MVA is essential if the
that may affect walking, understanding the factors that contribute patient wishes to return to previous levels of activity. Rehabilitation
to walking dysfunction will allow for the development of specifically can be hindered by impaired MVA, which may reduce the ability to
targeted therapies. PARTICIPANTS: 20 people with hereditary strengthen the muscle. PARTICIPANTS: Twenty consecutive patients
(n=15) or spontaneous spastic paraparesis were compared to 5 (14 male and 6 female) with acute isolated unilateral ACL rupture
healthy controls matched for age, gender and mass. METHODS:
were recruited from an acute knee clinic at a mean of 86 days (range
A 10m walkway with two embedded force plates (Kistler type
16-172) after injury and all consented to participation in the study.
9286A,Switzerland) was used in conjunction with 3D motion analysis
ACL rupture was confirmed by clinical examination (arthrometry,
(CODAmotion, UK) in the recording and determination of joint
kinematics and kinetics. Control subjects walked at the same Lachman testing and anterior drawer tests) and MRI (15 participants).
cadence and stride length as the people with SP. Isometric muscle Mean age of the group was 30.5 years (SD 9.15). METHODS:
strength of the lower limb hip, knee and ankle muscles was recorded This was a cross-sectional observational study. Assessment of the
using a dynamometer (Biodex System3 USA). To estimate non-neural participants included subjective functional questionnaires (Lysholm,
and neural stiffness in the ankle plantarflexors and quadriceps low Tegner and IKDC Subjective Score), measurement of knee laxity and
amplitude (5º) slow (5º/s) and fast (60º/s) stretches were applied demographics. Quadriceps peak torque and MVA were assessed
with the subject at rest. ANALYSIS: Differences between groups during maximal voluntary isometric contractions (MVIC) using the
in muscle strength and knee flexion velocity were compared using twitch interpolation technique. Participants were seated in an upright
a two-tailed unpaired t-test. Differences in muscle hypertonia were position, with the knee flexed to 90º. Stimulation was delivered using
assessed using a repeated measures general linear model (2 a Digitimer DS100A, using 1Hz current of pulse width 200ms during
conditions: slow Vs fast stretch). In people with SP the relationship a rest period and during a MVIC. This was repeated three times
between the parameters of gait and measures of impairment was with a rest period of 120 seconds between repetitions. ANALYSIS:
investigated using multiple linear regression. RESULTS: People with Paired t-tests were used to compare side-to-side differences in MVA
SP showed a significant reduction in isometric muscle strength that
and peak torque. Bivariate correlations examined the relationships
was greater distally than proximally (41% mean reduction in the ankle
between MVA, peak torque, functional scores and time since injury.
plantarflexors and dorsiflexors Vs 25.5% mean reduction in the knee
Significance levels were set at 0.05. RESULTS: The mean MVA was
flexors and extensors Vs 24.5% mean reduction in the hip flexors
and extensors). Stiffness was significantly higher in people with SP 84.1% (SD 8.9) for the injured limb, and 88.4% (SD 7.7) for the
following both slow and fast stretches (Group effect Plantarflexors un-injured limb. Mean difference was 4.2% (95% CI -.35 to 8.84),
F(1,23) = 8.2 P < 0.05; Quadriceps F(1,23) = 7.09 P < 0.05). Stretch p > 0.05. The peak torque of the injured limb (164.6Nm, SD 72.5)
reflex activation was only seen with fast stretches. In people with was significantly lower than that of the un-injured limb (231.9 Nm,
SP maximal walking speed was slower (SP 1.2 m/s +/− 0.5 standard SD 80.6), with a mean (95% CI) difference 67.4 Nm (47.6 to 87.2
deviation Controls 1.9 m/s+/−0.2 t=3.7 P < 0.005) and maximal knee Nm), p < 0.001. For the injured limb MVA demonstrated a significant
flexion velocity was reduced (SP 216 o/s +/− 126 SD Controls 311 o/s relationship with IKDC score (p < 0.05, r=.48) and peak torque
+/−66 t=2.2 P < 0.05). Isometric hip flexor and plantarflexor strength (p < 0.05, r=.43). In addition, positive relationships were demonstrated
accounted for 71% of the variance in walking speed in people with between peak quadriceps torque per unit body mass and Tegner
SP [F(2,19) = 21.2 P < 0.001]. Passive stiffness seen following a slow activity level (injured limb p < 0.01, r=.54; uninjured limb p < 0.05,
quadriceps stretch and plantarflexor isometric strength accounted for r=.43). CONCLUSIONS: The results of this study suggest that in
56% of the variance in the maximal knee flexion velocity during swing the acute stage of ACL rupture a reduction in MVA of the quadriceps
phase [F(2,19) = 10.6 p < 0.001]. CONCLUSIONS: In agreement with may not be solely responsible for quadriceps weakness. Although
findings in stroke both plantarflexor and hip flexor strength are im- decreased activation was present to a similar degree in both limbs,
portant for maximal walking speed. In SP slower knee flexion during
there was a comparative significant weakness of the injured limb.
swing phase is associated with weakness in the plantarflexors, which
Further studies should consider the efficacy of differing rehabilitation
normally help to initiate swing phase, and increased passive stiffness
regimes on improving MVA of the quadriceps post-ACL rupture.
in the quadriceps. IMPLICATIONS: The influence of muscle strength
and passive stiffness on walking speed and kinematics suggest IMPLICATIONS: Decreases in the quadriceps strength and activation
that these properties may be appropriate targets for physiotherapy could increase susceptibility to joint injury, if not addressed with
intervention. KEYWORDS: Hereditary spastic paraparesis; walking, appropriate rehabilitation. KEYWORDS: ACL; Activation; Strength.
hypertonia. FUNDING ACKNOWLEDGEMENTS: Medical Research FUNDING ACKNOWLEDGEMENTS: No funding was received for
Council. CONTACT: [email protected] this study. CONTACT: [email protected]
ETHICS COMMITTEE: Joint National Hospital for Neurology and ETHICS COMMITTEE: South Tees Local Research Ethics Commit-
Neurosurgery and Institute of Neurology Ethics committee tee, Middlesbrough, UK
THE CHANGES OF MUSCLE STRENGTH ON SHOULDER JOINT EFFECTIVENESS OF DATABASE SEARCHING FOR EVIDENCE-
AFTER STRENGTHENING OF SCAPULAR MUSCLES BASED PHYSIOTHERAPY: COMPARING SEARCHING
Ijiri T, Miyashita K, Urabe Y, Takemoto Y, Obayashi H, Koshida S; METHODS TO IDENTIFY OPTIMAL SEARCH STRATEGIES
Department of Sport Rehabilitation, Graduate School of Health Fell D1 , Burnham J2 , Caswell C1 , Nuchereno A1 , Smolinski A1 ,
Sciences, Hiroshima University, Hiroshima, Japan Wood C1 ; 1 University of South Alabama, Department of Physical
PURPOSE: Muscular weakness on shoulder complex could be Therapy, Mobile, AL USA; 2 University of South Alabama, Baugh
influenced by not only glenohumeral joint but also scapulothoracic Biomedical Library, Mobile, AL, USA
joint. The representative case of muscle weakness on scapulotho- PURPOSE: This study compared effectiveness of Internet search
racic joint is winging scapula. The patients with winging scapula methods among physical therapy (PT) related personnel, to
are usually instructed to perform exercise to strengthen scapular identify characteristics of the most effective search methodology
muscles. However, the effect of exercises for scapular muscles is and techniques as a basis for effective training programs for
still unclear. Therefore, the purpose of this study was to examine the PT students and clinicians to support evidence-based practice.
changes of muscle strength on shoulder joint after scapular abduction RELEVANCE: Previous studies have investigated the effectiveness
and adduction exercise. RELEVANCE: This study could demonstrate of search methodology in other healthcare fields, but none in PT.
kinetic relationship between scapulothoracic joint and shoulder joint. PARTICIPANTS: This cross-sectional study utilized eight participants
PARTICIPANTS: Thirty healthy male subjects participated in this with various levels of search experience: two biomedical librarians,
study (average 22.5 years). Informed consent was obtained by all two PT students, two PT faculty, and two PT clinicians. METHODS:
the subjects prior to the experiment. METHODS: Each 10 subject Subjects were given two specific clinical questions devised by an
was assigned to abductor group(AB group), adductor group(AD experienced faculty member. Subjects then used search engines or
group), or control group(CO group). At first, muscle strength of databases of choice to find relevant articles and of those select
right shoulder flexion (FL), abduction(AB), external rotation(ER), the three articles most relevant to the clinical questions. Written
and internal rotation(IR) was measured in all the groups. The and electronic logs of search activities and downloaded results
measurement positions of shoulder FL and AB were adopted were collected. A computerized spreadsheet was used to manage
from Manual Muscle Testing (Daniels and worthingham 2002). The results including citation ratings, and for each search: number
positions of shoulder ER and IR were set with elbow flexion angle of retrieved articles, number of relevant articles, time length for
of 90 degree (1st position). The AB group and the AD group search. All articles retrieved were compiled in one spreadsheet
were instructed to perform the scapular abduction exercise and from which the expert faculty member, blinded to searcher identify
the scapular adduction exercise, respectively. Scapular abduction for each citation, rated each article for relevancy using an ordinal
exercise was modified “elbow push up plus”. Scapular adduction scale. The rankings, along search logs were used to analyze the
exercise was to perform scapular adduction with arms droop. Both results and determine which search strategies/methods were most
exercise groups were required to complete exercises with three sets efficient. ANALYSIS: Descriptive statistics and retrieval rates for
of 20 repetitions a day for seven days. The CO group did not perform relevant articles are compared among searchers. RESULTS: After
any exercise. Seven days later, subjects in all the groups were elimination of duplicates, a total of 30 articles remained. Eight
measured the muscle strength in the same way as the first time again. articles were rated “highly relevant” (1+), with each participant
Muscle strength obtained on the last day was normalized to the initial group contributing some relevant (1 and 1+) articles. Longer mean
strength of the measurement and compared. ANALYSIS: Paired search times were associated with searches for highly relevant
t-test was used to compare the muscle strength between before articles (31 minutes mean time for 1+, vs. 17.6 minutes mean
and after the exercises each three group. The level of statistical time for “not relevant”). Productive strategies are identified and
significance was set at 0.05 in this study. RESULTS: The muscle will be discussed. CONCLUSIONS: Certain search strategies and
strength of shoulder FL(107±6), AB(112±11), and IR(114±10) was techniques were associated with improved search results. Database
significantly increased in AB group, whereas the strength of shoulder choice did not affect the quality of retrieved articles, nor did
ER(106±7) was significantly increased in AD group. On the other the participant group. However, 8/8 highly relevant articles were
hand, nothing changed significantly in CO group. CONCLUSIONS: later found to be accessible through Medline, and 5/8 through
Based on our results, it is suggested that scapular abduction CINAHL. IMPLICATIONS: By using these databases, and using
exercise increases muscle strength of shoulder FL, AB, and IR. the suggested search strategies, including sufficient time, health
Since shoulder FL, AB, and IR include the scapular posterior tilt, professionals can increase return of high quality, relevant literature.
upward rotation, and protraction movement, the increase of scapular KEYWORDS: literature, literature search, evidence-based prac-
abduction strength could have lead to the increase of shoulder FL, tice. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
AB, and IR. The reason that scapular adduction exercise increased [email protected]
muscle strength of shoulder ER will be the same mechanism. The ETHICS COMMITTEE: University of South Alabama Institutional
muscle strength of shoulder complex would depend on the function Review Board
of scapulothoracic joint that was strengthened. IMPLICATIONS: This
reveals biomechanical construction of shoulder complex and may
be helpful information to physical therapy. KEYWORDS: Scapula, Research Report Platform Presentation
Strength, Shoulder. FUNDING ACKNOWLEDGEMENTS: This study 2103 Monday 4 June 16:55
was unfunded. PP Crystal Pavilion B & C
ETHICS COMMITTEE: Ethical Review Board in Hiroshima University AN INVESTIGATION INTO FATIGUE AND DEPRESSION IN
PEOPLE WHO HAVE HAD A STROKE
O’Connell C, Stokes E; Department of Physiotherapy, School of
Medicine, Trinity College Dublin, Ireland
PURPOSE: There is increasing evidence to suggest that people
with stroke experience fatigue following the stroke. This fatigue
is not ameliorated by rest, or attributable to specific activities. It
was previously thought that this fatigue was a symptom of post
stroke depression, but people with stroke suggest that it may services provision. However, the ICF is not yet being widely used by
exist independently. The aim of this study was to evaluate fatigue physical therapists in clinical practice. In Switzerland, an exhaustive
and depression following a stroke. In addition the relationship process involving a Delphi exercise and a consensus conference
between both conditions was investigated. RELEVANCE: Population enabled development of a first version of so-called ICF intervention
demographics are changing in Ireland. An increasing number of categories for physical therapists treating patients with problems
people over the age of 65 is anticipated to lead to an increase in the in internal medicine. The next step in the development process
prevalence of cardiovascular disease and stroke. People with stroke and the aim of this study is to address the content validity of
participate in physiotherapy rehabilitation and frequently report that these ICF intervention categories. RELEVANCE: The health-political
fatigue is a limiting factor in complete participation, both in hospital demand for transparency regarding services of health-care providers
and post discharge. Thus fatigue may prevent optimum recovery from is increasing. In this context, a tool like lists of ICF intervention
stroke. PARTICIPANTS: 60 people with a WHO diagnosis of stroke categories is of interest, because they offer the opportunity to define
in the previous three years, and who were living in their own homes a profile of patient’s problems that can potentially be treated by
in the community, participated in the study. These were aged and physical therapists using a language understood by all different
gender matched with 60 people in the community who have not had health professionals. PARTICIPANTS: The study was performed
a stroke. METHODS: All 120 participants completed a questionnaire with convenience samples of 300 clinical records. The records
that included: • The Multidimensional Fatigue Inventory, • The were included if patients were at least 18 years old, had received
Geriatric Depression Scale, • The Barthel ADL index, and • The physical-therapy treatment for an internal medicine condition in
Reintegration to Normal Living Index, which measures the extent to acute, rehabilitation or community health-care situations at any time
which person has adapted to limitations imposed by a condition. from January 2003 to November 2005. METHODS: The study was
ANALYSIS: The quantitative data was analysed in using non- conducted as a retrospective cross-sectional multicenter study in
parametric significance tests and chi-squared analysis. RESULTS: Switzerland. In each center, a person responsible for the study sent
The Multi-dimensional Fatigue Inventory returns fatigue scores in 5 a predefined number of records to the study leader. The study leader
domains; general fatigue, physical fatigue, reduced activity levels, extracted all treatment goals and all interventions documented in
reduced motivation and mental fatigue. Significant differences were the patient records and linked them to the ICF categories based
noted across all five domains between people with stroke and on established linking rules. To assure the accuracy of the linking
those without, Mann-Whitney p < 0.0000 for all and point estimates process, 10% of the clinical records were randomly selected and
for the difference of 7.0, 9.0, 7.0, 5.0 and 6.0 respectively. The linked by a second health professional. ANALYSIS: Descriptive
Geriatric Depression Scale ranges from 0-30. A difference between statistics were used to describe the study population and to describe
people with stroke and age/gender-matched controls exists, and how often a goal, intervention or technique had been named in the
is statistically significant (Mann-Whitney p < 0.0000). A relationship clinical records. A cut-off point of a frequency of 5% was chosen to
exists between the mental fatigue subscale of the MFI and depression identify the ICF categories that were to be included in the lists. The
in people with stroke. Chi-squared analysis returns c2 =7.6, p < 0.01. reliability of the linkage process was evaluated by calculating kappa
Mental fatigue scores in people with stroke are higher in those with coefficients and nonparametric bootstrapped confidence intervals.
depression than those without. Mann-Whitney analysis computes the RESULTS: Estimated kappa values range from 0.79 to 0.84.
point estimate for the difference as 4, the 95% confidence interval is None of the 95% confidence intervals encloses zero, showing that
(1.999-6), p < 0.002. CONCLUSIONS: Fatigue and depression are linker agreement exceeds chance. The validation process enabled
both largely reported in people with stroke in Ireland. The levels identification of 36 second-level ICF intervention categories for the
of fatigue and depression are much higher in people who have acute, 41 for the rehabilitation and 38 for the community health-care
had a stroke, indicating they are attributable to the stroke. Fatigue situations. CONCLUSIONS: Most of the ICF intervention categories
and depression may co-exist in people with stroke, but increasing contained in the first version have been confirmed. These lists of ICF
evidence suggests that fatigue is independent of depression. This intervention categories are available for intervention documentation
fatigue remains under-investigated and untreated in people who have in a standardised common language. IMPLICATIONS: The defined
had a stroke in Ireland. IMPLICATIONS: Fatigue and depression are ICF intervention categories offer the possibility to make physical-
common after a stroke. They are widely reported and appear to exist therapy interventions intelligible for the different partners in the
independently of function. The results of this study will be used to health-care system. In clinical work, the use of these lists, implying
inform the creation of a randomised controlled trial to investigate critical evaluation of the interventions, could have a positive
possible physiotherapeutic interventions to alleviate fatigue after impact on treatment. KEYWORDS: International Classification of
a stroke. KEYWORDS: Stroke, Fatigue, Depression. FUNDING Functioning, Disability and Health, Intervention, Physical therapy,
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] Internal medicine. FUNDING ACKNOWLEDGEMENTS: We grate-
ETHICS COMMITTEE: The Joint Research Ethics Committee of fully acknowledge the Swiss Physiotherapy Association for its
the Adelaide and Meath Hospital Tallaght and St. James’s Hospital, financial support and the cooperation of all participants in this study.
Dublin, Ireland. CONTACT: [email protected]
ETHICS COMMITTEE: The study was approved by the local ethics
committees of Geneva and Zurich
VCEC Ballroom A Research Report Platform Presentation
CONTENT VALIDITY OF THE FIRST VERSION OF 2347 Monday 4 June 16:55
INTERVENTION CATEGORIES FOR PHYSICAL THERAPISTS VCEC Ballroom B & C
BASED ON THE ICF: INTERNAL-MEDICINE AREA TRUNK MUSCLE CONTROL IN BACK PAIN: HOW CAN THE
Bürge E1 , Cieza A2 , Allet L3 , Finger M4 , Stucki G2 , VARIABILITY BE EXPLAINED?
Huber E5 ; 1 Haute Ecole de Santé Geneva Switzerland; Hodges P1 , Cholewicki J2 , Coppieters M1 , Macdonald D1 ; 1 Division
2 Ludwig-Maximilians-University, Munich, Germany; 3 University of Physiotherapy, The University of Queensland, Brisbane, Qld,
Hospital Geneva Switzerland; 4 Rehaklinik Bellikon Switzerland; Australia; 2 Department of Orthopaedics & Rehabilitation, Yale
5 University Hospital Zurich Switzerland University School of Medicine, New Haven, CT, USA
PURPOSE: Physical therapists have been among the first to recog- PURPOSE: Low back pain (LBP) is associated with changes in
nize the potential of the International Classification of Functioning, trunk muscle control. However, these changes have been debated as
Disability and Health (ICF) to improve clinical practice and health authors cite both increased and decreased activity. Such variability
is difficult to reconcile and often interpreted to suggest that the of their families, on blood pressure, exercise capacity and body
trunk muscle adaptation to pain is heterogeneous. Yet, the variability mass index (BMI). RELEVANCE: Hypertension is a difficult condition
could be explained by the system’s redundancy, that is, multiple to manage because of the need for patients to change their
strategies can achieve the same goal. We argue that the nervous health behaviour.This study is a follow-up to a more complex
system commonly aims to increase spinal stability to protect it from study done at a hypertension clinic in a tertiary care hospital
pain and (re)injury but the strategy may vary between individuals in Johannesburg,South Africa, in which encouraging results were
and between tasks. We addressed this issue by investigation of shown in improvements in cardiovascular risk factor modification
individual and task variation in the response of trunk muscles in patients with hypertension. PARTICIPANTS: Thirty two patients
to experimental pain. RELEVANCE: Physiotherapists train trunk participated in this study (80% power using a drop in blood
muscle control for the management of LBP based on evidence of pressure of 5(±4) mmHg at a significance level of 95%). New
deficits in this system. However, without clear understanding of the patients to the clinic were invited to participate in the study and
underlying mechanism the rationale for these interventions is unclear. signed informed consent prior to any data collection. No specific
PARTICIPANTS: Seventeen healthy volunteers with no history of exclusion criteria were imposed as health behaviour is independent
LBP, or major respiratory or neurological disorders participated. of age,severity of disease,signs and symptoms. METHODS: Baseline
METHODS: Electromyographic activity (EMG) of trunk flexor (rectus data included demographic information and the measurements of
abdominis (RA), obliquus internus (OI) and externus abdominis weight,height,(BMI) resting blood pressure and resting heart rate.
(OE)) and extensor (thoracic (TES) and lumbar erector spinae Patients underwent a six minute walk test. Patients were randomly
(LES) and latissimus dorsi (LD)) muscles was recorded bilaterally allocated to an experimental group or a control group once baseline
while participants slowly moved the trunk between −20º (extension) data had been collected. All patients were given a structured
and +20º (flexion) prior to and after injection of hypertonic saline progressive home walking programme and an exercise diary. The
into the right longissimus, and after pain resolution. Pain was patients in the experimental group and a member of their families
reported on an 11-point numerical rating scale. Two trials were had a once a month educational telephone call from a research
performed in each direction. ANALYSIS: EMG data were rectified, assistant not involved in the data collection.The calls covered basic
low pass filtered at 1 Hz and the root mean square (RMS) of dietary changes needed,progression of the walking programme and
the 12 EMG signals was calculated at each trunk angle. The the need to take all medication as prescribed at the same time
minimum RMS EMG was calculated and the value for each muscle each day. The control group had no intervention.At six months all
at this angle was recorded. EMG was defined to be increased patients were weighed,their resting blood pressure measured and
or decreased if it changed by>15% from baseline. Minimum RMS their exercise capacity measured. All measurements were taken by
EMG was compared between trials before, during and after pain the author whio was blinded as to group allocation and baseline
with a repeated-measures ANOVA. RESULTS: Participants reported data. ANALYSIS: The similarity of the baseline data was established
pain of 6.1(2.7) after saline injection. With movement between using the independent t test for continuous data and Fisher’s
flexion and extension the minimum RMS EMG increased by 13-30% exact test for categorial data. Changes in blood pressure,exercise
during pain (P < 0.05). After the pain resolved minimum RMS EMG capacity and BMI were established by the Wilcoxon Rank Sum
returned to control values. There was considerable variation between and Kruskal- Wallis test as data were not normally distributed.
individuals with variable combinations of increased and decreased An intention to treat analysis was followed. RESULTS: Fourteen
activity. Left OI, RA and right OE and OI EMG increased in>50% patients in the experimental group and fifteen patients in the control
of participants. Right LD, RA, OE and TES, and left OI and TES group completed the programme. There was a clinically significant
EMG decreased in>25%. CONCLUSIONS: These data indicate that difference in the change in systolic blood pressure(p = 0.01) and
although experimental LBP was associated with variable changes diastolic blood pressure(p = 0.02) between the experimental and
in trunk muscle activity, there was a net increase in activity when all control groups. There was a clinically significant difference (p < 0.001)
muscles were considered. This finding is consistent with the proposal in the change in exercise capacity between groups.There was no
that the nervous system responds to pain by increasing muscle change in BMI in either group. (p = 0.58). CONCLUSIONS: The better
activity to protect the spine from the real or perceived threat of pain control of blood pressure and improvement in exercise capacity in
or (re)injury. IMPLICATIONS: Rather than training people with LBP the experimental group indicates that when patients unerstand what
to increase the stability of the spine the goal of training may be they have to do and are supported, better blood pressure control and
better directed to optimization of spinal stability. This may involve improved exercise capacity can be achieved. Reductions in BMI are
reduced activity of some of the trunk muscles. This underscores too difficult to achieve in an intervention like this. IMPLICATIONS:
the necessity for detailed assessment to direct management. This is a simple and potentially effective way to educate and support
KEYWORDS: Low back pain, spinal stability, electromyography. patients as they attempt to change their health behaviour. Future
FUNDING ACKNOWLEDGEMENTS: Paul Hodges is supported by work would include multi-centered studies and cost analyses of this
the National Health and Medical Research Council of Australia. programme. KEYWORDS: family-support,hypertension,education.
Jacek Cholewicki is supported by NIH grant R01 AR051497. Michel FUNDING ACKNOWLEDGEMENTS: Funding was obtained from
Coppieters is supported by the University of Queensland. CONTACT: the Faculty Research Fund at the University of the Witwatersrand.
[email protected] CONTACT: [email protected]
ETHICS COMMITTEE: Medical Research Ethics Committee of The ETHICS COMMITTEE: Obtained from the Committee for Research
University of Queensland on Human Subjects at the University of the Witwatersrand Johannes-
burg. Protocol Number:M030839

VCEC Exhibit Hall A
THE EFFECT OF A FAMILY INTERVENTION ON THE
MANAGEMENT OF PATIENTS WITH HYPERTENSION
Stewart A; Department of Physiotherapy School of Therapeutic
Sciences Faculty of Health Sciences University of the Witwatersrand
Johannesburg South Africa
PURPOSE: To establish the effects of a monthly telephonic
educational session to patients with hypertension and a member
TRAINING RISK FACTORS ASSOCIATED WITH ADOLESCENT THERAPEUTIC EXERCISE IN MUSCULOSKELETAL
DANCE AND ACROBATIC GYMNASTICS INJURY PHYSIOTHERAPY: A SUMMARY OF SYSTEMATIC REVIEWS
Purnell M1 , Shirley D1 , Adams R1 , Nicholson L1 , Crookshanks D2 ; Taylor N, Dodd K, Shields N, Bruder A; School of Physiotherapy,
1 School of Physiotherapy, University of Sydney, Sydney, Australia; La Trobe University, Melbourne, Australia
2 School of Theatre, Film and Dance, University of New South
PURPOSE: To evaluate the evidence from systematic reviews that
Wales, Sydney, Australia therapeutic exercise in musculoskeletal physiotherapy practice can
PURPOSE: The purpose of this study was to determine risk factors lead to health benefits. RELEVANCE: The treatment of problems
for injury associated with dance and acrobatics training during of movement is one of the major dimensions of musculoskeletal
adolescence. RELEVANCE: Dance and acrobatic gymnastics are physiotherapy practice. Prescription of exercise is one of the most
artistic sports which require superior flexibility, control and intensive common treatment options applied by physiotherapists. Conclusions
training during adolescence. The incidence of traumatic and overuse based on systematic reviews of randomised controlled trials are
injury is high however little is known about the risk factors in considered to provide the highest level of evidence about the
order to successfully treat these injuries and prevent reoccurrence. effectiveness of an intervention. PARTICIPANTS: The ‘participants’ in
PARTICIPANTS: 148 male and female participants (75 ballet and/or this study were 21 systematic reviews in the area of musculoskeletal
theatrical dance students and 73 acrobatic gymnasts) volunteered for practice. Reviews were selected by searching electronic databases
the study. Dance students aged 16 to 19.5 years, were recruited from for systematic reviews that evaluated the effects of therapeutic
Sydney based dance schools and universities. Acrobatic gymnasts exercise. As well as being required to be a systematic review
aged 8 to 26 years were recruited from New South Wales acrobatic that evaluated therapeutic exercise in a musculoskeletal diagnostic
gymnastics clubs. METHODS: A widely used Australian dance injury group, reviews also had to include at least one randomised
survey was modified for the purpose of this study which requested controlled trial, be considered to be good or reasonable quality
information regarding chronic injury, most recent dance or acrobatics as assessed on a quality assessment scale, and be written in
related injury as well as treatment, dieting behaviour, training history English. METHODS: The quality assessment was completed by
and awareness of injury prevention strategies. ANALYSIS: Data was two independent reviewers using a quality checklist designed for
analysed with SPSS 12 for Windows. Risk factors were examined by systematic reviews and data were extracted from each included paper
Pearson’s correlation, ANOVA, t-tests and ROC curves. RESULTS: using a standardised form. ANALYSIS: The quality assessment was
The results indicate that 47% of dance students and 37% of acrobats completed by two independent reviewers using a quality checklist
had sustained an injury within the past 6 months. The majority of designed for systematic reviews and data were extracted from each
dance students (51%) and acrobats who were also aged 16 years included paper using a standardised form. RESULTS: The review
and over (62%) reported being affected by chronic injury at the included seven reviews on low back and neck pain, 10 reviews on
time of the survey. Age of onset for acrobatics-related injury and peripheral musculoskeletal practice (including fracture rehabilitation
chronic injury averaged 13.7 and 14.7 years respectively, comparable and musculoskeletal disorders of the upper and lower limbs), and
with adolescent dance injuries at 14.1 and 14.9 years. The knee four reviews on arthritis. In total 226 randomised and controlled
and ankle were the most common sites of injury. The majority of trials were evaluated and the reviews were rated between 73 and
participants (82%) who required treatment for their most recent dance 84 out of 100 on the quality assessment scale (M 78.5, SD 4.9).
or acrobatics-related injury consulted a Physiotherapist. Significant In musculoskeletal practice, therapeutic exercise reduced pain and
risk factors for injury were training over 8.5 hours per week at age improved activity levels in people with chronic low back pain, and
14 years (p < 0.001) for dancers and age 13 years for acrobats osteoarthritis of the knee; reduced sick leave in people with sub-
(p < 0.001). No increase in injury risk was identified in those who acute and chronic low back pain; and improved activity and led
trained in additional sports. CONCLUSIONS: A training threshold to a faster return to work after lumbar disc surgery. There was
may exist for 13 and 14 year old dance students and acrobatic also moderate or limited evidence to support the effectiveness of
gymnasts, which if exceeded, increases the risk of injury. These therapeutic exercise in such diverse clinical groups as ankylosing
injuries most commonly affect the knee and ankle. Further research spondylitis, cervicogenic headache, whiplash associated disorders,
is warranted to determine optimal training loads in order to minimise acute mechanical neck disorders, fractures of the proximal femur
injury risk as well as explore specific risk factors for knee and ankle and humerus, shoulder pain, lateral epicondylitis, patellofemoral pain
injuries. IMPLICATIONS: Limiting training hours of 13 and 14 year syndrome, and acute lateral ankle sprain. There were indications
old acrobatic gymnasts and dancers to 8.5 per week may prevent that exercise programs were more effective when they were relatively
injury. As participation in sporting activity did not increase injury risk, intense and individualised, but in many areas of practice one form
cross-training may enable these athletes to improve fitness without of exercise was no more beneficial than another. Very few adverse
subjecting their bodies to high intensity dance and acrobatics training effects of exercise were reported. CONCLUSIONS: This summary
during this critical period. Both health professionals and coaches of systematic reviews provides evidence that prescription of exercise
have a role in developing such a training program. KEYWORDS: can lead to health benefits for many of the clients presenting to
adolescent injury. FUNDING ACKNOWLEDGEMENTS: This work physiotherapy with musculoskeletal complaints. Future research is
was unfunded. CONTACT: [email protected] required to determine the types and details of exercise programs
ETHICS COMMITTEE: University of Sydney Human Research Ethics that lead to optimum benefits. IMPLICATIONS: Prescription of
Committee therapeutic exercise is a safe and beneficial treatment modality
for physiotherapists in their management of disorders of movement
for people with musculoskeletal conditions. KEYWORDS: Thera-
peutic Exercise, Exercise Therapy, Systematic Review. FUNDING
ACKNOWLEDGEMENTS: 1. Australian Physiotherapy Association.
A DESCRIPTIVE STUDY OF IMPAIRMENT, ACTIVITY LIMITATION DYNAMIC POSTURAL CONTROL FOLLOWING AN ANTERIOR
AND HEALTH STATUS IN PATIENTS WITH CHRONIC CRUCIATE LIGAMENT RECONSTRUCTION
INFLAMMATORY DEMYELINATING POLYNEUROPATHY, CIDP Clifford A1 , Holder-Powell H2 ; 1 University of Limerick, Ireland;
2 London South Bank University, UK
Eriksson Westblad M1,2 , Forsberg A2 , Press R3 ; 1 Department
of Physical Therapy, Karolinska University Hospital Huddinge, PURPOSE: Postural control is fundamental to the performance of
Sweden; 2 Division of Physiotherapy, Department of Neurobiology, normal activities of daily living as well as many sporting activities
Care Sciences and Society, Karolinska Institute, Stockholm, [1]. This study analysed dynamic postural control in subjects
Sweden; 3 Department of Clinical Neuroscience, Karolinska following an anterior cruciate ligament (ACL) reconstruction during
University Hospital Huddinge, Sweden a dynamic balance task, namely, a single-leg squat. This manoeuvre
PURPOSE: Chronic inflammatory demyelinating polyneuropathy is frequently assessed clinically as it requires dynamic control
(CIDP) is a disorder affecting the peripheral nerves. Despite of of the body over the weight-bearing limb and is a movement
immunomodulatory treatment the symptoms can proceed and lead frequently assumed during many sporting activities RELEVANCE:
to considerable disability. The purpose of this study was to describe The assessment and optimisation of postural control are important
the extent of impairments, activity limitations and health status in in the prediction and prevention of a lower-limb injury [2,3] and re-
patients with CIDP. RELEVANCE: There is a lack of descriptive data injury. It is proposed that the objective measurement of dynamic
on the functional consequences of CIDP. Therefore, the rehabilitation postural control in subjects following their ACL-reconstruction will
and medical care of patients with CIDP may be enhanced and assist in the design and implementation of more specific and
optimized if based on a stronger scientific body of knowledge. successful rehabilitation programmes PARTICIPANTS: Following
PARTICIPANTS: All 22 patients above 18 years of age registered ethical approval, subjects with no previous history of lower-limb
at the Neurology Department of the Karolinska University Hospital injury other than a unilateral ACL-injury who underwent an ACL-
in Huddinge diagnosed with CIDP by a neurological physician were reconstruction and four months of post-operative rehabilitation were
sent a letter with information of the study and were at the same time informed regarding the study. Fourteen subjects (9 males), with
asked to participate. Twenty one patients gave informed consent. a mean age ± SD of 31.2±8.0, volunteered to participate in
Their mean age was 54 years (range18-82). METHODS: Vibration the study. METHODS: Three-dimensional movement, using the
perception threshold (VPT) was measured with a Biothesiometer. Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion
Fatigue was quantified with the Fatigue Severity Scale. Functional analysis system, (Charnwood Dynamics, UK) was recorded during
Balance was tested using the Berg Balance Scale. The Nine-hole a single-leg squat of 5 seconds duration. The sampling frequency
Peg Test was used to evaluate finger dexterity. For the quantification was 100 Hz measured by two sensor units from 24 light emitting
of basic functional mobility the Timed “Up and Go” test was used. diodes placed on specific anatomical landmarks. Data was recorded
The Swedish version of the SF-36 questionnaire was used to from both the injured and uninjured limbs. ANALYSIS: The data
indicate health status. ANALYSIS: The data were analyzed with non- pertaining to segment rotation about the i) sagittal plane; ii) coronal
parametric descriptive statistical methods, including median score plane and iii) vertical axis were exported and analysed in a Mathcad
and inter quartile range (IQR). RESULTS: Fifty seven percent of the 2001i mathematical programme. The degree of movement and
group had a higher thumb VPT in relation to published normative wobble (defined as the deviation in movement from the mean
data. Similarly, 67% showed a higher ankle VPT. The Fatigue Severity path), occurring at the pelvis, hip, knee, and ankle was established.
Scale showed that 38% scored over 5, previously used as a cut-off Comparisons between the injured and uninjured side were made
value for classifying the patient as severely fatigued. The majority using the Student’s paired t-test. RESULTS: Significantly less
of the patients had reduced functional balance as indicated by ankle (p = 0.001), knee (p < 0.001) and hip (p = 0.01) flexion were
the Berg Balance Scale with a median score 49 (IQR13). Sixty found during an injured leg single-leg squat compared to the
two percent had a subnormal result in the Nine-hole Peg Test uninjured leg squat. The analysis of wobble identified a significant
compared to what has been reported in the literature. The SF-36 increase in wobble during knee flexion-extension (p = 0.04), foot
questionnaire showed that the study group scored lower than the supination-pronation (p = 0.045) and foot alignment (p = 0.02) on the
Swedish norm on the sub-scales describing physical health. For injured side. CONCLUSIONS: At four months following an ACL-
the sub-scales measuring psycho-social health no clear difference reconstruction, deficits in dynamic postural control exist, as identified
were observed compared to the normative values. CONCLUSIONS: by an increase in wobble. Additionally, a reduced degree of ankle,
The majority of the patients with CIDP had impairments and activity knee and hip flexion persists in most subjects; which appears
limitations, and the physical health was also affected. There is a need to be in contrast with normal subjects when wobble decreases
of research to investigate if rehabilitation and physical therapy for with reduced knee flexion. It is recommended that future studies
patients with CIDP, might effect impairments and activity limitations. examine the effects of specific postural control training protocols
IMPLICATIONS: Physical therapy might be necessary for improving on the outcome measures used in this study. IMPLICATIONS:
and maximizing a limited level of functioning. These results show that Alterations in postural control following an ACL-reconstruction have
the CIDP group has impairments, activity limitations and a reduced been identified in this study, which may predispose individuals to
health status. KEYWORDS: CIDP. Fatigue. Balance. FUNDING further injury or re-injury. Thus, it is proposed that future rehabilitation
ACKNOWLEDGEMENTS: The study was funded by grants from programmes assess and address postural control in order to optimise
the Swedish Association of Persons with Neurological Disabilities. functional outcome and reduce the risk of injury following an
CONTACT: [email protected] ACL-reconstruction. References: [1] Adlerton AK, Moritz U, Moe-
ETHICS COMMITTEE: The Regional Ethic Committee of Karolinska Nilssen R. Forceplate and accelerometer measures for evaluating
Institute in Stockholm. the effect of muscle fatigue on postural control during one-legged
stance. Physiotherapy Research International 8[4], 187-199. 2003.
[2] Mandelbaum BR, Silvers HJ, Watanbe DS, Knarr JF, Thomas SD,
Griffin LY, Kirkendall DT, Garrett W. effectiveness of a neuromuscular
and proprioceptive training program in preventing anterior cruciate
ligament injuries in female athletes: a 2-year follow-up. The American
Journal of Sports Medicine 33[7], 1003-1010. 2005. [3] McGuine TA,
Greene JJ, Best T, Leverson G. Balance as a predictor of ankle
injuries in high school basketball players. Clinical Journal of Sport Physiotherapy Research Foundation Tagged Grant 2005. CONTACT:
Medicine 10, 239-244. 2000. KEYWORDS: Postural control, anterior [email protected]
cruciate ligament and wobble. FUNDING ACKNOWLEDGEMENTS: ETHICS COMMITTEE: South East Sydney Area Health Service
This work was part of a PhD project that was done on a studentship Human Research Ethics committee-Eastern Section; The University
from King’s College London. Some funding was received from the of Sydney Human Research Ethics Committee
Association of Orthopaedic Chartered Physiotherapists to purchase
equipment for this project. CONTACT: [email protected]
ETHICS COMMITTEE: Guy’s Research Ethics Committee, King’s
College London Research Ethics Committee, St Marys Local 2676 Monday 4 June 17:15
DOES PERFORMANCE VARY DURING THE SIX MINUTE WALK
TEST IN PERSONS FOLLOWING HEMILIPLEGIC STROKE?
Research Report Platform Presentation Kilbreath S1 , Davis G1 , Lee M1 , Fiatarone Singh M1,2 , Crosbie J1 ,
Zeman B3 ; 1 Faculty of Health Sciences, University of Sydney,
Sydney, Australia; 2 Faculty of Medicine, University of Sydney,
Sydney, Australia; 3 Royal Rehabilitation Centre, Sydney, Australia
ACTIVE SHOULDER EXTERNAL ROTATION RANGE OF MOTION-
DOES THE METHOD OF MEASUREMENT INFLUENCE RANGE? PURPOSE: This study investigated how persons with varying
degrees of impairment following stroke performed the 6 min walking
Chen J1,2 , GinnK2 ,Herbert R2 ; 1 Prince
of Wales Hospital, Sydney, test (6MWT). We hypothesized that the distance completed, the
Australia; 2 The University of Sydney, Sydney, Australia temporal-spatial parameters of gait and heart rate (HR) would change
PURPOSE: To compare results of different, commonly-used methods over the duration of the test. RELEVANCE: The 6MWT is commonly
of measuring active shoulder external rotation range of motion used to assess walking endurance and aerobic fitness in persons
RELEVANCE: Shoulder stiffness is a common but poorly understood following stroke. PARTICIPANTS: Eighty-four persons (age 63±13 yr;
disorder of the glenohumeral joint. It is the major cause of shoulder 40±52 months since stroke) participated. METHODS: The distance
disability and pain, and is a consistent symptom of primary frozen completed and the maximum HR within each minute of the 6MWT
shoulder, with restriction especially in passive external rotation and were recorded. Also, for 24 participants, the temporal-spatial gait
abduction. External rotation is a common component of the physical parameters were measured in the first and last minute of the test.
ANALYSIS: The overall total distance was normalised to predicted
assessment of the shoulder, being measured both actively and
distance based on age, height and weight and overall maximal HR
passively. It is customary to measure this with the arm in neutral, or
was normalised to age-predicted maximal HR. Participants were
at 90º of abduction, with the patient in sitting or in supine-lying. This
categorized ‘severely impaired’ if the normalised distance completed
study investigated the variations in range of shoulder external rotation
in the 6MWT was <50% predicted distance and ‘less impaired’ if
as measured in these positions. PARTICIPANTS: 60 subjects, aged
distance was 50% predicted distance. Two-way repeated measures
30 to 86 years (mean 66.3), presenting for physiotherapy treatment
ANOVA assessed change in gait and HR over time, accounting
at a large teaching hospital for shoulder pain and stiffness of more
for difference in severity of impairment. Pearson correlations
than one month’s duration, were invited to participate. Twenty healthy
assessed the relationship between gait and HR. RESULTS: Less
adult, aged 22 to 50 years (mean 31.9), with no previous history
impaired (n=39) and severely impaired participants (n=45) achieved
of shoulder complaints, were also invited to participate. METHODS:
80.0±18.8% and 28.1±12.6%, respectively, of predicted distance.
Active external rotation was measured using photography, in sitting
The distance covered in each minute did not vary significantly across
and in supine-lying, in random order. In both positions, the shoulder
time for both groups. The distances achieved in the 1st and 6th
was abducted to 90 degrees in the coronal plane, elbow flexed to 90 min for the less impaired group were 68.1±15.2 m and 66.9±8.2
degrees and forearm pronated. The olecranon and the ulnar styloid m respectively, and 28.7±15.0 m and 26.9±15.2 m for the severely
process were marked. External rotation range was determined as impaired group. In the five severely impaired and 19 less impaired
the angle between the line passing through the olecranon and the participants in whom temporal-spatial variables were assessed, these
ulnar styloid and the horizontal frame of the plinth. ANALYSIS: We did not change from the 1st to 6th minute. Resting HR was not
calculated 95% confidence interval (CI) for mean differernce in range significantly different between groups, but exercise HR increased
of motion in sitting and in supine-lying using t-distribution. Pearson’s significantly during the 6MWT with the degree of tachycardia differing
correlation coefficient (r) was used to describe the strength of the between groups. Less impaired participants achieved 70±12%
relationship between the measurements obtained in sitting and in predicted HR while severely impaired participants achieved 64±14%
supine-lying. RESULTS: In the patient population, the mean range predicted HR. Post-hoc analysis of the change in HR during
of active shoulder external rotation in sitting (73º) was larger than 6MWT revealed that HR in the less severe participants significantly
in supine-lying (38º) (mean difference: 35º; 95% CI: 29-41º). Similar increased over each consecutive minute of walking; severely impaired
results were observed in the healthy subjects, with a mean active participants’ HR did not significantly increase after the second minute.
external rotation range of 105º in sitting and 75º in supine-lying (mean Maximum HR was small but significantly correlated with the 6MWT
difference: 30º, 95% CI: 25-35º). The correlation between sitting and distance (r = 0.41, P < 0.01. The correlation of these two variables
lying measurements was only moderate in both groups (r = 0.45, r2 slightly decreased when distance and HR were expressed relative
= 0.20 in the patients and r = 0.52, r2 = 0.27 in the healthy subjects). to predicted values (r = 0.31, p < 0.01) CONCLUSIONS: Walking
CONCLUSIONS: Range of active shoulder external rotation is performance did not deteriorate over the duration of the 6MWT in
greater in sitting than in supine-lying. The correlation between these people after stroke. However, use of the 6MWT solely as a proxy for
two measures is weak. These results were similar in both patients and aerobic fitness is not supported. As is the case in other older cohorts,
in healthy adults. IMPLICATIONS: Measurements of active shoulder the contribution of non-cardiovascular attributes to 6MWD, such as
external rotation performed in sitting and lying probably reflect strength, balance, body composition, and neuropsychological status,
different muscle actions and different scapulo-humeral relationship. needs to be investigated further in cohorts of stroke survivors, to
Considerable care must be exercised when interpreting clinical understand how to interpret this test clinically. IMPLICATIONS: The
measures of active shoulder external rotation range of motion so 6 MWT is a valid measure of walking capacity across a range
as not to over-estimate shoulder joint stiffness as this could have of walking abilities in persons following stroke. Temporal-spatial
significant clinical implications for intervention. KEYWORDS: shoul- measures can be derived from a sample of the test as a reflection
der, stiffness, measurement. FUNDING ACKNOWLEDGEMENTS: of the individual’s walking performance. KEYWORDS: gait, CVA,
measurement. FUNDING ACKNOWLEDGEMENTS: The project was studies are needed on physical therapy’s effectiveness in prevention
financially supported by the National Health and Medical Research and management IMPLICATIONS: Our findings will be published
Council of Australia (Project 302013 and 253639). CONTACT: as a state-of-the-art report on practice standards to provide a
[email protected] baseline on cross cultural disparities on asthma prevalence and
ETHICS COMMITTEE: University of Sydney Human Ethics Commit- an explanation for these, disparities in practice standards, and on
tee, Sydney Australia. research in the area. Based on current literature, recommendations
for practice, continuing and professional education, and research are
outlined. In light of the psychsocial literature, special consideraiton
needs to be given to factors such as self-efficacy and culture
2692 Monday 4 June 17:15 KEYWORDS: asthma, best practice, education, epidemiology, prac-
VCEC Exhibit Hall A tice, prevalence, prevention. FUNDING ACKNOWLEDGEMENTS:
PHYSICAL THERAPY’S ROLE IN THE PREVENTION, DETEC- Professor Dornelas de Andrade supported by Coodenacao de
TION AND MANAGEMENT OF ASTHMA: GLOBAL TRENDS AND Aperfeicoamnto de Pessoal de Nivel Superior (CAPES), Brazil.
NEW DIRECTIONS BASED ON CONTEMPORARY EVIDENCE CONTACT: [email protected]
Dornelas de Andrade A1 , Kelms C2 , Dean E3 ; 1 Department of
Physiotherapy and Department of Physiology, Federal University Research Report Platform Presentation
of Pernambuco Recife, Brazil; 2 School of Physiotherapy, Dalhousie 3015 Monday 4 June 17:15
University, Halifax, Nova Scotia, Canada; 3 School of Rehabilitation VCEC Meeting Rooms 11-12
Sciences, University of British Columbia, Vancouver, Canada
EFFECT OF TWO ANKLE BRACES AND TWO ANKLE
PURPOSE: We conducted structured and systematic reviews related BANDAGES ON ANKLE POSITION AND ANKLE MOBILITY: A
to adult asthma to report on 1. the prevalence across countries COMPARATIVE STUDY
and changes over time, 2. the status of physical therapy’s role
Vaes P1 , Vandenbussche G2 , Duquet W2 , Van Gheluwe B2 ;
in prevention, detection and management, and 3. evidence-based 1 Physiotherapy dept., Faculty of Physical Education and Physical
directions for practice and research. RELEVANCE: Reports of
Therapy, Vrije Universiteit Brussel, Brussels, Belgium; 2 Human
the World Health Organization(WHO) support that the prevalence
Biometry and Biomechanics department, Faculty of Physical
of asthma is increasing worldwide. Whether this represents an
Education and Physical Therapy, Vrije Universiteit Brussel,
increase, or increased detection is unclear. For physical therapy
Brussels, Belgium
to be responsive to global healthcare needs, a state-of-the-
art update is timely regarding the prevalence of asthma, its PURPOSE: To measure and document effects of different methods
etiology and diagnostic features, and evidence-based prevention of external ankle support on joint stability. RELEVANCE: The
and management strategies.symptoms is not entirely clear, nor high incidence of trauma to the foot-ankle complex in sports and
its effectiveness in reducing medical intervention, medication, recreational activities has contributed to a proliferation of external
and hospitalization. PARTICIPANTS: study citations (1996-2005) ankle-stabilizing supports such as strapping, taping and bracing.
were screened according to inclusion and exclusion criteria. Key Preventive measures are thought to decrease ankle sprain incidence
words/strings were defined. Citation sources included Cochrane by providing mechanical support. There is a need for a reliable
Library, Medline, PubMed and CINAHL METHODS: A structured procedure to collect data on changes in mobility with the use of
review was conducted of WHO epidemiological reports and estab- the external support. PARTICIPANTS: A group of 22 volunteers
lished databases to extract asthma prevelance data. A systematic with healthy ankles (12 men) with a mean age of 21.6 years
review was conducted to provide state-of-the-art evidence regarding (range 18-27±2.2), were included in the brace study and a group
the effectiveness of physical therapy interventions. Standardized op 15 volunteers with healthy ankles (10 men) with a mean age
guidlines for systematic reviews (Edger 2003) and quality rating of 22.3 years (range 16-30±2.8) were included in the bandage
scale were adopted (Sakett et al 2000). Implications for practice study. METHODS: Two commercially available ankle braces (ASO
and research were derived. ANALYSIS: 39 extracted studies related ankle stabilizer and Aircast A60) and two bandage procedures
to asthma prevention/education; and 52 studies to intervention, (multilayer strapping and self applied taping) were tested; using
31 of which were ecclectic programs. Research directions were a surface EMG and an inversion stress apparatus. To compare
based on the congruence of epidemiological and pathophysiology braces and bandages, the restriction of rest position and inversion
literature, the International Classification of Function, and the WCPT mobility in relation to the no-support condition was measured.
definition of physical therapy (Strategic Directions and Priorities, ANALYSIS: A repeated measures ANOVA was used to compare
2003). RESULTS: Physical therapists are pre-eminently suited to the no-brace versus braces and the no-bandage versus bandages
address the needs of people with asthma. There is a dearth of setting. Paired samples t-tests with Bonferroni correction was used
controlled trials on adult asthma regarding prevalence and physical as a posteriori test. Finally an ANCOVA was applied to compare
therapy intervention (prevention/management) which precluded valid the tested braces results with the strapping and taping. The level of
systematic review. Studies were limited by lack of standardized statistical significance was set at P < 0.05. A statistical power of >0.90
definitions and reporting, and flaws in research methodology. was obtained. RESULTS: A significant decrease of inversion mobility
Although commonly practiced, breathing control and breathing (p < 0.05) was found during stress in healthy ankles supported by
pattern re-education have little conclusive support. Relaxation has therapeutic strapping, self applied taping, A60 and ASO bracing
modest support, but may improve lung function. Exercise training (51.3º in the no-bandage condition versus 36.8º with therapeutic
improves fitness but not lung function. The role of physical therapists strapping and 42.9º with taping; 46.2º in the no-brace condition
in aerosol use was not evident in the literature. Self-monitoring versus 41.2º with A60 and 41.3º with ASO). Comparing bandages
was encouraged (e.g., peak flow rate). If mentioned, the effect with braces in the stress situation, the only significant differences
of education was confounded by other interventions. Although found were between both braces and strapping. The A60 brace
physical therapy has traditionally had a role in asthma prevention reached significant inversion mobility decrease during the 15kg
and management, the role of the nurse in symptom-reduction inversion stress test although this brace caused a significantly
education is more often cited. CONCLUSIONS: With respect to smaller change in inversion position of the ankle in the rest
prevalence, disparities may reflect different diagnostic standards, position. CONCLUSIONS: Multi layer ankle strapping applied by
and access to medical care. Inconsistent findings from outcome an experienced physiotherapist reduced ankle inversion significantly
studies may reflect lack of control for disease stage and acuity. There more than the two ankle braces. Rest position was significantly
is support for education, relaxation, and exercise. Well-controlled overcorrected in eversion position after applying the strapping
procedure. IMPLICATIONS: Physiotherapists can advice patients training at similar speeds to OG walking presents greater muscular
about efficacy and reliability of external ankle support based on challenges to single joint hip and knee stabilizers, yet reduces
measurements of influence on rest position and limitation of inversion demand on key stance and swing ankle muscles. Further work
mobility. KEYWORDS: ankle, inversion mobility, external support, is required to determine the impact of altered movement patterns
ankle brace, ankle bandage. FUNDING ACKNOWLEDGEMENTS: on muscular demands in select patient populations (e.g., stroke).
The research committee of the Physical Education and Physical IMPLICATIONS: This study’s results provide essential guidance
Therapy Faculty of the Vrije Universiteit Brussel funded this research related to recommending EL training as a therapeutic intervention
project-FWOAL384. CONTACT: [email protected] across the continuum of care. KEYWORDS: Gait, therapeutic in-
ETHICS COMMITTEE: The Ethics Committee of the Academic terventions, electrophysiology. FUNDING ACKNOWLEDGEMENTS:
Hospital of the Vrije Universiteit Brussel-Brussels-BELGIUM Daniels Fund, Denver, CO. CONTACT: jburnfi[email protected]
ETHICS COMMITTEE: Institutional Review Board, Madonna Reha-
bilitation Hospital, Lincoln, NE, USA
VCEC Meeting Room 16 Research Report Platform Presentation
MUSCULAR DEMANDS DURING ELLIPTICAL TRAINING 2697 Monday 4 June 17:15
COMPARED TO OVERGROUND WALKING VCEC Meeting Room 17
Burnfield J1−3 , Buster T1 , Provorse A1,2 , Takahashi S1,2 ; ISCHAEMIA AS A MODEL OF FOCAL NERVE INJURY
1 Movement Sciences Center, Madonna Rehabilitation Hospital, Boland R1−3 , Han S1,4 , Kiernan M1,3,4 ; 1 Spinal Cord Research
Lincoln, NE, USA; 2 University of Nebraska – Lincoln, Lincoln, Centre, Prince of Wales Medical Research Institute, Randwick,
NE, U.S.A.; 3 Department of Biokinesiology and Physical Therapy, Australia; 2 School of Physiotherapy, Faculty of Health Sciences,
University of Southern California, Los Angeles, CA, USA University of Sydney, Lidcombe, Australia; 3 Institute of Neurological
Sciences, Prince of Wales Hospital, Randwick, Australia
PURPOSE: Retaining or regaining walking function is a primary
goal of many persons with chronic medical conditions. The elliptical PURPOSE: Focal peripheral neuropathies are characterised by
crosstrainer, widely available in fitness and rehabilitation settings, paraesthesias and numbness but mechanisms underlying these
has been advertised as a device which promotes movements similar symptoms are complex and not well understood. The aim of this study
to walking. Buster et al (2006) identified general similarities in leg was to investigate mechanisms underlying neurological symptoms
movements during elliptical training (EL) and overground walking in response to experimental ischaemia of the median nerve.
(OG), with the notable exception that subjects were postured in RELEVANCE: Understanding the relationship between neuropathic
greater flexion at the hip, knee and ankle during EL. The extent symptoms such as paraesthesia and pain, and axonal function
to which more flexed postures influence lower extremity muscle may improve the current management of focal neuropathies and
activation patterns, however, was not reported. The current study suggest new therapeutic interventions. PARTICIPANTS: Five healthy
compares lower extremity muscle demands during EL to OG walking. participants aged between 21 and 43 years volunteered to participate
It was hypothesized that leg extensor muscle activity would be and ethics approval from the South Eastern Sydney Area Health
greater during EL owing to the need to stabilize the flexed hip, knee Service was granted before the study commenced. METHODS:
and ankle, and that dorsiflexor activity would be lower during EL Ischaemia as a model of focal nerve injury was induced by inflating
due to the external support provided by the footplate throughout a sphygmomanometer cuff above the elbow to an occlusive pressure
swing. RELEVANCE: Greater understanding of muscular demands of 200 mmHg for 10 minutes in the right arm of participants.
associated with EL is essential to guide clinicians’ therapeutic Median nerve sensory excitability was assessed before, during, and
recommendations with this device. PARTICIPANTS: Seven adults, after the ischaemic period using electrical techniques that monitor
free from impairments that might hinder gait (mean age = 26 years). the threshold current required to excite the nerve. A computer
METHODS: Subjects participated in three familiarization sessions controlled external current source stimulated median sensory axons
on the Elliptical Cross-Trainer (Life Fitness™ 95Xi). During session while continuously adjusting stimulus intensity to maintain the
four, foot-floor contact patterns (compression closing footswitches) target proportional response of maximum threshold. Concurrent
and dominant leg muscle activation patterns (EMG) were recorded recordings of paraesthesia rated on a 0-10 scale of intensity were
simultaneously as subjects ambulated OG at a self-selected speed taken throughout the experimental period. ANALYSIS: Data were
and elliptical trained at a speed approximating (±5%) that obtained analysed using Memplots for Windows©. All data were pooled and
during OG walking. ANALYSIS: Footswitch (OG) and footplate means (for each minute) for the following parameters were plotted
(EL) data defined gait cycle phasing. EMG activation patterns against time for the experimental period of 47 minutes: Normalised
(expressed as a percentage of maximal activity recorded during OG thresholds for each stimulus intensity; changes in supernormality
walking, %Max OG) were identified for gluteus maximus(GMAX), and superexcitability; and intensity of paraesthesiaas. RESULTS:
gluteus medius(GM), vastus lateralis(VL), medial hamstrings(MH), Threshold currents for stimulus durations of 0.2 and 1 ms fell
medial gastrocnemius(MG), and tibialis anterior(TA). Paired T- by 19% and 22% respectively during ischaemia, peaking at 8
tests determined if EMG (mean, duration) varied significantly minutes, which coincided with significant changes in refractoriness
between conditions for each muscle (Bonferroni adjusted alpha and supernormality. The intensity of paraesthesias peaked at
level, p < 0.0083). RESULTS: Mean EMG activity was decreased 7/10 after 7 minutes of ischaemia before declining in the final
during EL training compared to OG walking in MH (15 vs. 58%Max 3 minutes of occlusion. Changes after release of the cuff were
OG; p = 0.001), MG (21 vs. 53%Max OG; p < 0.001), and TA (11 rapid, with axonal hyperpolarisation, and associated reductions in
vs. 48%Max OG; p < 0.001). EMG duration was longer during EL refractoriness and supernormality. Intense paraesthesias of 9/10
compared to OG in GMAX (43 vs. 14%Max OG; p < 0.001), GM (36 intensity peaked 4 minutes after cuff release and ceased by the
vs. 18%Max OG; p = 0.006), and VL (83 vs. 28%Max OG; p < 0.001). 10th minute when electrical parameters approached but had not
In contrast, TA EMG duration was shorter during EL compared to reached pre-ischaemia levels. CONCLUSIONS: Nerve ischaemia
OG (11 vs. 44%Max OG; p < 0.001). CONCLUSIONS: Consistent induced significant paraesthesias but perhaps counter-intuitively,
with the original hypothesis, EMG duration was greater in select more intense levels accompanied release of ischaemia. This can
lower extremity stabilizers (GMax, GM, VL) during EL training. One be explained by mechanisms underlying post-ischaemic axonal
exception was that the mean MG EMG was reduced during EL. The hyperpolarisation. IMPLICATIONS: This study has implications for
finding of reduced TA EMG (mean and duration) also was consistent physiotherapists treating patients with focal neuropathies such
with the original hypothesis. Collectively, these data suggest that EL as carpal tunnel or cubital tunnel syndromes. The rationale for
using interventions such as manual therapy must account for the Swedish Centre for Research in Sports and The Local Research
the neurophysiological mechanisms that induce symptoms such and Development Council for Gothenburg and Southern Bohuslän,
as paraesthesias. KEYWORDS: ischaemia, nerve, paraesthesia. Sweden. CONTACT: [email protected]
FUNDING ACKNOWLEDGEMENTS: NSW Ministry for Health ETHICS COMMITTEE: Approval for the study was obtained from the
and Medical Research and Spinal Cord Injury Grants Program. Human Ethics Committee at Göteborg University, Sweden.
ETHICS COMMITTEE: South Eastern Sydney Area Health Service
Human Ethics Committee
IN VIVO KINEMATICS OF HEALTHY SHOULDERS DURING
2454 Monday 4 June 17:15 LOADED AND UNLOADED SCAPTION MEASURED BY A
VCEC Meeting Room 18 SINGLE-PLANE SHAPE-MATCHING TECHNIQUE
RELIABILITY AND VALIDITY FOR TEST BATTERIES FOR
Gamada K1 , Nishinaka N2 , Kon Y2 , Banks S2 , Tsutsui H3 ; 1
MAXIMAL SINGLE-LEG HOP PERFORMANCE AND MUSCLE
Department of Physical Therapy, Hiroshima International University,
POWER IN PATIENTS WITH ACL INJURY
Higashi-Hiroshima Japan; 2 Department of Mechanical and
Neeter C1 , Gustavsson A, Thomeé R, Grävare Silbernagel K, Aerospace Engineering, University of Florida, Gainesville, USA;
Augustsson J, Karlsson J; 1 Dept of Orthopaedics, Lundberg 3 Department of Orthopaedics and Rehabilitation, Showa University
Laboratory, Göteborg University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
PURPOSE: The purpose was to develop test batteries with high PURPOSE: Scapulohumeral rhythm and glenohumeral kinematics
ability to discriminate performance between the injured and the are 2 major components of shoulder biomechanics and the effects
uninjured side in patients with anterior cruciate ligament (ACL) injury. of loading during scaption (scapular plane abduction) on shoulder
RELEVANCE: The literature clerly points out that there is a need for kinematics have not been determined. The goals of this study
reliable, valid and sensitive instruments to evaluate muscle functionto were to determine if scapular upper rotation is different and if
in order to determine when it is safe to return to strenuous physical the superior translation of the humeral head is different between
activities. PARTICIPANTS: For the single-leg hop test battery 15 loaded and unloaded shoulder scaption. We hypothesized that
healthy subjects performed five hop tests at three separate occasions there would be no differences in glenohumeral translation and
in a test-retest design on each leg (n = 30). Thereafter 30 patients scapulohumeral rhythm for the 2 conditions in healthy shoulders.
with ACL injury were tested 6 months after injury and 35 patients RELEVANCE: Selection of a load in therapeutic exercise may be
were tested 12 months after ACL reconstruction. For the muscle a key to modifying kinematics. This study will provide knowledge
power strength test battery 13 healthy subjects were tested in a in the effect of 3kg-loading on healthy shoulder kinematics during
test-retest design on each leg (n = 26). Twenty-three patients with scaption. PARTICIPANTS: Ten healthy shoulders of 10 participants
an ACL injury were tested 6 months after injury and 44 patients (8 males) were enrolled in this IRB-approved, prospective study.
were tested 6 months after ACL reconstruction. METHODS: Five METHODS: A shape-matching technique (Banks, 1996) using single-
hop tests were analysed and the three tests with the highest ability plane fluoroscopy and CT-based patient-specific shoulder models
to discriminate hop performance between the injured and uninjured were used for kinematic analysis. Participants performed 3 cycles
side were chosen for the test battery: the counter movement jump, of unilateral scaption with and without a 3kg hand-held load under
the hop for distance and the side hop test. Three tests were chosen fluoroscopic surveillance at 15 Hz, during which the fluoroscopy
for the strength test battery to reflect quadriceps and hamstrings was set at approximately 90º from the scapula plane. They also
muscle power in a knee extension and a knee flexion test (open underwent CT scan at 0.5mm slice pitch, from which geometric bone
chain) and lower extremity muscle power in a leg press test (closed models of the humerus and scapula were created. ANALYSIS: A
chain). ANALYSIS: Conventional methods were used for descriptive custom program (KneeTrack) produced by a co-author (SB) was
statistics and correlations. Non parametric methods were used for used for the shape-matching procedure to obtain 6 degrees-of-
group comparisons. Significance was considered at p < 0.05. Test- freedom shoulder kinematics, whose estimated errors were 1.5mm
retest analysis was determined by intraclass correlation coefficient in sagittal translations and 1.5 degrees in 3 rotations in knee
(ICC). A methodological error in percent was calculated. Lower kinematics (Fregly, 2005). Cardan/Euler angle convention (Tupling
limb symmetry index (LSI) was calculated to determine whether a and Pierrynowski, 1987) was used for quantitative analyses. Two-
side-to-side leg difference was classified as normal or abnormal. way repeated measure ANOVA was used for kinematics comparisons
In this study LSI greater than or equal to 90% was classified as and p < 0.05 were used for the level of significance. RESULTS:
normal. RESULTS: No significant differences were found between Approximately 60º of glenohumeral abduction was observed for both
test occasions in any of the three strength tests or the three hop tests. loaded and unloaded conditions. The starting location (contact point)
The ICC ranged from 0.87 to 0.98 and the methodological error from of the humeral head, defined as the location of the nearest point of
3 to 10%, for the strength and hop tests. The sensitivity for the hop the humeral head projected onto a hypothetical glenoid plane, was
test battery was 87% in the patients with ACL injury and 91% in the at 2mm inferior to the midpoint of the glenoid fossa and the ending
patients after ACL reconstruction. The three strength tests combined location was at the midpoint for both conditions. The superior-inferior
into one test battery gave a sensitivity of 60% for the patients 6 contact points at any of the abduction angles showed no statistical
months after ACL injury and 94% for the patients 6 months after ACL differences between loaded and unloaded conditions. Scapular upper
reconstruction. CONCLUSIONS: The principal finding of this study rotation during 60º of glenohumeral abduction was 32º and 22º for
was that a test batteries had high ability in terms of discriminating unloaded and loaded conditions, respectively. Statistical differences
hop as well as strength performance between the injured and the were detected at 30º, 40º and 50º of glenohumeral abduction.
uninjured side, both in patients with ACL injury and in patients after The largest difference in the glenohumeral rhythm (1.4 and 5.0 for
ACL reconstruction. It is concluded that the test batteries showed unloaded and loaded conditions, respectively), defined as a ratio
high test-retest reliability and a higher sensitivity than any of the of glenohumeral abduction to scapular upper rotation at given 10º
tests individually. IMPLICATIONS: The test battery may contribute increments of glenohumeral abduction, was detected at the range of
to the decision-making process of deciding whether patients can 30º to 40º of the glenohumeral abduction. (Note that the larger the
return safely to strenuous physical activities after ACL injury or ratio is, the smaller the scapular contribution is.) CONCLUSIONS:
reconstruction. KEYWORDS: power, hop, test battery. FUNDING A load of 3kg was not enough to change glenohumeral kinematics,
ACKNOWLEDGEMENTS: This study was supported by a grant from but was large enough to enhance stabilizing effect of the scapula
during scaption. IMPLICATIONS: A load of 3kg for scaption in healthy going home, consideration needs to be given to higher-level mobility
shoulder may be a suitable load when the therapeutic intension is skills that enable role performance. It should not be assumed
to enhance scapular stability without changing glenohumeral kine- that those who live with their families or who have received
matics. KEYWORDS: shoulder kinematics, glenohumeral translation, TPA are not in need of further physiotherapy. Physiotherapists
scapulohumeral rhythm. FUNDING ACKNOWLEDGEMENTS: No should ensure that they do a comprehensive assessment of goals,
funding for this study was received by any of the authors. CONTACT: that the patient has adequate transportation, and advocate for
[email protected] adequate community services. KEYWORDS: stroke, needs, service
ETHICS COMMITTEE: Approved by the Ethics Committee of delivery. FUNDING ACKNOWLEDGEMENTS: Hamilton Community
Department of Orthopaedics and Rehabilitation, Showa University Foundation. CONTACT: [email protected]
Fujigaoka Rehabilitation Hospital ETHICS COMMITTEE: Research Ethics Boards of St. Joseph’s
Healthcare Hamilton, Hamilton Health Sciences and Joseph Brant
Memorial Hospital
PREDICTING PHYSIOTHERAPY NEEDS FOLLOWING STROKE: 2491 Monday 4 June 17:35
AN ANALYSIS OF CLINICAL AND DEMOGRAPHIC FACTORS VCEC Ballroom A
DePaul V1,2 , DeHuek A3 , Rieck M3 , Pollock B2,4 , Yip D4 , IDENTIFICATION OF INTERVENTION CATEGORIES FOR
Pagliuso S4 , Moreland J1,2 ; 1 St. Joseph’s Healthcare, Hamilton, PHYSIOTHERAPY ON THE ICF
Canada; 2 McMaster University, Hamilton, Canada; 3 Joseph Brant Huber E1,2 , Stoll J3 , Finger M3,4 , Stucki G5,6 , Cieza A5 ;
Memorial Hospital, Burlington, Canada; 4 Hamilton Health Sciences, 1 Department of Rheumatology and Institute of Physical
Hamilton, Canada Medicine, University Hospital Zurich, Switzerland; 2 Association

of Physiotherapy, Sursee, Switzerland; 3 Physiotherapy Science
PURPOSE: To determine the clinical and demographic factors of
Studies, Department of Rheumatology and Institute of Physical
individuals with stroke who feel they need follow-up physiotherapy
Medicine, University Hospital Zurich, Switzerland and Faculty of
after discharge from hospital, but do not receive it. To examine
Health Sciences, Maastricht University, the Netherlands; 4 Rehaclinic
whether there is a bias in the provision of follow-up physiotherapy.
Bellikon, Bellikon, Switzerland; 5 ICF Research Branch of the
To improve prescription of physiotherapy follow-up. RELEVANCE:
WHO FIC Collaborating Centre (DIMDI), IHRS, Ludwig-Maximilian
On discharge from hospital, physiotherapists decide whether to refer
University, Munich, Germany; 6 Department of Physical Medicine
patients for ongoing therapy. We performed a comprehensive needs
and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
assessment following discharge that showed some individuals felt
they needed physiotherapy but were not receiving it. To improve PURPOSE: To identify, in consensus process, a first version
how we meet patient needs, it is important to explore this finding. of intervention categories that describe the most relevant and
PARTICIPANTS: 213 patients with stroke were recruited from 4 common patient problems treated by physical therapists based on
acute care hospitals. METHODS: This is a multi-centred prospective International Classification of Functioning, Disability and Health (ICF).
longitudinal cohort study examining the comprehensive self-reported RELEVANCE: The ICF is a worldwide agreed-upon system for
needs of individuals with stroke at discharge, six months and classification of all aspects of human health. It provides health
one year. Each individual participated in an extensive open-ended professionals, patients and peers with a common language. The
interview as well as a comprehensive checklist survey of needs. assessment of patient’s functioning and identification of resources
For this analysis, we examined data at discharge. Respondents is the basis of physiotherapists’ intervention plan, treatment, and
were divided into three groups: those that expressed a need for evaluation. If the results of assessment are translated into the
PT and were not receiving it (24%), those that were receiving ICF, a functioning-oriented physiotherapy diagnosis can be created
PT (40%), and those that did not express a need for PT and based on worldwide agreed-upon classification system. The use of
were not receiving it (36%). ANALYSIS: The three subgroups ICF-based physiotherapy diagnosis can contribute to facilitate the
were compared using chi-square and analysis of variance statistics. multidisciplinary work, to ensure quality of treatments and help to
RESULTS: There were clinically important differences between standardize clinical quality programs. PARTICIPANTS: 59 senior
groups in: receipt of TPA (p < 0.05), home care services before stroke, physiotherapists participated in a consensus conference in Switzer-
employment before stroke, education, first language, discharge living land. METHODS: The three diagnostic areas musculoskeletal,
situation (lives with family) and inability to drive (p < 0.05). The internal medicine and neurological and three health-care situations:
acute FIM score for patients reporting a need for physiotherapy acute, rehabilitation, and community health care were considered to
was 70.0, 80.3 in the group receiving physiotherapy and 93.5 in create nine different groups of physiotherapists. A formal decision-
those not needing physiotherapy (p < 0.10). Discharge FIM scores making and consensus process integrating results of a Delphi
were similar for all groups. On open-ended questions, patients exercise was conducted in each of the groups to decide the most
reporting a need for physiotherapy reported more needs related to relevant and common patient problems treated by physiotherapists
motor control, energy, driving (p < 0.05) and affordable transportation. in each of the diagnostic areas and health-situations, respectively.
This group reported a higher need to resume their roles (p < 0.05) ANALYSIS: We reported absolute and relative frequencies of
and independence (p < 0.05). A greater need was also reported ICF intervention categories of components body functions, body
for day hospital (p < 0.05). On surveys (close-ended questions), structures, activities and participation and environmental factors.
individuals reporting a need for physiotherapy had just as much Only those intervention categories which were voted for by more
difficulty or more difficulty with picking up things from the floor, than 50% of the senior physiotherapists are presented. RESULTS:
using their wheelchair, getting up and down from the floor, standing The nine lists containing first versions of intervention categories for
for long periods, walking outdoors, walking in crowded places and physiotherapists represent a total of 349 different ICF categories.
doing stairs. CONCLUSIONS: In many ways, patients expressing Twenty-five ICF categories were defined on chapter level, 162 on
a need for physiotherapy but do not receive therapy are similar first level, 142 on second level and 20 on third level. The greatest
to those who receive physiotherapy. Some variables suggest that accordance was discovered in the component Body Function chapter
decisions to refer to physiotherapy may be based on social and 7, Neuro-musculoskeletal and Movement Related Function and in
transportation factors rather than physical need. Further research the component Activity and Participation, chapter 4, Mobility. The
on how decisions are made about referral to physiotherapy is resulting nine lists are very heterogeneous with respect to length
needed. IMPLICATIONS: Although therapists prepare patients for and ICF categories contained. The smallest list contained 57 and the
largest 191 ICF categories. CONCLUSIONS: This study represents variations in strategy, there was little change at any of the loading
a step toward identifying a list of intervention categories relevant intervals (P > 0.05). Unlike the other abdominal muscles, the activity
for physical therapy according to the ICF. The nine lists containing of TrA was unchanged by reduced predictability. CONCLUSIONS:
the first versions of intervention categories for physiotherapists Agonist/antagonist co-contraction did not increase during any of the
are still very comprehensive. This reflects the complex profile of predictable or unpredictable loading tasks, instead agonist activity
patients treated by physiotherapists and the high demands which reduced during the unpredictable tasks. TrA was the only muscle
confront physiotherapists in their daily work. Further investigations that demonstrated increased activity with loading in both directions
are needed to validate the results of this study. IMPLICATIONS: and was unaffected by the reduced predictability. IMPLICATIONS:
In the future, lists with intervention categories based on the ICF Co-contraction was found to decrease when participants anticipated
could be established as checklists in clinical practice. They could the load release at an unexpected time. This is counterintuitive
build the basis for a functioning oriented PT diagnosis. A better as the nervous system is expected to prepare for a perturbation
understanding of decision-making and consequently the amount of by increasing co-contraction. While the purpose of this adaptation
interventions given would provide us with an important basis for a is unclear, it appears that increased co-contraction is not always
more rational decision-making, the allocation of resources in services perceived as the ideal strategy to protect the spine. This study also
provision and the reimbursement of physiotherapeutic interventions. provides further support for TrA contributing to lumbar stabilization in
The intervention lists are intended to improve the professional status a manner that is different to other trunk muscles. Increased activation
of physical therapists. KEYWORDS: ICF, International Classification of TrA in flexion and extension may be advantageous by enhancing
of Functioning, Intervention categories, Physiotherapy. FUNDING stability without compromising the flexion or extension torque.
ACKNOWLEDGEMENTS: We gratefully acknowledge the Swiss KEYWORDS: co-contraction, lumbar spine, stability. FUNDING
Physiotherapy Association for its financial support and the cooper- ACKNOWLEDGEMENTS: PH was supported by the National
ation of all participants in this study. Health and Medical Research Council of Australia. CONTACT:
ETHICS COMMITTEE: The study was approved by the ethic [email protected]
committee of Zurich, Switzerland ETHICS COMMITTEE: Ethical approval for this study was provided
by the Medical Research ethics Committee of the University of
Queensland.
VCEC Ballroom B & C Research Report Platform Presentation
CO-CONTRACTION IS REDUCED RATHER THAN INCREASED 3230 Monday 4 June 17:35
IN PREPARATION FOR UNEXPECTED TRUNK UNLOADING VCEC Exhibit Hall A
McCook D, Hodges P; Physiotherapy Division, University of CLINICAL EFFECTIVENESS OF A CARDIAC REHABILITATION
Queensland, Brisbane, Australia AND PRIMARY PREVENTION PROGRAM DESIGNED FOR
WOMEN
PURPOSE: Lumbopelvic stability relies on, amongst other factors,
Price J, Landry M, Delos-Reyes F, Rolfe D, Childerhose D,
co-contraction of the lumbo-pelvic muscles. Changes in load
Sternberg L; Women’s Cardiovascular Health Initiative, Women’s
and predictability are expected to affect the associated control
College Hospital, Toronto, Ontario, Canada
strategies of both the deep and superficial lumbo-pelvic muscles. We
hypothesized that co-contraction of the trunk muscles would increase PURPOSE: Background: Cardiac Rehabilitation (CR) has been
with increasing load and in preparation for an unpredictable unloading shown to be an important intervention in the care of cardiovascular
perturbation. RELEVANCE: Despite evidence that the deeper trunk patients, however studies have reported lower enrollment and
muscles contribute to spinal control, few studies have considered participation rates for women compared to men. In addition to this
their role in incremental loading and unloading tasks, or whether their under-representation in traditional CR programs, there is a large
activation may preclude or compliment increased co-contraction of dropout rate among women. The purpose of this paper is to present
the more superficial lumbo-pelvic muscles. PARTICIPANTS: Eleven outcomes from this gender-specific program. RELEVANCE: The
healthy males with no low back pain history volunteered. METHODS: Women’s Cardiovascular Health Initiative is unique in Canada and
Participants were positioned in a loading frame and performed 5 s offers comprehensive CR and primary prevention (PP) programs for
isometric extension and flexion efforts to randomly presented loads women. Components of the program include exercise training, group
of 50, 100, 150 and 200N. Tasks were repeated with participants education sessions on risk factor and lifestyle modification strategies,
knowing the load would be released at an unpredictable time during and individual counseling and support. All of these components
the isometric hold. Maximum voluntary contraction (MVC) efforts encourage individual lifestyle changes, while also considering the
were performed in both directions. Electromyographic activity (EMG) context of each woman’s life by utilizing a women-centered model
was recorded from 8 trunk muscles using surface electrodes and fine- to guide its content and delivery. This may improve outcomes
wire electrodes. ANALYSIS: RMS EMG amplitudes were calculated for women who may otherwise not access or drop out of such
and normalized to MVC. Data were compared between force levels programs. PARTICIPANTS: Of 768 clients assessed for entry,
and tasks with a repeated measures ANOVA. RESULTS: When 697 women enrolled between 11/01/1996 to 12/31/2003, with 298
participants isometrically extended, EMG activity of the paraspinal joining the CR stream and 308 in PP. Baseline characteristics were
muscles increased with increases in load (P < 0.006). During the described and compared between CR and PP clients. METHODS:
flexion tasks, EMG activity of the abdominal muscles increased This study is a retrospective cohort study design. Data was
from the 100N load (P < 0.0001), obliquus externus increased from collected through WCHI database files, individual client charts,
50N (P = 0.03). Activity of the antagonist muscles did not increase and the self-administered survey questionnaire. ANALYSIS: Among
during any of the predictable submaximal loading tasks, in either 590 completers, clinical outcomes (exercise capacity, body mass
direction (P > 0.15). Only transversus abdominis (TrA) EMG increased index (BMI), waist circumference, body fat percentage) and health
in both directions; in flexion from 100N, and in extension from outcomes (SF-36 physical and mental summary scores) were
150N (P < 0.028). When predictability was reduced, EMG of the compared before and after the program using a t-test. RESULTS:
lumbo-pelvic agonist muscles in both the flexion and extension tasks Of the 632 women enrolled between November 1, 1996 and
was less than in the predictable trials at 200N (P < 0.037), and May 31, 2004, 315 patients entered CR (mean age = 64.4±11.4
also at smaller loads for some muscles (P < 0.048). However, there yrs) and 317 entered PP (mean age = 57.6±10.1 yrs). Baseline
was minimal change in the respective antagonist muscles. Even characteristics will be described in both CR and PP patients. Among
when the antagonist activity was pooled to account for individual 542 patients completing the program, clinical outcomes (exercise
capacity, body mass index (BMI), waist circumference (WC), body was also notable (p < 0.01). For the muscular function, an improved
fat percentage (BF)) and health outcomes (SF-36 physical and MVIC for knee extension was only observed in the sedentary group
mental summary scores) were assessed before and after partaking (p < 0.05), a functional improvement of muscle fatigability for all the
in the program. The compliance rate to completion for both subjects. CONCLUSIONS: These results suggested that postural
groups was 85%. Statistically significant improvements (p < 0.0005) in control and muscular function were sensitive to training on such a
exercise capacity (mean change = 2.36 METS ±1.77 (CR) (n=218), rehabilitation device. IMPLICATIONS: It seems likely that training on
1.86±1.58 METS (PP) (n=213)), BMI (mean change −0.53±1.35 this device would better suit a population with an initial low physical
(CR), −0.82±3.16 (PP)), WC (mean change −2.7±4.61 cm (CR), activity level and could be applied to elderly or disabled people,
−1.88±4.05cm (PP)), BF (−0.56±2.32% (CR), −1.11±1.75% (PP)) especially those with sensory disabilities. Moreover, for healthy active
and SF-36 physical scores (4.3±7.94 (CR), 2.93±7.55 (PP)), mental or trained subjects, greater effects could be obtained by increasing
scores (3.02±9.31 (CR), 3.64±8.67 (PP)) were observed at time exercises’ intensity and specificity. KEYWORDS: motor function,
of discharge. CONCLUSIONS: The valuable effects of participation rehabilitation device, training. FUNDING ACKNOWLEDGEMENTS:
in a women-centered program, demonstrated by improvements in This study has been funded by LPG Systems, France. CONTACT:
exercise capacity, quality of life, and greater patient compliance, [email protected]
provides evidence of the need for consideration of gender-specific ETHICS COMMITTEE: This study was approved by the Ethics
variables when designing and implementing CR and PP programs Committee of Pitié-Salpêtrière Hospital in Paris, France.
for women. IMPLICATIONS: The implications for clinical practice
and health care policy are far reaching. One should consider
gender specific variables in the design of Cr and PP programs to
improve outcomes for women. KEYWORDS: Cardiac rehabilitation, 2967 Monday 4 June 17:35
women’s health, outcomes. FUNDING ACKNOWLEDGEMENTS: VCEC Meeting Room 17
None. CONTACT: [email protected] CAN GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM
ETHICS COMMITTEE: Ethics approval from the Toronto Academic PREDICT FUNCTIONAL LIMITATIONS AMONG OLDER ADULTS
Health Sciences Council Ethics Review Board, for Research Ethics WITH CEREBRAL PALSY?
Involving Human Subjects was awarded Furui T1 , Furui M, Shiraishi K2 , Tuchiya Y3 , Collins D4 ; 1 Osaka
Kawasaki Rehabilitation University, Kaizuka, Japan; 2 Office IL, the
Research Report Platform Presentation Center of Independent Living, Kohriyama, Japan; 3 Aich University,
2023 Monday 4 June 17:35 Toyohashi, Japan; 4 University of Pittsburgh, Human Engineering
VCEC Meeting Room 16 Research Laboratories, Pittsburgh PA, USA
CHANGES IN BALANCE AND STRENGTH PARAMETERS PURPOSE: To investigate the progression of functional limitations
FOLLOWING TRAINING WITH SPINEFORCE® OR HUBER® among older adults with cerebral palsy (CP) living in community
DEVICE IN HEALTHY SUBJECTS settings as assessed by performance on the Gross Motor Function
Classification System (GMFCS) [1]. RELEVANCE: CP is the most
Portero P1,2 , Couillandre A3 , Duque Ribeiro M1 , Thoumie P1 ;
1 Service de Rééducation Neuro-Orthopédique, INSERM UMR 731, disabling, childhood onset condition for adults [2]. The Japanese
population of people with CP was estimated to be 99,800 in a
Hôpital Rothschild, 33 boulevard de Picpus, 75571 Paris Cedex 12,
2001 survey [3]. Straus et al. found that preserved mobility was
France; 2 Département STAPS, Université Paris 12, 94000 Créteil,
a predictor of mortality rate of individuals living with CP aged 60
France; 3 UFR STAPS, Université Paris 10, 92000 Nanterre, France
years or older in a longitudinal epidemiologic study [4]. Our study
PURPOSE: The aim of this study was to analyse the effects of focused on investigating secondary problems which often lead to
training performed on a SpineForce® (Huber® ) device design by declines in quality of life and independence among adults with CP [5].
LPG Systems (France). RELEVANCE: This device designed to PARTICIPANTS: Inclusion criteria: individuals with CP over the age
improve balance and muscular function has not yet been assessed of 36 living in community. Sixty-four participants (mean age 50.5 SD
during a training programme that could be proposed to patients 7.53, male 56.1%) were recruited through support organizations for
with altered motor function by physical therapists. PARTICIPANTS: people with disabilities in Japan. METHODS: Using peer interviews,
Twelve healthy adults took part in the training programme. This study people with CP gathered information and life histories from consented
was approved by the Ethics Review Committee of Pitié-Salpêtrière participants; one variable included in the data collected was age
Hospital in Paris and informed consent was obtained from each at time of cervical spinal surgery. The GMFCS was also used to
subject prior to participation. METHODS: The training programme quantify the progression of functional limitations longitudinally. The
lasted two months, three times a week on a rehabilitation device GMFCS is an ordinal rating scale, ranging from 1 (most functional)
involving the whole body. Instrumental assessment of postural control to 5 (least functional) [1]. Recently, Jahnsen et al found self-reported
(Satel® force platform) and muscular function (Cybex Norm® ) was level of the GMFCS by adults with CP was reliable. [6]. We regarded
performed before and after training. Postural control was measured the GMFCS level at 12 years of age as the variable by which
in different experimental conditions by a parameter of position (mean participants were categorized at baseline as follows: G1: Highest
anteroposterior position of center of foot pressure (CP)) and by two Functioning group – GMFCS Level 1, 31% (n=20), G2: Marginal
parameters of stability (length and surface of the displacement of Ambulatory group – GMFCS Level 2-3, 36% (n=21) G3: Wheelchair
CP). The assessment of the muscular function was performed during group – GMFCS Level 4-5, 36% (n=25). ANALYSIS: Event 1 (E1):
knee and spine extension and included maximal voluntary isometric age at time of cervical spinal surgery for secondary problems,
contraction (MVIC), as well as a measure of muscle fatigability. Event 2 (E2): age when people declined one level of the GMFCS
The Bouchard questionnaire allowed us to split the population into from baseline. Times of events were compared between groups by
sedentary and active groups. ANALYSIS: A Wilcoxon test was used Logrank test after the evaluation of cumulative incidence by Kaplan-
to examine the training effect for each group and pooled subjects. Meier survival curve. Hazard ratio and its 95% confidential interval
A Mann-Whitney test was used to compared groups.Regression were calculated by Cox’s proportional hazards model. RESULTS:
analyses were performed using Spearman coefficient correlation. (E1) 17 participants (26%)had histories of cervical spinal surgery;
RESULTS: For static postural control, a more forward CP position G1 participants received this surgery at a younger age than other
for the maximal backward inclination condition (p < 0.01), a diminution participants (p < 0.05), and hazard ratio of surgery at G1 was 3.583
of the length of CP displacement in eyes closed on foam condition (95% CI; 1.195-10.743). (E2) 41 participants (64%) declined one level
and in the maximal forward inclination condition were observed. In of the GMFCS from baseline; G2 participants declined at a younger
this latter condition a diminished surface of the CP displacement age than those in other groups (p < 0.05), and hazard ratio was 4.636
(95% CI; 2.322-9.255). CONCLUSIONS: These finding suggest that Cincinnati rating scale of knee examination compared to the non-
the level of the GMFCS at age of 12 can be critical in predicting operated extremities. In a pilot study, there was no difference between
cervical spinal surgery and declines in functional performance due to summated extension moments of current samples’ non-operated
aging. Surprisingly the people who had the highest baseline GMFCS extremities and matched healthy subject). METHODS: A within-
scores received cervical spinal surgery more often and at a younger subject design was selected to compare extension moments of the
age than participants in other groups. The vulnerability of marginal operated and non-operated sides. Bilateral lower extremity kinetic
walkers in our results is consistent with the result of Strauss et data were collected during walking on an instrumented walkway.
al. [4] and Jahnsen et al. [5]. IMPLICATIONS: We should consider Data from two successive trials of foot-force plate contact were
physical therapy approaches for individuals with CP from a life-long analyzed. The mean summated extension moment of hip, knee
perspective to rather than an infantile approach, which places too and ankle of each lower extremity was calculated and compared
much stress on achievement of walking. References: 1. Palisano R, on both sides. Additionally, knee extension moments on both sides
Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development were compared. ANALYSIS: Data were analyzed using paired t-
and reliability of a system to classify gross motor function in children test with a = 0.05. RESULTS: There was no significant difference
with cerebral palsy. Developmental Medicine and Child Neurology (p = 0.8) between the summated extension moment of the operated
1997; 39: 214-223. 2. Krigger KW. Cerebral palsy: an overview. and non-operated lower extremities with means (standard deviation)
American Family Physician 2006 January; 48(1): 91-100. 3. Ministry of 0.7 (0.25) and 0.73 (0.27), respectively. Similarly, there was no
of Health, Labor and Welfare. 2001 Survey on the Actual Status significant difference (p = 0.56) between the knee extension moment
of People with Physical Disabilities. Accessed on line September 9 of the operated and non operated limbs 0.28 (0.12) and 0.37 (0.08)
2006 at: http://www.dbtk.mhlw.go.jp/toukei/kouhyo/indexkk_9_1.html. respectively. CONCLUSIONS: The similarity of the summated lower
4. Strauss D, Ojidane K, Shavelle R, Rosenbloom L. Decline in extremity and knee moments between both limbs may indicate that at
function and life expectancy of older person with cerebral palsy. the end of the rehabilitation period, subjects undergoing this operative
NeuroRehabilitation 2004;19:69-78. 5. Ko HY, Park-ko I. Spinal technique were able to adequately absorb the shock imposed on
cord injury secondary to cervical disc herniation in ambulatory their lower extremities during the loading response subphase of the
patients with cerebral palsy. Spinal Cord. 1998 Apr; 36(4): 288- stance phase. Future trials should include more demanding tasks
92. 6. Jahnsen R, Aamodt G, Rosenbaum P. Gross Motor Function such as jogging and running to investigate the difference between
Classification System used in adults with cerebral palsy: agreement the moments of operated and non operated sides. IMPLICATIONS:
of self reported versus professional rating. Developmental Medicine Kinetic parameters may help establish evidence about outcomes
and Child Neurology. 2006 Sep; 48(9): 743-8. KEYWORDS: Adults of rehabilitation programs. The results of this study indicate that,
with Cerebral Palsy,Secondary Ploblems, Gross Motor Function earlier return to functional activity may be safer for patients who had
Classification System. FUNDING ACKNOWLEDGEMENTS: This anterior cruciate ligament reconstruction using hamstring autograft
study partially supported by Office IL, Center of Independent Living, compared to patients with patellar tendon autograft. KEYWORDS:
and a fellowship grant through University of Pittsburgh. CONTACT: Knee, moments, rehabilitation. FUNDING ACKNOWLEDGEMENTS:
[email protected] None. CONTACT: [email protected]
ETHICS COMMITTEE: Board of Directors, Office IL, the Center of ETHICS COMMITTEE: The Faculty and University Councils of Post
Independent Living. Graduate Studies and Scientific Researches, Cairo University, have
approved the research work plan.
VCEC Meeting Room 18 2364 Monday 4 June 17:55
SUMMATED EXTENSION MOMENTS OF LOWER VCEC Meeting Room 17
EXTREMITY FOLLOWING ANTERIOR CRUCIATE LIGAMENT HAND FUNCTION AND RELIABILITY OF OUTCOME MEASURES
RECONSTRUCTION IN PERSONS WITH CHARCOT-MARIE-TOOTH’S DISEASE
Radwan A1,2 , Khalil M1 , Elazzazi A2 , Elhafez S1 ; 1 Faculty of Svensson E, Hager-Ross C; Department of Community Medicine
physical therapy, Cairo University, Egypt; 2 Utica College, Utica, and Rehabilitation Section for Physiotherapy, Umeå university,
New York, USA Umeå, Sweden
PURPOSE: To adequately absorb shock during the loading response PURPOSE: To describe hand function in persons with Charcot-
subphase of the gait cycle, a rapid increase in lower extremity Marie-Tooth’s disease (CMT) and to evaluate the reliability of
joints extension moments occur. This increase was found to be selected outcome measures addressing dexterity, grip strength and
significantly lower in persons who had anterior cruciate ligament sensation. As a comparison, we tested the function of the lower
(ACL) reconstruction using the patellar tendon autograft. This extremity with Short Physical Performance Battery (SPPB), and
study investigated extensor moments of subjects’ who had ACL evaluated test-retest reliability. RELEVANCE: Charcot-Marie-Tooth is
reconstruction using the hamstrings muscle tendon as an autograft. a peripheral neuropathy causing progressive sensory loss, muscle
RELEVANCE: Inability of the lower extremity extensor muscles atrophy and weakness. The lower extremities are first affected and
to generate sufficient moments may lead to excessive anterior most studied. The hand function is successively reduced but is not
translational shear force on the upper end of the tibia. Adequate so well described. Although CMT is the most common inherited
moments are necessary to offset the flexion tendency during the neuropathy, research on physiotherapy management is limited. It is
loading response and protect the new graft from being exposed important to establish the conditions and needs of these patients,
to excessive premature stresses especially during high demanding and to have reliable outcome measures to monitor the illness and
activities. PARTICIPANTS: Kinetic gait parameters were collected evaluate rehabilitation. PARTICIPANTS: Twenty out of 24 persons
from both operated and non-operated lower extremities of 7 male with CMT registered at the neurological clinics in three counties
subjects who had ACL reconstruction 6 month ago with mean of northern Sweden (~630,000 inhabitants, comparative to world
(standard deviation) age 28.3 (6.7), height 1.77 m (.09), and reported incidence); 9 men, 11 women aged 24-73 years. All
weight 83.4 kg (9.7). Subjects were included in the study if they subjects were right handed. METHODS: We examined hand function
underwent the same operative technique and followed a standardized and evaluated test-retest reliability (1 week interval), using Box
rehabilitation protocol. Subjects were excluded if they had other and Block Test; BBT, Nine-Hole Peg test; NHP, grip and pinch
lower extremity surgeries or if the operated extremity scored less strength; Grippit® , tactile sensation with Shape Texture Identification
than 85% on the single leg hop test or subjective key of the test; STI, and for the lower extremity Short Physical Performance
Poster Displays, Monday 4 June S185
Battery; SPPB. ANALYSIS: Descriptive statistics were used for the placebo group (interference-electrotherapy with suction cups
evaluation of functional ability. To assess test-retest reliability we used without electricity) (n=37). METHODS: Subjects were treated four
intraclass correlation coefficients (ICC), limits of agreement (LOA) times with a one-week follow-up assessment. The measurements of
according to Bland Altman, coefficient of repeatability (CR) and the VAS and pressure pain threshold were taken three times (baseline,
average within-subject coefficient of variation (CV). For STI, linear before the second treatment and one week after the last treatment).
weighted kappa was used. RESULTS: All but one person had hand The whole intervention took 4-5 weeks. The assessor was blinded
symptoms including reduced sensation. Patients scored on average with the treatment method. ANALYSIS: The data were analysed
approximately 2/3 compared to age- and sex-matched controls in statistically with SPSS for Windows, Release 11.0.0 (SPSS Inc.,
the BBT, and needed 60-95% more time to finish the NHP test while 1989-2002). The distributions of VAS measurements were non-
the grip strength was reduced by 50%. As for reliability, the BBT normal tested with the Shapiro-Wilk test. Nonparametric tests were
and NHP showed very high ICC values (0.95 and 0.99 respectively; used. The intragroup mean changes of VAS in time were analysed
interpreted according to Munro). Grip strength showed very high with the Friedman test. The Mann-Whitney test was used in pairwise
reproducibility between tests (ICC 0.99), acceptable LOAs, no bias comparisons of the groups on VAS and pressure pain threshold
and low CVs. Pinch strength showed very high ICC values, but a large measurements. Bonferroni correction was used. RESULTS: The VAS
range of LOA and a high CR (8.5N). The STI showed limitations measurement performed a week after the last treatment pointed
in terms of how well it can describe patients either performing out that comparing manipulative therapy with placebo the p-value
very well or very poorly. CONCLUSIONS: Impaired hand function was 0.02, which is a statistically significant result (95% confidence
is common in CMT and the tested instruments can all be used interval). The intra-group results of the VAS measurements between
for evaluation. Certain factors, however, like limited time aspects the first and the last measurement showed clinically significant pain
for the NHP test and the number of trials used, should be taken reduction in all three groups. Pressure pain threshold values had
into consideration. Pinch strength evaluation should be interpreted increased in both the manipulation group and in acupuncture group,
with caution. The STI test is not optimal to evaluate changes whereas in the placebo group they had decreased. The differences
in sensation because of the limited scale. IMPLICATIONS: The were not statistically remarkable. CONCLUSIONS: Manipulative
reliability and clinical implementation of above outcome measures therapy is more efficient than placebo in treating the pain caused
is communicated, which is important in order to develop evi- by mechanical thoracic spine dysfunction when measured one
dence based physiotherapy management of people diagnosed with week after the last treatment. The difference between the effect
CMT. KEYWORDS: Charcot-Marie-Tooth’s disease, reliability, hand of acupuncture and placebo is not significant. Within the future
function. FUNDING ACKNOWLEDGEMENTS: Swedish Association studies manipulative therapy should be combined to other treatments,
of Persons with Neurological Disabilities (NHR), Swedish Asso- especially exercise therapy, to achieve similarity with the real
ciation of Registered Physiotherapists’ minnesfond, Stiftelsen JC treatment procedure. The need for further studies is obvious
Kempes Stipendiefond and Västerbotten County Council, Sweden. because of neck-shoulder problems generality. IMPLICATIONS: The
CONTACT: [email protected] education of using manipulative therapy is essential for clinical
ETHICS COMMITTEE: Regional Ethical Review Board, Umeå, practices. KEYWORDS: manipulative therapy, acupuncture, thoracic
Sweden. spine, mechanical dysfunction. FUNDING ACKNOWLEDGEMENTS:
Poster Displays, Monday 4 June
Research Report Poster Display
Research Report Poster Display 01-05 Monday 4 June 09:00
01-01 Monday 4 June 09:00 VCEC Exhibit Hall B & C
VCEC Exhibit Hall B & C REFLEXOLOGY: A TREATMENT FOR PHANTOM LIMB PAIN?
A RANDOMIZED CONTROLLED TRIAL FOR THE Brown C1 , Lido C2 ; 1 Prosthetic Services Centre, Wolverhampton
EFFECTIVINESS OF MANIPULATIVE THERAPY AND City NHS Trust, Wolverhampton, England; 2 Thames Valley
ACUPUNCTURE ON PAIN CAUSED BY MECHANICAL University, London
THORACIC SPINE DYSFUNCTION
PURPOSE: The main objective was to test if reflexology could be
Lehtola V1 , Korhonen I2 ; 1 Kuopio University, Faculty of Medicine,
used as a non-invasive form of phantom limb pain relief. The second
Health Sciences (FINLAND); 2 Kotkan OMT-Fysio (FINLAND)
objective was to test the possibility that patients might be able
PURPOSE: A randomized, assessor blinded, placebo-controlled trial to achieve any positive results with self-treatment. RELEVANCE:
was conducted in order to make a comparison between the short- Management of phantom limb pain has always been a part of the
term effectiveness of manipulative therapy and acupuncture on physiotherapists role and whilst there have been single case studies
the pain caused by mechanical thoracic spine dysfunction and on by physiotherapists into using reflexology to treat this phenomenon,
pressure pain threshold. RELEVANCE: Neck and shoulder areas the author could not find any larger research studies. It was felt
are traditionally assessed and treated as being dysfunctions of the that more research is needed in this area in order to build the
cervical spine. The share of the thoracic spine has hardly been evidence base required for this method of phantom limb pain
studied epidemiologically. It has, however, been noted clinically that relief. PARTICIPANTS: There were 7 men and 3 women with
local pain dysfuncions in the thoracic area do exist. PARTICIPANTS: unilateral lower limb amputations, varying from below knee to hind
The research sample consisted of 114 female patients aged between quarter levels, and a history of phantom limb pain. Aetiologies were
20 and 60. The primary complaint of the subjects was pain in the osteomyelitis, trauma, diabetic gangrene, ulceration, thigh tumour
thoracic spine area. The continuance of the symptom had to be and necrotizing fasciitis. The mean age was 62.5 years. METHODS:
less than three months before the first assessment. The recruitment Same-subject, experimental pilot study; recording pain in weekly pain
to the trial happened in the arranged local GP and occupational diaries during a 30-week period. Phase 1 six weekly diaries for base
health centres, whose staff were advised to refer potential subjects line of pain. Phase 2 six weekly diaries and six weekly reflexology
to a private physiotherapy clinic for evaluation. 114 subjects of the treatments. Phase 3 six weekly diaries only, resting phase. Phase 4
total of 133 patients sample with the mechanical thoracic spine six weekly diaries and six weekly teaching sessions. Phase 5 six
dysfunction were randomized to the final study on grounds of a weekly diaries and self treatment. ANALYSIS: A numerical rating
questionnaire and a clinical examination. Five persons dropped out pain scale; 0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe
the trial. The total of 109 subjects were randomly divided into pain, an ordinal duration rating scale; 0 = not applicable, 1 = once a
the manipulation group (n=37), the acupuncture group (n=35), and week, 2 = a few days a week, 3 = once a day, 4 = more than this, and
a numerical lifestyle scale; 0 = not applicable, 1 = does not interfere, moderate AE while 7 experienced a severe AE. Acute exacerbations
2 = slight interference, 3 = moderate interference, 4 = interferes resulted in a significant reduction in 6MW (mean change 59 +/−
a lot, 5 = completely interferes were used in the diaries. These 80m, p < 0.001). While there was no effect of AE on dyspnea
scales were sanctioned by a clinical specialist in pain management. (p = 0.1), there was a significant reduction in the fatigue domain of
The statistician entered the data into the Statistical Package for the the CRQ (mean change = 0.99 +/−1.29, p < 0.001), the emotion
Social Sciences (SPSS), it was analysed using both parametric and domain (mean change = 0.58 +/− 0.95, p = 0.003) and mastery
non-parametric tests, there was no difference between the results domain (mean change = 0.53 +/− 1.36, p = 0.04). CONCLUSIONS:
of these and therefore, parametric tests were reported (ANOVA & Patients with lower functional exercise capacity are more likely to
LSD). Effect sizes analysis was also carried out in order to account experience exacerbations. The incidence of AE after PR is higher
for the small sample. RESULTS: Repeated measures ANOVA for than previously reported. This study shows a significant loss in
average reported pain revealed a highly significant ‘overall’ difference, functional exercise capacity and in some areas of HRQL two weeks
whereby the treatment phase does makes a difference to pain; after AE. IMPLICATIONS: Future treatment of AE should include
F(4,28) = 4.38, p = .007. This indicates that the probability of finding targeting functional exercise capacity and HRQL. Further research
this pattern due to chance is less than 1%. The same test was used on early intervention with PR is indicated. KEYWORDS: Acute
for the analysis of duration and affect on lifestyle; F(4,36) = 4.98, exacerbation of COPD, 6-minute walk test, health-related quality of
p = .003 and F(4,36) = 3.57, p = .01 CONCLUSIONS: The project life. FUNDING ACKNOWLEDGEMENTS: S. J. Carr was awarded
indicated that reflexology treatment, teaching and self-treatment Fellowships from the Ontario Respiratory Care Society, Ontario Lung
were effective in eradicating or reducing the intensity and duration Association and from the Canadian Respiratory Health Professionals
of phantom limb pain in this group of patients. IMPLICATIONS: of the Canadian Lung Association. Dr. D. Brooks holds a New
Physical therapists could play a pivotal role in the treatment of this Investigator Award from the Canadian Institute for Health Research
phenomenon by using reflexology and could empower the patients (CIHR). Financial support was received from the Ontario Thoracic
to self-treat. KEYWORDS: Intensity, duration, lifestyle. FUNDING Society.
ACKNOWLEDGEMENTS: Wolverhampton City NHS Primary Care ETHICS COMMITTEE: Research Ethics Committee at West Park
Trust, c/o Research & Development Department, The Beeches, Healthcare Centre and the Ethics Review Committee at the University
Penn Hospital, Wolverhampton, West Midlands, England. CONTACT: of Toronto.
[email protected]
ETHICS COMMITTEE: Wolverhampton District Local Research
Ethics Committee; REC reference number: 04/Q2701/31; Approved: Research Report Poster Display
11th February 2005; Completed December 2005 02-17 Monday 4 June 09:00
VCEC Exhibit Hall B & C
INFLUENCE OF THE EXERCISE CHARACTERIZED BY BREATH-
ING MODE OF PROLONGED EXPIRATION ON CARDIOVASCU-
02-13 Monday 4 June 09:00 LAR RESPONSES AND AUTONOMIC NERVOUS ACTIVITIES
Matsumoto T, Matsunaga A, Saitoh M, Yonezawa R, Kutsuna T,
CHARACTERIZATION OF ACUTE EXACERBATION AFTER Nanri Y, Ishii A, Yamamoto K, Sato T, Sawairi T, Masuda T; Graduate
PULMONARY REHABILITATION IN INDIVIDUALS WITH school of medical sciences, Kitasato university, Kanagawa, Japan
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PURPOSE: The patients who have severe left ventricular dysfunction
Carr J1,2 , Goldstein R1,2 , Brooks D1,2 ; 1 West Park Healthcare
(LVD) were generally prescribed lower intensity exercise in the
Centre, Toronto, Canada; 2 University of Toronto, Toronto, Canada
beginning of a phase I cardiac rehabilitation, because excessive
PURPOSE: This study was designed to characterize acute exacerba- increases of heart rate (HR) and blood pressure (BP) were observed
tions (AEs) after pulmonary rehabilitation (PR) and to examine their during the exercise and induced serious arrhythmias originated from
effects on functional exercise capacity and health-related quality of the imbalance of autonomic nervous activities. On the other hand, the
life (HRQL). RELEVANCE: Despite improvements in health status prolonged expiration breathing (PE) that is controlled 1 to 2 of the
achieved through (PR), the benefits diminish with time. Patients have inspiration and expiration time is known to activate parasympathetic
identified experiencing an AE as a main contributing factor to reduced nervous activity resulting in decreases of HR and BP after PE.
adherence. Exacerbations are related to a general deterioration in However, there are few reports that examined the influence of
health. As disease severity increases, the frequency of AEs and PE on autonomic nervous activities during exercise. The purpose
hospital admissions also increase. Little research has been done of the present study was to clarify the influence of the exercise
on the effects of AEs on functional exercise capacity or HRQL characterized by breathing mode of PE on cardiovascular responses
after PR. PARTICIPANTS: Sixty patients who completed PR were and autonomic nervous activities. RELEVANCE: The present study
recruited. Of these, seven dropped out leaving 53 who completed helps to prescribe the patients with severe LVD safer and more
the study. METHODS: This descriptive study used prospective data effective exercise in a cardiac rehabilitation. PARTICIPANTS: Thirty-
collection. Baseline measures were done at completion of PR and four healthy young men (22+-1 years old) and 30 elderly men (68+-
patients were followed for 26 weeks. If patients experienced an AE, 4 years old) were classified into two groups: the Japanese style
measures were repeated two weeks after the onset of symptoms. calisthenics was carried out with a controlled respiration time of
Primary outcome measures were the 6-minute walk test (6MW) and 2-second inspiration and 4-second expiration in PE group or with
the Chronic Respiratory Disease Questionnaire (CRQ). ANALYSIS: normal breathing in control group. METHODS: The Japanese style
Between-group comparisons using t-tests were done to compare calisthenics was performed after 15-minute rest and followed by
those who experienced AEs to those who did not, and repeated another 15-minute rest as the exercise protocol, which spent 5
measures comparisons using paired samples t-tests were done for minutes 30 seconds in PE group and 3 minutes 10 seconds in control
pre-, post- AE analyses. RESULTS: At baseline, the mean age was group. HR and BP were measured by a Holter electrocardiogram
69 (+/− 9 years), 49% were female, 23% were on oxygen with (ECG) and the cuff method using autonomic manometer, respectively.
activity, 66% had moderate COPD, 34% had severe COPD and Respiration rate (RR), tidal volume (TV) and peak oxygen uptake
the mean number of co-morbidities was 5.9 (+/− 2.5). Of the 53 (peak VO2) were measured by using the expired gas analysis. The
patients, 34 (64%) experienced a moderate or severe AE within power of low- and high-frequency components (LF: 0.04-0.15Hz,
26 weeks. The difference in baseline 6MW distance between those HF: 0.15-0.40Hz) was analyzed by heart rate variability that was
who did (416 +/− 95m) and those who did not (350 +/− 95m) obtained from a Holter ECG. HF and the ratio of LF to HF
experience an AE was 66m (p = 0.018). Twenty-seven experienced a (LF/HF) were used as indexes of parasympathetic nervous activity
and the dominancy in sympathetic nervous activity, respectively. type of upper limb activity, but both unilateral and unilateral loaded
The change from plasma concentration of norepinephrine (NE) at positions were found to be significantly associated with sternal pain
rest to NE after exercise (DNE) was analyzed as an index of (p = 0.009). CONCLUSIONS: In this group of patients with chronic
sympathetic nervous activity. ANALYSIS: The changes in these sternal instability, bilateral upper limb movements were significantly
parameters were analyzed by two-way ANOVA. RESULTS: HR, less associated with sternal pain than unilateral movements.
RR, peak VO2 and LF/HF during exercise were significantly lower IMPLICATIONS: Consideration should be given during rehabilitation
in PE group than those in control group regardless of age planning to the choice of unilateral, bilateral, weighted or unweighted
(P < 0.05,respectively). TV and HF during exercise were significantly exercise for those patients with sternal separation who report pain
higher in PE group than those in control group regardless of age on upper limb movement. The results here provide preliminary data
(P < 0.05,respectively). DNE did not change significantly in PE group, to suggest that bilateral unloaded movements were associated with
although it elevated significantly in control group regardless of age lower frequency of pain. KEYWORDS: Sternal Instability, Cardiac
(P < 0.05). In PE group, the increase of HR during exercise was Surgery, Exercise. FUNDING ACKNOWLEDGEMENTS: University
significantly lower in elderly men than in young ones (P < 0.05). In of Sydney, Australia. CONTACT: [email protected]
both groups, BP during exercise was significantly higher in elderly ETHICS COMMITTEE: The University of Sydney, Australia.
men than in young ones (P < 0.05). CONCLUSIONS: PE activated
parasympathetic nervous activity and consequently restrained an
excessive increase of HR during exercise. IMPLICATIONS: The
present study suggests the usefulness of the exercise characterized 03-17 Monday 4 June 09:00
by breathing mode of PE for elderly persons or severe LVD patients. VCEC Exhibit Hall B & C
KEYWORDS: breathing mode, autonomic nervous activity, exercise FACTORS CONTRIBUTING TO COMPETENCY OF PHYSIO-
training. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: THERAPY CLINICAL INSTRUCTORS: A QUALITATIVE STUDY
[email protected]
Fox P, Yeung E, Chung E, Helm D
ETHICS COMMITTEE: The study protocol was approved by the
Ethics Committee of Kitasato University. PURPOSE: The purpose of this study was to gain a better
understanding of the factors that contribute to the competency of
physiotherapy clinical instructors. RELEVANCE: Little is known about
Research Report Poster Display the competencies required for physiotherapy clinical instructors to
02-21 Monday 4 June 09:00 perform well and the factors that facilitate and hinder performance.
VCEC Exhibit Hall B & C PARTICIPANTS: All physiotherapists from 3 teaching hospitals in
UPPER LIMB MOVEMENTS, PAIN AND STERNAL SEPARATION Toronto, Canada were invited to participate in the study. Sixteen
IN PATIENTS WITH STERNAL INSTABILITY FOLLOWING physiotherapists who had supervised at least 2 students in the
CARDIAC SURGERY past 2 years volunteered to participate in the study. The majority
of participants were female (81%) and 50% of the participants
El-Ansary D1,2 , Adams R2 , Waddington G1 ; 1 The University
had less than 5 years of clinical experience. Fifty-six percent of
of Canberra, ACT, Australia; 2 The University of Sydney, Sydney,
participants had supervised 3 or more students in the past year.
Australia
METHODS: A qualitative approach using focus group methodology
PURPOSE: The purpose of this study was to examine the effects of was used. Three focus groups were conducted by an experienced
a variety of upper limb exercises on the patient with sternal instability moderator using 9 open-ended questions with probes. In addition,
after first evaluating the reliability of ultrasound measurement participants were asked to identify and rate the 5 most important
of sternal separation. RELEVANCE: Physical therapists routinely competencies (out of a list of 15 competencies) of a clinical instructor.
prescribe upper limb exercises for patients who have undergone a Key points were written on a flip chart for the purpose of verification
median sternotomy during cardiac surgery. It is not currently known by participants. The focus groups were audio taped. The audio tapes
whether upper limb exercises should be unilateral or bilateral, and were transcribed verbatim. ANALYSIS: NVivo was used to organize
conducted with or without additional loading, in order to minimise pain and code the data. Open and axial coding was used to analyze data
and further sternal separation. PARTICIPANTS: Eight subjects who and generate themes. RESULTS: In general, similar themes were
had chronic sternal instability after cardiac surgery. METHODS: The generated in the 3 focus groups. Participants agreed that taking on
region of greatest instability along the sternum for each participant the role of a clinical instructor was a positive learning experience
was identified as a reference point for all measurements. The amount but could be challenging as well. Specific challenges related to
of sternal separation at this point was measured from the projected students were identified as: personality differences, difficulty with
ultrasound image. In order to evaluate the effects of unilateral versus providing feedback on inappropriate professional behaviours, conflict
bilateral upper limb exercises, a series of upper limb movements were resolution, and students performing at a lower competency level
examined with each participant in a supported seated position. These than what they perceive. Participants also described the presence
simulated the routine active range of shoulder motion exercises of competing priorities in their role as clinical instructor. Participants
used by physical therapists, and sternal separation measures were identified the following intrinsic qualities of a successful clinical
taken at rest (0 degrees), midrange (90 degrees) and at the end instructor: professionalism, flexibility, respectfulness, approachability,
of the range (180 degrees or earlier as determined by the subject’s sensitivity and possessing a passion for their area of practice.
capability), both with and without a 1kg weight placed in the hand/s. Strategies to facilitate a student’s clinical experience were: utilizing
Pain was recorded using a visual analogue scale. Each movement good organizational skills, setting expectations of student and
condition was repeated three times, in a random order, and the clinical instructor early on, clear and on-going communication
mean sternal separation under the particular condition combination between student and clinical instructor, role modeling for student,
obtained. ANALYSIS: Analysis of Variance with repeated measures establishing a good relationship with student and collegial support.
was used to examine the effects of the three factors: load, arm/s and Participants rated the most important competencies of a clinical
position on the ultrasound-determined size of the sternal separation. instructor as 1) establishes a good learning environment, 2) adjusts
Receiver Operating Characteristic (ROC) analysis was conducted teaching to student needs, and 3) asks questions that promote
on pain report and individual patient sternal separation. Data were learning. Supporting quotes illustrate the themes. CONCLUSIONS:
analysed with a p value <0.05 throughout, using SPSS version Participants identified several intrinsic qualities of a competent
12.0.1 for Windows. RESULTS: Test-retest reliability for sternal physiotherapy clinical instructor as well as strategies to facilitate the
separation measurement with upper limb exercises ranged between student experience. Although clinical teaching provides a positive
0.77 and 0.93. Amount of sternal separation was not related to learning experience for physiotherapy clinical instructors, several
challenges were identified. IMPLICATIONS: Findings from this study IMPLICATIONS: Educational opportunities need to be provided to
may be used to plan initiatives to support professional development of the clinical educators to promote direct supervision and implement
clinical instructors. The results may also be used to identify or develop strategies for providing this supervision throughout all levels of
a tool for students to evaluate the clinical instructor. Future studies clinical education experiences. KEYWORDS: Clinical Education,
need to examine student perspectives on competencies of clinical Supervision. FUNDING ACKNOWLEDGEMENTS: N.A.
instructors. KEYWORDS: clinical instructors, competency, focus ETHICS COMMITTEE: Received approvoal from the Institutional
groups. FUNDING ACKNOWLEDGEMENTS: This work was funded Review Board at The University of South Dakota prior to the
by the Allied Health Research Fund at the University Health Network conduction of this study.
in Toronto, Ontario, Canada. CONTACT: [email protected]
Board; St. Michael’s Hospital Research Ethics Board
07-05 Monday 4 June 09:00
Research Report Poster Display REFLECTIVE PHYSIOTHERAPISTS FROM PROBLEM-BASED
04-01 Monday 4 June 09:00 LEARNING ENVIRONMENTS
Lähteenmäki M1,2 ; 1 Pirkanmaa Polytechnic, Tampere, Finland;
REPORTED LEVELS OF SUPERVISION DURING FULL-TIME 2 Tampere University, Tampere, Finland
CLINICAL EDUCATION EXPERIENCES: PERSPECTIVES OF
CLINICAL INSTRUCTORS AND STUDENTS PURPOSE: Problem-based learning (PBL) is getting more and
Karges J; The University of South Dakota, Department of Physical more popular as a pedagogical approach for professional education.
Therapy RELEVANCE: There is still considerable debate around the learning
outcomes and effectiveness of PBL. The first aim of this research
PURPOSE: The primary purpose of this study was to determine the is to examine the elements that are intrinsic for creating problem-
level of supervision for two classes of physical therapy students as based learning environments. The second aim is to compare PBL
they progressed from novice to entry-level while on their full-time physiotherapy education with subject-based physiotherapy education
clinical education experiences (CES). The secondary purpose was from students’ perspective. PARTICIPANTS: The target group
to analyze the supervision data in relation to the American Physical consisted firstly of first year physiotherapy students (PBL) from one
Therapy Association (APTA) HOD 06-00-18-30 and other practice educational institution. Secondly there were physiotherapy students
issues to develop educational opportunities for clinical instructors from the second, third and fourth academic year from three different
to facilitate appropriate supervision across all CES. RELEVANCE: educational institutions from two different countries. Two of the last
Direct supervision is the standard set by the APTA, yet that level of student groups studied in subject-based (16 + 16 students) and
supervision has not been typically reported by students while on full- three in problem-based education (6 + 13 + 5 students). In addition
time CES. PARTICIPANTS: Thirty-six students from a potential of there were also teachers (4), physiotherapists (4) and last year
116 CES from the classes of 2003 and 2004 participated (31.03%). students (5) from one institution that used problem based learning.
Thirty-three of 116 clinical instructors (CIs) participated (28.45%). METHODS: This was an ethnomethodological study. For the first aim
METHODS: Data collection for this IRB approved study occurred of the study I interviewed teachers, physiotherapists and last year
from November 2002-July 2004. A daily log sheet was developed students. In addition I gathered written descriptions and organised
for the CIs and students to independently track the total number three group discussions with the first year physiotherapy students.
of patients seen each day and the level of supervision provided by For the second aim of the study I gathered written descriptions
the CI. Definitions were given for the following supervision choices: from five different students groups about their experiences during
Direct Supervision (HOD 06-00-18-30), Minimal Supervision, No all their practical placements. ANALYSIS: For the data analysis
Supervision/Independence, and Observation Only (student observed I used qualitative content analysis for finding different categories
only). Participants were also asked questions relating to challenges from the students’ descriptions. After that I calculated the amount
with supervision, beneficial strategies for supervision issues, and of descriptions for different categories per each student group.
reasons for observation only. ANALYSIS: Levels of supervision RESULTS: Problem-based learning environment was conceived
were summarized with percentages; SPSS 11.5 was used to of dialogical co-operation between teachers, physiotherapists and
analyze the differences in supervision between the two groups. students. Four types of dialogue was identifies: understanding
RESULTS: There was no significant difference (t=.123; p = 0.904) dialogue in developing and updating curricula, expert dialogue in
between the supervision levels as reported by the CIs versus creating problems, teachers inner dialogue in developing education
the students. However, the supervision levels did change from and guiding dialogue in making decisions about the students best.
the first to the last clinicals. Supervision reported by the CIs for PBL environment was perceived as an environment that supported
Clinical Education I was Direct 39.88%, Minimal 27.51%, None student’s reflective learning as an experimental learning process. I
7.14%, Observation Only 25.56%, and for Clinical Education IV categorized the descriptions that subject-based and problem-based
was Direct 6.94%, Minimal 17.14%, None 41.19%, Observation students wrote about in terms of three categories: performance-
Only 32.93%. Supervision recorded by the students for Clinical centred therapy, therapy that takes the patient into account and
Education I was Direct 44.79%, Minimal 27.24%, None 4.48%, reflective therapy. Subject-based students described their therapy
Observation Only 23.48%, and for Clinical Education IV was Direct mostly as performance-centred as well as therapy that takes the
8.53%, Minimal 20.21%, None 38.29%, Observation Only 32.96%. patient into account. Problem-based students described their therapy
The most common challenge for supervision reported by the CIs mostly as therapy that takes the patient into account as well
and students was the Medicare B regulation. The most common as reflective therapy. CONCLUSIONS: These results support the
times the students observed were for Medicare B patients, at conclusion that problem-based learning environment as realized in
the start of the rotations, new or unique cases/techniques, and this case helps the students to become reflective in their therapy
when watching other therapists. Open communication between the practices. This means for instance that they are goal oriented, search
students and CIs was the most commonly reported strategy for and use new knowledge actively for therapy and they are critical
dealing with supervision issues. CONCLUSIONS: The level of in problem solving. IMPLICATIONS: This research suggests that
supervision provided to these students decreased as they progressed problem-based learning is a successful pedagogical approach in
through their clinical education experiences and did not necessarily physiotherapy for developing patient-oriented reflective practitioners.
follow the guidelines from HOD 06-00-18-30. The Medicare B It is why PBL is worth implementing and developing. KEYWORDS:
restrictions also seemed to be a challenge in the outpatient settings. Physiotherapy education, Problem-based learning, Subject-based
learning. FUNDING ACKNOWLEDGEMENTS: I want to thank The therapy (LLLT) has been used as a treatment in many clinical
Finnish Academy and especially it’s Life as Learning-project and conditions and with effects on reducing post-injury inflammation
Pirkanmaa Polytechnic that have made this research possible. and accelerating soft and hard tissue healing. LLLT stimulates
CONTACT: marja-leena.lahteenmaki@piramk.fi mitochondrial respiration, increases the synthesis of DNA, RNA and
ETHICS COMMITTEE: Ethical boards in different health care regulatory proteins, and promotes cell proliferation in normal and
organisations in Finland. malignant cells. However, the mechanism by which LLLT acts on
cells is not fully understood. PARTICIPANTS: Human osteosarcoma
cell lines: MG63 and U2OS METHODS: Cell lines were grown and
passaged using standard aseptic tissue culture protocols. For laser
08-13 Monday 4 June 09:00 irradiation, the wells of 96-well plates were seeded with 1x104 cells
VCEC Exhibit Hall B & C in fresh growth medium then incubated for 24hr at 37ºC in 5%CO2.
EFFECTS OF LOW-LEVEL LASER (ASGAINP) THERAPY ON A single dose of irradiation was performed (670nm, 780 nm and
THE HEALING OF THIRD-DEGREE BURNS IN RATS 830 nm, 30 mW) at the intensities of 0.5, 1, 5 and 10 J/cm2.
Calazans V1 , Meyer R1 , Munin E2 , Lima J1 ; 1 LABMORF/UNISUAM; Cell proliferation was assessed 24hr after treatment by colorimetric
2 UNIVAP spectrophotometry ANALYSIS: Data were described as means and
standard deviation (SD) of the percentage. A 2-way ANOVA test
PURPOSE: Low-level laser therapy (LLLT) is a form of phototherapy was used to assess the significance of differences between the
that involves the application of low power monochromatic and percentage of increase or decrease of irradiated groups compared
coherent light to injuries and lesions. It has been used successfully with negative (untreated) controls, and the Duncan’s test to identify
to induce wound healing in nonhealing defects. RELEVANCE: Other the differences. A p value of 0.05 was set for determining statistical
wounds treated with lasers include burns, amputation injuries, skin significance. RESULTS: It was observed that MG63 osteosarcoma
grafts, infected wounds, and trapping injuries. PARTICIPANTS: We cell proliferation increased significantly after 670nm (at 5 J/cm2) and
used 30 rats Wistar, females (weigh 200 g). The animals were divided 780nm laser irradiation (at 1, 5 and 10 J/cm2, p 0.05), but did not
in three groups of ten animals: Sulfa Group, treated with conventional alter after 830nm laser irradiation. In contrast, U2OS cell proliferation
therapy (SULFA), bath with PVPI and dressing with sulfadiazine; was found significantly increased after irradiation with all laser
Laser Group (LASER), treated with laser therapy; and Sulfa + wavelengths studied and at all doses (p 0.05). CONCLUSIONS:
Laser Group (SULFA+LASER), treated with conventional therapy The results of the present study suggest that laser irradiation has
more laser therapy. METHODS: The animals were anesthetized stimulatory effects on osteosarcoma cell proliferation. However, these
with Ketamine i.m. After that, we made a third-degree burn with a data highlight that different osteosarcoma cell lines have different
circumferential metal blade (iron), measuring 3 cm of diameter for 5 responses to different types of laser using specific irradiation pa-
seconds. The temperature was controlled for a digital thermometer rameters. Further investigations are required to investigate possible
in 100º C. Immediately after the burn, we removed a biopsy, with response mechanisms that may explain the outcomes obtained when
a pusch of 3mm of diameter. Eight sessions of laser therapy with examining laser irradiation of cultured cells. IMPLICATIONS: Such
Laser Diode (AsGaInP), with wavelength of 658 nm and power of future studies will undoubtedly contribute to a better understanding
30 mW, in five fixed points with fluency of 3 J/cm2 for area. After of the safety and efficacy of LLLT in clinical oncology. KEYWORDS:
15 days, the animals were sacrificed and we removed the last cell proliferation, low level laser therapy, osteosarcoma. FUNDING
biopsy. ANALYSIS: Histopathologic evaluation using hematoxylin and ACKNOWLEDGEMENTS: Capes-Coordenação de Aperfeiçoamento
eosin and Picro-Sirius staining showed a fibrionopurulent exudate de pessoal de Nivel Superior. CONTACT: [email protected]
in all groups. RESULTS: We observed an increased of deposit of
collagen fibers in SULFA+LASER, compared with the other groups.
RT-PCR analysis showed an increased of IGF and TGF-b expression Research Report Poster Display
in SULFA+LASER group. CONCLUSIONS: Our data indicate that 08-21 Monday 4 June 09:00
Low-level laser therapy associated with sulfadiazine (conventional VCEC Exhibit Hall B & C
treatment) constitute a promising therapy for the third-degree burns. LOW LEVEL LASER THERAPY (670 NM) ON THE VIABILITY OF
IMPLICATIONS: This study is to important for physical therapy RANDOM SKIN FLAP IN RATS
practice because the Low-level laser therapy is a clean, fast and
Parizotto N1,2 , Bossini P2 , Rennó A1 , Fangel R1 , Habenschus R1 ;
efficient form of treatment of burns. KEYWORDS: third-degree 1 Department of Physiotherapy, Federal University of São Carlos,
burns; low-level laser; Rats. FUNDING ACKNOWLEDGEMENTS:
São Carlos (SP), Brazil; 2 Bioengeneering Master Program,
PIBIC/UNISUAM. CONTACT: [email protected]
University of São Paulo, São Carlos (SP), Brazil
ETHICS COMMITTEE: UNISUAM ethics committee approved this
study. PURPOSE: Skin flaps are widely used in plastic surgery, mainly
in repair surgeries. After this reconstructive procedure, one of the
main consequences is the decrease of blood flow in the area,
which can be responsible by tissue necrosis. In this context, a
08-17 Monday 4 June 09:00 lot of studies have investigated treatments able to increase the
VCEC Exhibit Hall B & C viability of the flap and the low level laser therapy (LLLT) has been
THE EFFECTS OF LASER IRRADIATION ON PROLIFERATION chosen as an efficient treatment to reduce post-injury inflammatory
IN OSTEOSARCOMA CELL LINES (MG63 AND U2OS) processes and to stimulate the formation of new blood vessels.
However, the use of a wide range of fluences by different authors
Renno A1 , Mcdonnell A2 , Laakso L3 , Parizotto N4 ; 1 Federal
and the lack of standardized experimental conditions make it difficult
University of São Carlos, Sao Carlos, Brazil; 2 Griffith University,
to compare published results. RELEVANCE: The aim of this study
Brisbane, Australia; 3 Griffith University, Gold Coast, Australia;
4 Federal University of São Carlos, Sao Carlos, Brazil was to investigate the dose-response effects of 670 nm laser on the
viability of random skin flap in rats. PARTICIPANTS: One hundred
PURPOSE: In order to progress our understanding of the physiolog- Wistar male rats were used in this study. The animals were divided
ical processes and clinical parameters involved in the field of laser into 5 groups: group 1 (control group); group 2 (treated with 3
therapy, and to determine the responses of malignant bone cells to J/cm2); group 3 (treated with 6 J/cm2); group 4 (treated with 12
laser irradiation, we investigated the dose-response effects of 670nm, J/cm2) and group 5 (treated with 24 J/cm2). METHODS: The skin
780 nm and 830 nm laser on cell proliferation of two osteosarcoma flap was made on the back of all animals studied (dimensions: 10
(MG63 and U2OS) cell lines in vitro. RELEVANCE: Low level laser x 4 cm) and before the sutures were done, a plastic sheet was
interposed between the flap and the donor site. Laser irradiation based on a single practice session, so other conditions might merit
was performed immediately after the surgery and on days 1, 2, further investigation. IMPLICATIONS: Ultrasound imaging does not
3 and 4 post-surgery. The irradiation was made punctually, on 24 provide the kind of feedback that can be immediately and intuitively
points on the skin surface and around it. The percentage of the used by a patient to selectively control muscle activity. KEYWORDS:
necrosis area of the flap was calculated by the paper template transversus abdominis muscle, learning, ultrasonography. FUNDING
method at the day 7 postoperative. ANALYSIS: The ANOVA test ACKNOWLEDGEMENTS: This work was supported by grant-in-aid
was used to compare changes among the groups and the Tukey for scientific research no. 17791630 by the Ministry of Education,
test to identify the differences. A p level of 0.05 was considered Culture, Sports, Science and Technology in Japan. CONTACT:
as being statically significant. RESULTS: The animals of all treated [email protected]
groups showed a statistically significant difference when compared ETHICS COMMITTEE: This work was approved by the ethics
to the control group (necrosis area: 49, 92%). The necrosis area of committee of Ibaraki Prefectural University of Health Sciences
the treated groups were 41.82% (group 2); 36.51% (group 3); 29.45%
(group 4) and 20.37% (group 5). CONCLUSIONS: This present study
has demonstrated that the 670 nm laser was efficient to increase
the viability of the skin flap, at all fluences used, with a tendency 10-05 Monday 4 June 09:00
of reaching better results at higher dosages. IMPLICATIONS: We VCEC Exhibit Hall B & C
think that this results can help the physical therapists in their COMPARATIVE ELECTROMYOGRAPHIC ANALYSIS OF
clinical practice. KEYWORDS: low level laser therapy, fluences, sur- LUMBAR ERECTORS RECRUITMENT AT STAND POSITION
gical flaps, necrosis. FUNDING ACKNOWLEDGEMENTS: CAPES, AND THERAPEUTIC RIDING POSITIONS
CNPq. CONTACT: [email protected] Santos R3 , Cyrillo F1,2 , Sakakura M3 , Perdigão A3 , Torriani C2 ,
ETHICS COMMITTEE: The Animal Ethics Committee of Federal Monteiro C2 ; 1 UNICID; 2 FMU; 3 Hı́pica de Santo Amaro
University of São Carlos approval this project.
PURPOSE: This study aimed to analyze the muscular recruitment of
lumbar erector muscle in healthy subjects, comparing itself muscle
Research Report Poster Display recruitment necessary for stand position maintenance, and its relation
10-01 Monday 4 June 09:00 with the horseback riding positions. RELEVANCE: Studying and
VCEC Exhibit Hall B & C understanding the physiological aspects of human body allows the
EFFECT OF REAL-TIME ULTRASOUND IMAGING FEEDBACK applicability of knowledge of rehabilitation, in order to elaborate
ON LEARNING TRANSVERSUS ABDOMINIS CONTRACTION more effectiveness and individualized programs of treatment to
each patient. Inside physical limitations, many times stand position
Murai M1 , Ohashi Y1 ; 1 Ibaraki Prefectural University of Health
isn’t possible of being adopted and kept, making difficult trunk
Sciences; 2 Ibaraki Prefectural University of Health Sciences
muscle activation in these patients. Thus, position’s changes during
PURPOSE: The purpose of this study was to investigate the therapeutic riding session aim activate or inhibit muscle recruitment
effect of ultrasound feedback on learning how to draw the in diverse ways. PARTICIPANTS: Nine female healthy subjects,
abdominal wall in. RELEVANCE: This study clarifies the difficulty of aged 20 to 25 years METHODS: The subjects were positioned
training a person to voluntarily control the transversus abdominis. standing and seated frontal and dorsal on the back of the horse.
PARTICIPANTS: Subjects were 9 healthy young women with no Electromyography surface MIOTEC® and a software Myography with
history of musculoskeletal disorders. Mean age was 22.1±0.9 4 channels, bipolar circle surface silver electrodes were positioned
years, mean body weight was 53.6±5.3 kg, and mean height was at erector lumbar muscle motor point, according to the technique
161.1±2.9 cm. METHODS: 1) The design consisted of a) a pretest suggested by Cram et al 1998. Horse was maintained static and
immediately followed by b) 10 minutes of practice with ultrasound with slow steps walking, 20 meters straight. Orthostatic position
feedback, then c) a posttest 15 minutes after the practice ended. was analized during 30 seconds.Data were analyzed considering
The task in each of these three phases was voluntary activity of average recruitment in each task (stand on the floor, sitting frontal and
tightly drawing the abdomen inward. 2) During the 10 minutes of dorsal over horseback). ANALYSIS: Statistic analysis using Wilcoxon
feedback the subject, viewing an ultrasound image of the abdominal Test including a significance level of 0.05 (5%). RESULTS: The
muscles 1 cm medial to the ASIS, practiced widening the layer results was, comparing the values of muscle recruitment average
corresponding to the transversus abdominis. 3) Relative degree of at stand position, 18.78mV, already seated on the stopped horse,
widening was determined for all three layers of abdominal muscles being the subject seated frontal, the average was 20.83mV, and at
in the region. As an index of contractile activity for each muscle dorsal position 21.61mV (p = 0.206). In the maximum peak of muscle
layer. the difference between the width observed during voluntary recruitment, values gotten in the stand position, frontal and dorsal on
effort and the width observed during rest was divided by the width horseback, had been, respectively, 28.56mV, 39.83mV and 43.06mV
observed at rest. ANALYSIS: Relative changes in thickness of all (p = 0.108). Already with the horse walking, the position frontal had a
three abdominal muscles over the three phases were subjected average of 30.00mV, and dorsal 56.89mV (p = 0.001). For the muscle
to two-way factorial analyses of variance. Scheffé’s test was used recruitment peak the values gotten in the positions frontal and
for multiple comparisons. RESULTS: The internal oblique and dorsal had been, respectively, 57.11mV and 103.11mV (p = 0.002).
transversus abdominis exhibited significantly greater relative changes CONCLUSIONS: Inside rehabilitation process, to inhibit or to
in thickness than the external oblique whenever the subject voluntarily facilitate postural standards is one of the bases for the therapeutically
tried to draw the abdominal wall in. The external oblique displayed no success. Seen the varied physical disabilities, we inquire that average
notable change from the resting state. Relative change in thickness similarity does not exist that is considered statistically significant in
did not significantly vary across the pretest, practice, and posttest the muscular recruitment when compared the stand positions and
phases for any muscle. The transversus abdominis did, however, horseback riding, as much how much dorsal frontal, for the peak
show a tendency to be selectively activated during the practice and average. Thus, we consider that these positions do not have
phase, but the results were variable and statistical significance was statistical differences, what shows similar muscle activation of the
not reached (p = 0.06). CONCLUSIONS: These results suggest that trunk when seated on the back of the horse comparative to the
the transversus abdominis cannot easily be selectively activated position in foot in the ground. These data indicate that biomechanic
without the internal oblique being activated as well. Even though relation between the positions exists, what in the clinical applicability
the transversus abdominis might be amenable to selective activation offers to therapists conditions to elaborate complementary treatment
when ultrasound imaging is presented for feedback, carryover of this programs for trunk motor control.We concluded that exists difference
selectivity beyond the feedback appears to be nil. These results are between the positions dorsal and frontal, considered statistically
significant. Of this form, we can say that in the dorsal position Research Report Poster Display
we always have the average greater. IMPLICATIONS: Physical 11-13 Monday 4 June 09:00
Therapy Practice KEYWORDS: Hippotherapy, Postural Control, VCEC Exhibit Hall B & C
Rehabilitation. FUNDING ACKNOWLEDGEMENTS: Hı́pica de Santo EXERCISE IN PREVENTION AND TREATMENT OF ANXIETY
Amaro. CONTACT: [email protected] AND DEPRESSION AMONG CHILDREN AND YOUNG PEOPLE
ETHICS COMMITTEE: São Paulo
Larun L1 , Nordheim L1 , Ekeland E2 , Hagen K3 , Heian F4 ;
1 Norwegian Knowledge Centre for the Health Srvices; 2 Norwegian
Research Report Poster Display Physiotherapist Association; 3 Diakonhjemmet Hospital, Oslo;
10-09 Monday 4 June 09:00 4 Molde Hospital, Norway

PURPOSE: To assess the existing evidence on the effects of exercise
MORPHOLOGICAL EVIDENCE OF APOPTOSIS IN THE RAT interventions to reduce or prevent anxiety or depression in children
KIDNEYS FOLLOWING STRENUOUS EXERCISE and young people up to 20 years of age. RELEVANCE: Depression
Iwatsuki H1 , Shoumura K2 , Suzuki T1 ; 1 Aomori University of Health and anxiety are common psychological disorders for children and
and Welfare; 2 Hirosaki University adolescence. Psychological (e.g. psychotherapy), psychosocial (e.g.
cognitive behavioral therapy) and biological (e.g. SSRIs or tricyclic
PURPOSE: The presence of weakly bound Fe3+ and Fe2+ is drugs) are among treatments offered. The large varieties of thera-
very important in the pathogenesis of ischemia/ reperfusion injury peutic interventions give rise to questions of clinical effectiveness
of various organs, because they can catalyze the generation of and side effects. Physical exercise is inexpensive with few if any side
highly reactive hydroxyl radicals (OH•) through Haber-weiss reaction. effects. PARTICIPANTS: Children and young people up to the age of
The purpose of this study was to demonstrate through visuals the 20, with or without anxiety and depression. METHODS: A systematic
distribution of Fe2+ and Fe3+ in the rats’ kidney by acute exercise review based on randomized controlled trials with outcome measures
using perfusion-Perls and -Turnbull methods. RELEVANCE: This for depression and anxiety. We searched the Cochrane Controlled
study is based on the prescriptions of physical fitness for the athletes. Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL,
PARTICIPANTS: This study was carried out in accordance with PsycInfo, ERIC and Sportdiscus up to August 2005. Two authors
the Guidelines for Animal Experimentation, Aomori University of independently selected trials for inclusion, assessed methodological
Health and Welfare. Twelve male adult Wistar rats (8-12 weeks of quality and extracted data. ANALYSIS: The trials were combined
age) were divided into three groups as control, exercise only once using meta-analysis methods. A narrative synthesis was performed
and 5 days of exercise groups. METHODS: The exercise-trained when the reported data did not allow statistical pooling. RESULTS:
groups ran on a motor-driven treadmill (0% grade) for 45 min at 16 studies with a total of 1191 participants between 11 and 19
a speed of 25 m/min a day. The animals were anesthetized with years of age were included. Eleven trials compared vigorous exercise
intraperitoneal pentobarbital sodium (40 mg/kg) and transcardially versus no intervention in a general population of children. Six
perfused with the flushing solution, fixative and nonheme iron staining studies reporting anxiety scores showed a non-significant trend in
solution. After the perfusion, the rat kidney paraffin sections were favour of the exercise group (SMD −0.48, 95% CI −0.97 to 0.01).
carried out by DAB/CoCl2 intensification to visualize nonheme iron. Five studies reporting depression scores showed a statistically
ANALYSIS: One-way analysis of variance followed by Bonferroni significant difference in favour of the exercise group (SMD −0.66,
post-hoc comparisons were used to analyze the differences between 95% CI −1.25 to −0.08). However, all trials were generally of low
each groups. RESULTS: 1) Some tubular cells positively stained for methodological quality and they were highly heterogeneous with
Fe2+ and Fe3+ exhibited nuclear condensation in 5 days of exercise regard to the population, intervention and measurement instruments
group. 2) Fe2+ positive reaction product was distributed in the cortex used. Five trials comparing vigorous exercise to low intensity exercise
and in the outer stripe of the outer medulla in rats during the 5 days show no statistically significant difference in depression and anxiety
of exercise. However, Fe2+ positive reaction product did not appear scores in the general population of children. Three trials reported
in those regions of rats that exercise only once. 3) High intensity- anxiety scores (SMD −0.14, 95% CI −0.41 to 0.13). Two trials
exercise causes an acute decrease in renal blood flow and on reported depression scores (SMD −0.15, 95% CI −0.44 to 0.14). Four
immediate increase in regional blood flow after exercise. Therefore, trials comparing exercise with psychosocial interventions showed no
extensive nuclear injury caused by generation of weakly bound Fe2+ statistically significant difference in depression and anxiety scores in
and hydroxyl radicals within nuclei through reduction of intranuclear the general population of children. Two trials reported anxiety scores
Fe3+ by superoxide (O2•−), and extrusion of injured nuclei into (SMD −0.13, 95% CI −0.43 to 0.17). Two trials reported depression
the tubular lumen. CONCLUSIONS: Some tubular cells positively scores (SMD 0.10, 95% CI −0.21 to 0.41). CONCLUSIONS: Exercise
stained for Fe3+ and Fe2+ exhibited nuclear condensation in the rat is promoted as an active strategy to prevent and treat depression
kidneys after strenuous exercise, suggesting that they are undergoing and anxiety. Research data are sparse and mostly done on college
apoptotic cell death. IMPLICATIONS: We suggest that this study students. Exercise may decrease anxiety and depression in healthy
is based on the prescriptions of physical fitness for the athletes. children when compared to no intervention. The research base
KEYWORDS: Strenuous exercise, Rat kidneys, Histology. FUNDING for children in treatment is scarce. IMPLICATIONS: Exercise is a
ACKNOWLEDGEMENTS: This work was supported by a Grant(06A- much less expensive intervention than those currently applied by
4) from the Research Center for Health Sciences at Aomori University many practitioners. For children and young people in treatment
of Health and Welfare, Japan. CONTACT: [email protected] the evidence is scarce. Since exercise has no known negative
ETHICS COMMITTEE: Animal Research Committee, Aomori effects, and has many positive effects on somatic health, it might
University of Health and Welfare be an important instrument in improving children and young peoples
emotional health. KEYWORDS: Children, youth, exercise, anxiety,
depression, systematic review. FUNDING ACKNOWLEDGEMENTS:
Research Report Poster Display Research Report Poster Display
11-17 Monday 4 June 09:00 11-21 Monday 4 June 09:00
VCEC Exhibit Hall B & C VCEC Exhibit Hall B & C
A PHYSIOTHERAPY HEALTH EDUCATION PROGRAM IS 10,000 STEPS PER DAY TO IMPROVE HEALTH: INVESTIGATING
EFFECTIVE IN IMPROVING KNOWLEDGE ON BACK CARE IN FAST AND SLOW WALKING SPEEDS
PRIMARY SCHOOL LEARNERS IN SOUTH AFRICA
Purcell C, Bulley C, MacPherson C, Macmillan L, Crawford L,
Mostert K, Barrie A, Biniek A, van Heerden A, De Beer N, Sirilli S, Joyce D; Queen Margaret University College, Edinburgh, Scotland
Powell Y; University of Pretoria, Pretoria, South Africa
PURPOSE: The aim of this study was to develop and implement PURPOSE: This study investigated whether individuals walking
a four-week physiotherapy health education program on back care 10,000 steps per day at fast and slow walking speeds are likely
in a school with limited resources, in a previously disadvantaged to achieve the minimum recommended daily energy expenditure
rural area in South Africa. Would such a program be effective in from physical activity. RELEVANCE: The promotion of participation
increasing learners’ knowledge on back care? Would it influence in physical activity (PA) and exercise is increasingly important in
their views on physical activity positively? RELEVANCE: The World physiotherapy practice. One strategy is to encourage walking; the
Health Organisation launched a Global School Health Initiative to British Heart Foundation (2005: http://www.bhf.org.uk) suggest a
promote the health of the youth. Unfavorable health behavior, such minimum of 10,000 steps per day to reduce risk factors for disease.
as bad postural habits, seems to be established by the age of The American College of Sports Medicine (ACSM) recommend that
12 years. In a South African province the lifetime prevalence of at least 140 kilocalories per day are expended through PA (Balady et
low back pain in school children aged 13 to 18 years is 56.2%. al., 2000: ACSM’s Guidelines for Exercise Testing and Prescription).
Although a few health education studies showed short-term success
However, there is a lack of research to investigate whether individuals
in improved knowledge on principles of back care, documented
walking 10,000 steps per day expend more than 140 kilocalories,
evidence in a developing country was not found. PARTICIPANTS:
and whether walking speed influences the likelihood of meeting
The population were the grade six primary school pupils from
two schools in a rural district(Moretele,Hammanskraal) North-West ACSM guidelines. PARTICIPANTS: A convenience sample of 30
Province. Both schools do not offer formal, structured physical undergraduate students was recruited (12 men: mean age 25.5
education. The intervention group comprised 30 participants and years; mean height 190.5 cm; mean weight 75.0 kg; 18 women:
the control group 28. (This sample had 90% power to detect a mean age 22.3 years; mean height 166.5 cm; mean weight
difference in mean score of 15%s, assuming a SD of 16.5%). 58.3 kg). Individuals with relevant medical history were excluded.
Although in the same district the schools were not in close proximity Ethical approval was granted by Queen Margaret University College
to each other in order to prevent interaction between the groups. All research ethics committee. METHODS: An experimental same-
participants and their parents / guardians gave consent to participate subject design was used in a laboratory-based study comparing
in the study by signing a comprehensive information form after a physical activity energy expenditure (PAEE: kilocalories) while
verbal explanation. Permission was received from the Department of walking at 3.2 kilometres per hour (kph: slow speed) and 6.4kph
Education. METHODS: The immediate effects of the health education (fast speed). Each participant walked for 1,000 steps on a level
program were studied by means of a questionnaire in a pre-test/post- treadmill, measured using the tally-count method, while wearing
test, non-equivalent control group design. The program, based on a Tritrac-R3D accelerometer to monitor PAEE (kilocalories). Data
evidence, was implemented twice weekly, each session lasting 60 were collected on two separate days and the order of walking
minutes, over a four week period. Participants were taught the basic
speeds was randomised. ANALYSIS: Data were processed by
anatomy and pathology of the spine and the basic principles of back
multiplying PAEE achieved during 1,000 steps on a treadmill by 10
care during daily activities. ANALYSIS: The baseline comparability
of the intervention and control groups was determined using Fisher’s to estimate the likely PAEE from the recommended 10,000 steps.
exact test. A two-group t-test was applied to compare the post- The percentage of individuals who would theoretically achieve the
test scores. The findings were confirmed with ANOVA with the recommended level of PAEE was calculated. The estimated PAEE
pre-intervention score as covariate. The chi-square test was used for each walking speed was compared using the Wilcoxon signed-
to statistically compare attitude towards physical activity scores. ranks test as not all the data were normally distributed (Shapiro-
RESULTS: At baseline the groups were comparable in terms of de- Wilks: 3.2 kph trial: p = 0.03; 6.4 kph trial: p = 0.00). RESULTS:
mographics and base-line knowledge. After invervention, knowledge Out of 30 participants, 29 (96.7%) participants achieved the daily
regarding ergonomics was significantly higher in the intervention PAEE recommended by the ACSM during the slow walking speed
group than the control (p < 0.0001). Post-test the intervention group (3.2 kph). The theoretical PAEE (kilocalories) from walking 10,000
also had a more positive view of physical activity after the program steps was significantly greater at the faster walking speed (Z=-4.782,
(p < 0.01). CONCLUSIONS: These results illustrate that primary p = 0.000). CONCLUSIONS: On extrapolation from 1,000 steps on a
school children, in a rural area in the North-West Province, SA, treadmill, energy expenditure while walking 10,000 steps at a slow
understood the principles of back care and had a positive change walking speed is likely to meet ACSM recommendations, although
in views regarding physical activity, after participating in a health significantly more energy is expended at a faster walking speed. This
promotion programme, such as the one used in this study. However,
exploratory study used a controlled setting that removed the impacts
the long-term effects, for example after one and six months, require
of conditions such as gradient and wind resistance; it is likely that the
further research. IMPLICATIONS: In line with the WHO Global
estimate of PAEE during 1000 steps on a treadmill underestimates
Health Initiative, physiotherapist could effectively implement health
education programs on back care in primary schools. KEYWORDS: the energy expended in a real life setting. Further field-based work
Ergonomics, health promotion. FUNDING ACKNOWLEDGEMENTS: is recommended, including the impact of accumulating short or
Unfunded. CONTACT: [email protected] long periods of stepping. IMPLICATIONS: These results suggest
ETHICS COMMITTEE: Faculty of Health Sciences Ethics Committee, that physiotherapists can recommend the accumulation of 10,000
University of Pretoria, Pretoria, South Africa steps per day while walking at slow or fast speeds. KEYWORDS:
Physical activity; exercise; recommendation; energy expenditure.
FUNDING ACKNOWLEDGEMENTS: Queen Margaret University
College. CONTACT: [email protected]
ETHICS COMMITTEE: Queen Margaret University College research
ethics committee
TRUNK MUSCLE ACTIVITY PATTERN DURING NORMAL WHAT DOES THE PHYSICAL THERAPIST SEE IN
WALKING OBSERVATIONAL GAIT EVALUATION?
Egasaki E1 , Takeda H2 ; 1 Department of Physical Therapy, Nakano Takizawa M, Iwai K, Ito H; Ibaraki Prefectural University of Health
General Hospital, Nakano-ku, Tokyo, Japan; 2 Department of Sciences, Ami. Ibaraki, Japan
Physical Therapy, Faculty of Health Sciences, Mejiro University, PURPOSE: The purpose of this research was to examine the
Iwatsuki-ku, Saitama-shi, Japan relationship between the results of observational gait evaluation
PURPOSE: There are many reports about lower-limb muscles by physical therapists and actual walking data. RELEVANCE:
pattern by using surface electromyogram (SEMG), however, there Exploring the content of observations by a physical therapist may
is few that shows the characteristic pattern of trunk muscle as a be useful in confirming the content validity of subjective evaluation.
basic index. The purpose of this study is to analyze trunk muscle PARTICIPANTS: The subjects of this study were 9 physical therapists
activity pattern in normal walk. RELEVANCE: We will be able (with 2-18 years of experience) and 21 people over 65 years
to evaluate patient’s condition with effective way and to exercise old age who were ambulant and independent in activities of daily
the therapy, after understanding trunk muscle activity pattern in living without the need for a brace or a cane. METHODS: Gait of
normal walk. PARTICIPANTS: Subjects were 13 volunteers (man the elderly people over a 10 m walkway was recorded by video
12, woman 1). Their age was from 18 to 27 years (mean, 20.0 cameras from two directions and footprints were recorded by ink on
years), body mass index (BMI) was from 18.0 to 29.7 (mean, 21.9). paper. Variability of stride length in walking 10 m was calculated
They had no injuries or disease in trunk and lower-limbs. Subjects by coefficient of variation (CV). Viewing the video recordings, the
were explained about this research, they agreed with participation physical therapists used a five-level scale to subjectively grade
in the study. METHODS: The muscles were left Rectus abdominis propulsive force, lack of steadiness, and risk of falling. ANALYSIS:
(RA), bilateral Obliquue internus abdominis (OIA), bilateral Obliquue Multivariate comparison analysis was used to compare gait speed
externus abdominis (OEA) and bilateral Lumbar paraspinals (LP). or CV of step length with the subjective grades assigned by the
Foot-switch was attached with left foot (toe, first metatarsal head, physical therapists. RESULTS: Grades for propulsive force and for
fifth metatarsal head, and heel). Muscle activity and foot pressure lack of steadiness differed with gait speed and stride length CV.
data were collected using TeleMyo2400T V2® (Noraxon), in advance Grades for risk of falling differed with stride length CV, but not with
all signals were sampled at 1500Hz by MyoVideo™ (Noraxon), gait speed. CONCLUSIONS: When judging risk of falling by visual
and MyoReserch (Noraxon) was analyzed. Each muscles maximal observation of an elderly person who is independent in activities of
voluntary contraction (MVC) was measured by Daniels et al muscle daily living, a physical therapist does not appear to use gait speed
manual test (MMT). Each EMG, standing posture and walking, as an important factor in that judgment. IMPLICATIONS: Part of the
were represented by percent maximal voluntary contraction (%MVC). content of clinical observation by the physical therapist was able to
Subjects maintained standing and walked comfortably for 10 meters be confirmed. KEYWORDS: observational gait evaluation, speed,
on a wooden floor then analyzed third step as a walking cycle. A variability. FUNDING ACKNOWLEDGEMENTS: This research was
walking cycle was from the contact of left heel to the next contact partially supported by the Ministry of Education, Culture, Sports,
of same heel. A walking cycle was divided into heel contact, loading Science and Technology Grant-in-Aid for Exploratory Research.
response, foot flat, heel rise, toe-off and swing phase. ANALYSIS: CONTACT: [email protected]
The collected data of potential muscle action was rectified, and ETHICS COMMITTEE: This work approved by the ethics committee
normalized using MVC for one second. Analysis was applied with of Ibaraki Prefectural University of Medical Sciences in Japan
repeated measure and one-way analysis of variance (ANOVA) with
post-hoc-test of Bonferroni/Dunn was applied. P-value <0.05 was
considered statistically significant. RESULTS: Left RA and OEA didn’t
show any difference with %MVC in walking from it in standing. On 13-09 Monday 4 June 09:00
the other side, OIA was significantly (p < 0.01) high in walking cycle VCEC Exhibit Hall B & C
compared with it in standing. LP was significantly (p < 0.01) increased ACCURACY OF TWO-DIMENSIONAL GAIT ANALYSIS USING A
from at the time of heel contact and also between heel rise and DIGITAL VIDEO CAMERA
toe-off. CONCLUSIONS: RA and OEA have no particular activity
Suzuki Y, Sato H, Simoda H; kitasato university, Japan
in normal walking. OIA always act more in walking, and LP has
two peak periods that occurs at the time of heel contact and also PURPOSE: A digital video camera is a useful tool for recording
between heel rise and toe-off. Consequently OIA and LP are needed human motion in clinical situations. The purpose of this study
for the acquisition of the normal walking cycle even if possible to was to determine the accuracy of two-dimensional gait analysis
stand. Further studies are necessary with the trunk muscle activity using a digital video camera. To collect kinematic data with high
pattern during walking, using bilateral foot-switch. And then the trunk accuracy, we tried to correct the depth of the image of a digital video
muscle activity should be developed concerning with lower-limb. camera. RELEVANCE: In order to determine treatment goals or to
IMPLICATIONS: Evaluation and therapeutic exercise with OIA and evaluate the effect of a therapeutic intervention, a physiotherapist
LP are needed as well as lower-limb muscles before gait exercise. visually observes the patient’s gait. However, such observational gait
KEYWORDS: trunk muscle, walking, electromyogram. FUNDING analysis has poor reliability because it is a subjective method. If the
ACKNOWLEDGEMENTS: We would like to express to the volunteer kinematic data are collected with a digital video camera that is often
students of the Faculty of Health Sciences in Mejiro University used in clinical practice, the gait analysis may be more accurate.
and physical therapists of San-ai hospital, our deepest gratitude for PARTICIPANTS: Kinematic data were obtained for ten normal adult
supporting. CONTACT: [email protected] men (average height was 169.9 ±5.59 cm, weight 64.1 ±6.17, and
age 20.13 ±1.25 years). Written informed consent was received from
all participants. METHODS: A digital video camera was used to
collect kinematic data. In order to assess the accuracy, an Optotrak
optical movement analysis system was used to record the positions
of two-dimensional markers. Reflective markers and active markers
were attached on top of the head, acromion, greater trochanter,
lateral and medial femoral condyle, lateral and medial malleolus,
and the heads of the first and fifth metatarsal bones. The kinematic They indicate that on palpation, the spinal level corresponding
data were collected over five walking trials. ANALYSIS: To modify to the iliac crests can vary between individuals by three spinal
the depth of the two-dimensional image, we used the same lower segments. They also indicate that in the majority of cases (76%),
limb length for the limb on the far side and that on the near side the level is likely to equate to either the 4th spinous process or
of the camera. The positions of the kinematic data collected from the 4th/5th spinous process interspace. Further work might explore
a digital video camera and an Optotrak system were compared. To the gender variation in more detail, any effect of age variation
quantitatively indicate the degree of accuracy of the marker position, or any possible diurnal variation in corresponding spinal levels.
a multiple correlation coefficient was calculated. RESULTS: The IMPLICATIONS: The implications suggest the use of caution in
average of the multiple correlation coefficient between the kinetimatic clinical practice when identifying spinal levels by reference to the
data derived from the digital video marker position with correction and iliac crests and this study provides an important description of the
Optotrak data was 0.94 with a standard deviation of 0.05. Whereas variation which might be expected. These implications are particularly
the average of the multiple correlation coefficient between the non- relevant in the teaching of novices. KEYWORDS: anatomy, palpation,
corrected kinematic data derived from digital video and Optotrak teaching. FUNDING ACKNOWLEDGEMENTS: University of the
was 0.69 with a standard deviation of 0.1 for the kinematic data for West of England. CONTACT: [email protected]
the toe of the interior side lower limb. CONCLUSIONS: Improved ETHICS COMMITTEE: Faculty Ethical Committee, Faculty of
accuracy was achieved in detecting marker position by modifying Health & Social Care, University of the West of England, Bristol, UK
the depth of the image. This implies that two-dimensional gait
analysis could be performed correctly using a digital video camera.
IMPLICATIONS: Physiotherapist can easily try to do quantitative gait
analysis. KEYWORDS: a degital video camera,depth,two-dimension 14-21 Monday 4 June 09:00
analysis. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT: VCEC Exhibit Hall B & C
[email protected] DYNAMIC ANALYSIS OF SCAPULO-HUMERAL RHYTHM BY
3-DIMENSIONAL MOTION ANALYZER
Research Report Poster Display Yoshizaki K1,2 , Hamada J3 , Fujiwara T1.2 , Sahara R3 , Handa T1.2 ,
Endou T1.2 , Fujimoto T2 , Yamamoto I2 ; 1 Koriyama Institute
of Health Science; 2 Shinshu University; 3 Kuwano Kyoritsu Hospital
WHICH SPINAL LEVEL MOST COMMONLY CORRESPONDS TO PURPOSE: Few data about comparison of dominant and non-
THE ILIAC CRESTS? A STUDY USING ULTRASONOGRAPHY dominant arms has been available in shoulder kinematics. The
purpose of this study is to evaluate scapulo-humeral rhythm
Downing A1 , Zawadzki A2 , Hayter R3 , Hayward T4 , Barker T5 , during abduction and adduction for bilateral upper extremities.
Rogers-Nash I6 ; 1 University of the West of England, Bristol, RELEVANCE: These studies are useful in evaluation and treatment
UK; 2 University of the West of England, Bristol, UK; 3 University of the disturbance in function of the shoulder. PARTICIPANTS:
of the West of England, Bristol, UK; 4 University of the West of Twenty healthy subjects, 19-50 years old, were participated. Informed
England, Bristol, UK; 5 University of the West of England, Bristol, consent were obtained for all participants. METHODS: The reflecting
UK; 6 University of the West of England, Bristol, UK markers were put on the skin surface of bilateral coracoids processes
PURPOSE: The purpose of this study was to identify which spinal of scapula, posterior horns of the acromion inner borders of spine of
level most commonly corresponds with the highest point of the iliac scapula, epicondylus lateralis of the humerus, epicondylus medialis
crests. RELEVANCE: The received understanding within manual of the humerus, 5th lumbar vertebra, 2nd and 7th thoracic vertebra.
therapy practice and its teaching commonly declares that the highest The 3-dimensional motion analyzer was used to measure scapulo-
point on the iliac crests corresponds with a particular posterior spinal humeral rhythm. Movements of the Humerus and Scapula (Spina
level in the prone lying position. This is used as a landmark to scapulae) were evaluated in every 10 degree of upper extremity with
guide identification of the spinal level. Commonly cited relationships upward and downward motions. These proportional values were com-
(such as the 4th or 5th lumbar spinous process) are not supported pared between dominant and non-dominant sides. ANALYSIS: The
by evidence other than some work undertaken by anaesthetists paired t-test was used to examine the difference between dominant
with subjects in the lumbar flexed position, which may lead to a and non-dominant sides of the scapulo-humeral rhythm. RESULTS:
different iliac crest/spinal segment relationship. PARTICIPANTS: A There was no significant difference between dominant and non-
mixed gender, ethically approved sample of convenience (N=34) dominant sides of the scapulo-humeral rhythm when it was observed
consisted of healthy, volunteering undergraduate students from the every 10 degrees (P < 0.05). CONCLUSIONS: There was a certain
Faculty of Health & Social Care at the University of the West of tendency of the fluctuation in the proportional value of the scapulo-
England. Subjects were excluded if they had a history of spinal humeral rhythm with individualistic variability. IMPLICATIONS: These
injury or pathology. METHODS: Following assessment by palpation findings will due to provide the one of etiological considerations about
of the iliac crests with the subjects in prone lying, a piece of fine the shoulder disturbance. KEYWORDS: Scapulo-humeral rhythm,
metal wire was placed across the spine between the highest points Domination of upper extremity, 3-dimensional motion analyzer.
of the crests. The corresponding spinal level was then identified FUNDING ACKNOWLEDGEMENTS: The president Fujiwara of
by ultrasonography, using the clearly seen image of the wire as a Koriyama Tohto Academy acknowledgements the fund of our work.
guide to the relate the iliac crest level with the relevant point on CONTACT: [email protected]
the posterior spine. ANALYSIS: Descriptive analysis identified the ETHICS COMMITTEE: There are meny fine system for ethics in the
range of corresponding spinal levels and the frequency distribution Japanese University
of the different levels. RESULTS: Results showed that the levels
corresponding to the iliac crests ranged between the 3rd-5th lumbar
spinous processes. The most commonly corresponding spinal level
was the 4th lumbar spinous process (41%). The second most
common level was the 4th/5th lumbar spinous process interspace
(35%). The 5th lumbar spinous process corresponded in 18% of
cases and the 3rd spinous process in 6%. Slight trends in gender
contributions to these results were noted – the females contributed
relatively more heavily to the lower spinal levels. CONCLUSIONS:
These results contribute towards the evidence underpinning practice.
Research Report Poster Display total knee arthroplasty for osteoarthritis. RELEVANCE: Although
16-01 Monday 4 June 09:00 extensive evidence supports the improvement in pain and dysfunction
VCEC Exhibit Hall B & C for the majority of patients following total knee arthroplasty, the rate
IT TAKES TIME TO RESTORE THE BELIEF IN ONE’S ABILITY – of improvement over the immediate postoperative period particularly
EXPERIENCES OF PERSONS TREATED WITH ANTERIOR in the older age group is less well documented in the literature.
CRUCIATE LIGAMENT RECONSTRUCTION PARTICIPANTS: This was a different subject experimental design
using a convenience sample of nine patients under 70 years and
Olofsson L1 , Söderman K2 ; 1 The Research and Development
nine patients over 70 years undergoing primary elective total knee
Unit, Jämtland County Council, Östersund, Sweden; 2 Department
arthroplasty at Our Lady’s Hospital, Navan, Co Meath in Ireland.
of Community Medicine and Rehabilitation, Physiotherapy, Umeå
METHODS: The WOMAC (The Western Ontario and Mc Master
University, Umeå, Sweden
Universities Index questionnaire)was completed preoperatively and
PURPOSE: The treatment of anterior cruciate ligament (ACL) injuries at 3 and 6 weeks postoperatively by both groups. Length of
is conservative or surgical depending on the degree of knee instability stay, discharge destination, time in rehabilitation, and rate of post-
and the individuals demand for activity level. There is a lack operative complications were also compared across both groups.
of studies focusing on experiences from the patients perspective Evaluation with the WOMAC questionaire was made preoperatively
covering the period from injury to recovery. The aim of this study in person by a physiotherapy assistant blinded to the study
was to describe and enhance the understanding of how individuals question. The questionaire was repeated by telephone at 3 and
treated with ACL reconstruction experience their injury, rehabilitation 6 weeks post-operatively. The patients were also blinded as to
and recovery. RELEVANCE: It takes long time to recover after the specific information being examined i.e. effect of age on
an ACL injury and it is therefore important for physiotherapists to outcome. ANALYSIS: The (WOMAC) questionnaire was completed
understand how these persons experience the rehabilitation process. preoperatively and at 3 and 6 weeks postoperatively by both groups.
PARTICIPANTS: Four men and three women, 19-57 years, were Length of stay, discharge destination, time in rehabilitation, and rate of
interviewed at one occasion between 10 and 31 months after the ACL post-operative complications were also compared using appropriate
reconstruction. They were selected to reach a maximum variation statistical analysis. RESULTS: There was no significant difference
sample according to gender, age, activity level, time between injury in the WOMAC scores of either groups preoperatively or at three
and ACL reconstruction and time between surgery and the interview. weeks with regard to pain stiffness or function. There was no
METHODS: A qualitative approach was used in order to capture the significant difference in length of stay, discharge destination, rate of
informants own perceptions and experiences. Data were collected complications or number of physiotherapy sessions required prior
with semi-structured interviews. The interviews were audiotaped and to discharge. At 6 weeks the younger group reported significantly
transcribed verbatim. An emergent design was applied, meaning that greater stiffness than the younger group. Patients in both groups
the design emerged during the study period, allowing the researchers showed significant improvement in pain, function, and stiffness at
to adapt the design as understanding deepened. ANALYSIS: The 3 weeks and 6 weeks when compared with their preoperative
analyses were carried out using the grounded theory method of scores. CONCLUSIONS: The age of patients post knee arthroplasty
constant comparison. To increase trustworthiness and to confirm replacement does not determine preoperative status or outcome at
the findings further triangulation of researchers and member check 3 weeks. There is limited evidence to suggest that the perception
was used. RESULTS: The analysis resulted in the core category of stiffness post surgery is higher among the younger population.
“From loss towards restored belief in one’s ability” that represents IMPLICATIONS: The results of this study contribute to an increasing
the process starting when the informants were injured. For some body of evidence which supports the theory that age does not affect
of the informants this process was still ongoing at the time for the recovery of function and pain alleviation in patients following total
interview. The process contained different stages that interacted knee arthroplasty. Clinically this is relevent with an increasing move
with each other. The informants used different procedures in order towards integrated care pathways for Orthopaedic patients. This
to manage incidents that occurred and strived towards restored study also increases the evidence to support the findings that there is
belief in their own ability during the temporally extended process. no difference in length of stay, discharge destination, or rehabilitation
CONCLUSIONS: The recovery was a long process and it took a needs in older or younger groups following total knee arthroplasty.
lot of effort for the informants to restore the belief in their own Finally this study contributes to the body of evidence which reports
ability. We conclude that the psychological aspects are important to improvement in pain alleviation, reduced stiffness and restoration
consider during the rehabilitation. IMPLICATIONS: Physical exercise of function as early as three weeks post-operatively in all patients
does not seem to be enough to enhance full recovery after following knee arthroplasty. KEYWORDS: Key words: Osteoarthritis,
ACL reconstruction. The findings suggest that the belief in one’s Total knee arthroplasty, Age, Early outcome measurements, Length
ability needs to be focused on during the rehabilitation process. of stay. FUNDING ACKNOWLEDGEMENTS: There was no specific
KEYWORDS: Physiotherapist, Qualitative approach, Rehabilitation funding provided for this research which was completed as part of
process. FUNDING ACKNOWLEDGEMENTS: We wish to thank an MSc in Physiotherapy at the University of Ulster at Jordanstown,
the County Council of Jämtland, Östersund, Sweden for financial Belfast in 2005. CONTACT: [email protected]
support. CONTACT: [email protected] ETHICS COMMITTEE: Health Service Executive (Dublin North East);
ETHICS COMMITTEE: The study was approved by the Ethical Republic of Ireland.
Committee of Medicine, Umeå University, Umeå, Sweden
Research Report Poster Display VCEC Exhibit Hall B & C
MUSCULAR RECOVERY AROUND THE HIP AND KNEE JOINT
AFTER TOTAL HIP ARTHROPLASTY
TOTAL KNEE ARTHROPLASTY AND AGE AS A PREDICTOR OF
Tsukagoshi R1 , Ichihashi N2 , Ohata K2 , Eguchi S1 , Okumura H3 ;
EARLY REHABILITATION OUTCOMES POST SURGERY 1 Department of Rehabilitation, Rakuyo Hospital, Kyoto, Japan;
Monaghan B1 , Baxter D2 , Barrett L1 ; 1 Physiotherapy Department, 2 School of Health Sciences, Faculty of Medicine, Kyoto University,
Our Lady’s Hospital, Navan, Co Meath; 2 Department of Kyoto, Japan; 3 Department of Orthopedic Surgery, Rakuyo Hospital,
Physiotherapy, University of Otago, Dunedin, New Zealand Kyoto, Japan
PURPOSE: The purpose of this study was to investigate the PURPOSE: This study examined differences between hip and knee
relationship between age and early rehabilitation outcome post muscular recovery in the early postoperative phase after total hip
arthroplasty (THA). RELEVANCE: Most of the studies investigating the grade II criteria suggested by Altman. They had grade I or II
recovery of muscle strength after THA for hip osteoarthritis have tibiofemoral OA as judged by Kellgren and Lawrence scale. The
focused on hip abductor muscle, and it is reported that abductor controls consisted of 20 healthy males and females. None of them
strength increases to more than the preoperative level within had any clinical or radiological sign of patellofemoral or tifiofemoral
several months after surgery. However, there are very few reports OA. METHODS: The study was a non-experimental case control
that evaluated the time course of changes in muscle strength study. Concentric peak torques of quadriceps and hamstring were
around the hip and knee joint throughout the preoperative and measured in both groups at an angular velocity of 90 and 150
postoperative period after THA. PARTICIPANTS: Fifty-four women degree/second. In addition, selected functional tests (timed-walking
with hip osteoarthritis who underwent unilateral cementless THA test), selected lower extremity range of motion (ROM) and thigh girth
participated in this study (mean age 60.0±7.8 years). METHODS: were assessed in both groups. ANALYSIS: Paired t-test showed
Hand-held dynamometer was used to measure maximal isometric no significant difference between the two lower extremity concentric
force of hip abductors, extensors, flexors, knee extensors, and peak torques at different speeds. Thus, the dominant and most
flexors on the involved and uninvolved limbs preoperatively and painful side (right in all participants) was selected for all statistical
again 2, 4, and 6 weeks postoperatively. The values of the analyses. The collected data for concentric peak torques at different
maximal muscle torques were divided by the individual subject’s speeds, timed-walking test, lower extremity ROM and thigh girth
body weight for normalization (Nm/kg). Furthermore, preoperative were analyzed statistically using the independent t-test to ascertain
ratios were calculated and expressed as a percentage (postoperative any significant differences between the patient and healthy groups.
value/preoperative value x100). ANALYSIS: ANOVAs and Scheffe’s RESULTS: The independent t-test revealed statistically significant dif-
F post hoc tests were used for statistical analyses. P < 0.05 was ferences between the two groups with regard to isokinetic concentric
considered significant. RESULTS: Hip abductor, extensor, and flexor peak torque at different angular velocities and for timed-walking test.
strength values of the involved limb 2 weeks postoperatively were However, no significant difference in lower extremity joints’ ROM and
significantly lower than the preoperative values, respectively, but thigh girth were seen. CONCLUSIONS: In conclusion, patients with
these 3 values 4 and 6 weeks postoperatively did not differ from knee OA, even in low grades and with minimum symptoms and signs,
the preoperative values. Knee extensor strength of the involved limb had muscle weakness and functional limitation in comparison with
2, 4, and 6 weeks postoperatively was significantly lower than the the matched healthy subjects. IMPLICATIONS: Based on the results
preoperative value. Knee flexor strength value of the involved limb 2 of this study isokinetic and functional changes are anticipated even
weeks postoperatively was significantly lower than the preoperative in low grades of knee osteoarthrits. In order to better rehabilitation
value, but the value after 6 weeks was greater than the preoperative and management, considering and knowing the different changes in
value. There were no significant differences in preoperative ratios osteoarthritis are essential. KEYWORDS: Osteoarthritis; Isokinetic
between hip abductors, extensors, flexors, and knee extensors 2 test; Functional Status. FUNDING ACKNOWLEDGEMENTS: Tehran
weeks postoperatively in the involved limb (ranged from 54 to 63%), University of Medical Sciences in Iran provided funding sources that
but the ratio of knee flexors (87%) was significantly higher than supported our work. CONTACT: [email protected]
those of the other 4 muscle groups. Six weeks postoperatively, ETHICS COMMITTEE: Tehran University Medical Sciences in
there were no significant differences in preoperative ratios between Tehran – Iran
hip abductors, extensors, flexors, and knee flexors in the involved
limb (ranged from 115 to 125%), but the ratio of knee extensors
(84%) was significantly lower than those of the other 4 muscle
groups. CONCLUSIONS: It was demonstrated that recovery of knee 17-17 Monday 4 June 09:00
extensor strength was delayed in comparison with hip musculature VCEC Exhibit Hall B & C
and knee flexors after THA. IMPLICATIONS: Exercise programs THE INTERNAL KNEE ABDUCTION MOMENT DURING
for patients with THA should address knee extensor strength in STEPPING IN SUBJECTS WITH KNEE OSTEOARTHRITIS IS
addition to strengthening of hip musculature. KEYWORDS: hip CORRELATED WITH PAIN AND DISABILITY
osteoarthritis, total hip arthroplasty, isometric strength. FUNDING Kito N1,2 , Shinkoda K2 , Kanemura N2 , Kato H3 , Ishii S4 ; 1 Hiroshima
ACKNOWLEDGEMENTS: This study was unfunded and indepen- International University, Higasihiroshima, Japan; 2 Hiroshima
dently performed. CONTACT: [email protected] University, Hiroshima, Japan; 3 Kivi International University,
Takahashi, Japan; 4 Kanagawa University of human services,
Research Report Poster Display Yokosuka, Japan
17-13 Monday 4 June 09:00 PURPOSE: The severity of symptoms in medial osteoarthritis of knee
VCEC Exhibit Hall B & C (knee OA) can be difficult to assess. Given that knee OA often affects
ISOKINETC AND FUNCTIONAL STATUS IN KNEE the medial compartment, studies have characterized the dynamic
OSTEOARTHRITIS knee joint loads using the internal knee abduction moment. In theory,
reduction of medial load may have a beneficial disease-modifying
Emrani A, Bagheri H, Hadian M, Talebian S, Jabalameli M,
effect on medial knee OA. However, there is debate as to whether
Olyaie G; Tehran Uniersity of Medical Sciences, Tehran, Iran
pain and disability of knee OA correlates with the magnitude of knee
PURPOSE: The aim of the study was to investigate and compare abduction moment. The purpose of this study was to determine if
the concentric torque of knee muscles (quadriceps and hamstring) a relationship exists between radiographic measures of knee OA
and functional status in two matched groups. RELEVANCE: Knee severity, clinical assessments of symptoms (pain and function) and
osteoarhtirits is one of the most common musculoskeletal diseases Internal knee and hip abduction moment (KAbM, HAbM) during
in middle-aged population.To better management, it is imperatvie to stepping movement. RELEVANCE: Knee OA is the most common
know the different kinetic,kinematic and functional changes following cause of chronic disability amongst seniors. The results support
the disease.This study was designed to provide useful information the use of biomechanical analysis of stepping movement as a
in knowing some common aspects of disease. PARTICIPANTS: The clinical evaluation tool for patients with knee OA. PARTICIPANTS:
subjects were invited to participate in the study from the public at 30 patients with early medial knee OA and 18 age-matched
large, using posters and interviews. They were 20 patients with knee asymptomatic control subjects. METHODS: Biomechanical data were
OA and 20 matched healthy subjects (controls). The following criteria collected from two force plates (ANIMA) and motion analysis system
were used to match the two groups: weight, height, age, and the (Kissei Comtec), and the KAbM, HAbM were calculated. We defined
activity level of the subjects. The patients (20 males and females) that %KAbM was the value which broke B by the value which added
had clinical symptoms and signs consistent with knee OA, and met KAbM and HAbM, and was shown by %. Pain and function measured
using the pain and function subscales of the WOMAC index. Weight- injection of corticosteroid and viscosupplementation are recognised
bearing antero-posterior radiographs were taken for all knee OA and accepted treatment modalities for OA knee. Some physiothera-
subjects. All raradiographs were read by auther and the Kellgren and pists working in extended roles are undertaking such injections. Corti-
Lawrence grade (K-L grade) was determined for each subject using a costeroids appear to have a short-term effect,repeated injection every
standard atlas. ANALYSIS: Significant differences between knee OA three months is said to be safe for at least two years.the response
and control subjects were identified with t-tests. In knee OA subjects, to viscosupplementation appears to be more durable justifying its
stepwise forward regression was used to identify which variables greater cost. There is growing evidence that the younger patient
contributed to the pain and function subscale of the WOMAC (<65) with mild to moderate OA knee is more likely to respond to
index. RESULTS: In knee OA subjects, there was poor correlation viscosupplementation as a preventative measure rather than an older
between radiographic K-L grade, pain or function, with no statistically patient with advanced disease. better patient selection would further
significant associations. The pain subscale of the WOMAC index was justify the higher cost of viscosupplementation. IMPLICATIONS: A
significantly correlated with the function subscale of the WOMAC better appraisal of the mode and length of action of intra-articular
index(r = 0.73, p < 0.001). KAbM was significantly correlated with the corticosteroid and viscosupplementation for OA knee is useful. This
pain subscale of the WOMAC index(r = 0.37, p < 0.05). KAbM, HAbM will help the clinical reasoning process when the decision is made
did not differ statistically between the knee OA and control subjects. as to which patints are most likely to benefit. KEYWORDS: OA
A significant difference in %KAbM was found between the two groups Knee; Intra-articular corticosteroid; Viscosupplementation. FUNDING
(p < 0.05)(mean ±SD: knee OA subjects 52.27% ±7.9%, control sub- ACKNOWLEDGEMENTS: This work was unfunded.
jects 45.72% ±0.1%). Stepwise forward regression analysis revealed
relatively high contributions of KAbM in single leg stance phase to
pain subscale of the WOMAC index. CONCLUSIONS: KAbM and Research Report Poster Display
%KAbM during stepping movement provide non-invasive, objective 19-05 Monday 4 June 09:00
information in the assessment of knee OA. It may be useful in assess- VCEC Exhibit Hall B & C
ment of physical therapy intervention for knee OA. IMPLICATIONS:
INFLUENCE OF WEIGHT-BEARING PAIN ON MOTOR
Our results suggest the need for future studies to examine the thera-
COGNITION AND PERFORMANCE IN POSTOPERATIVE
peutic effect of interventions targeting hip abduction moment for knee
PATIENTS WITH FEMORAL NECK FRACTURE: AN ANALYSIS
OA subjects. KEYWORDS: Knee osteoarthritis, Internal knee abduc-
BY AUTO-ESTIMATICS
tion moment, pain, disability. FUNDING ACKNOWLEDGEMENTS:
The work was unfunded. CONTACT: [email protected] Tanoue Y1 , Nishio Y2 ; 1 The School of Rehabilitation, National
ETHICS COMMITTEE: the ethics committee of hiroshima university Hospital Organization Kure Medical Center, Kure, Japan; 2 Tokiwadai
Home
Research Report Poster Display PURPOSE: A weight-bearing pain is thought to be very influential
17-21 Monday 4 June 09:00 in performance in postoperative patients with femoral neck fracture.
VCEC Exhibit Hall B & C In this study, we investigate how the pain affects motor cognition
and performance in the patients by using the step over task of
INTRA-ARTICULAR CORTICOSTEROID AND VISCOSUPPLE-
Auto-estimatics(AE). RELEVANCE: We may understand disablement
MENTATION INJECTIONS FOR OSTEOARTHRITIS OF THE
deeper by importing the concept of motor cognition in an assessment.
KNEE: A REVIEW OF THE LITERATURE
PARTICIPANTS: Twelve postoperative patients with femoral neck
Lewis T; St Helens and Knowsley PCT, Prescott, Merseyside, fracture (9 women, 3 men, mean age 78.6y ± SD 9.4). METHODS:
United Kingdom We applied the step over task of AE to the patients. The procedure
PURPOSE: The purpose of this study was to evaluate the the efficacy of the task was; (1) A tape showed in front of a patient’s tiptoe was
and safety of intra-articular corticosteroids and viscosupplemenation left away slowly, (2)The patient estimated the furthest distance that
in treatment of osteoarthritis (OA) of the knee. RELEVANCE: she/he thought she/he could step over without any failure, (3) The
Currently physiotherapists are working in extended scope and un- patient stepped over the tape actually. The estimated distance (ED),
dertaking intra-articular injection. Many more physiotherapists as first the actual distance (AD) and the success rate (SR) of the task were
line assessors are referring patients for such procedures. it is useful recorded for 4 weeks. ANALYSIS: The patients were divided into 2
for them to have an evidence upon which to base their treatment and groups: One was composed of 9 patients with pain (painful group;
referral criteria. PARTICIPANTS: The literature was searched from PF), the other was composed of 3 patients without pain (painless
1966 to August 2006 using Medline and from 1980 to 2006 using Em- group; PL). We compared PF with PL, and the 1st week’s average
base. The Cochrane Central Register of Controlled Trials (CENTRAL) with the 4th week’s average for each date. The statistical analysis
were also searched. METHODS: All published, peer-reviewed studies was carried out using an SPSS package. A two-way layout ANOVA
assessing the effects of intra-articular steroid and viscosupplemen- was employed. RESULTS: In AD and ED, PL was significantly better
tation in OA knee were looked at. In particular randomised controlled than PF (p < 0.05), and the 4th week’s average was significantly
clinical trials single/double blind, placebo-based/comparative studies better than the 1st week’s average(p < 0.01). In SR, on the other
reporting ay least one core OMERACT III outcome measure. hand, no significant differences were found in any comparison.
ANALYSIS: Methodological quality of trials was assessed and data CONCLUSIONS: These results suggest followings in postoperative
were extracted. RESULTS: In one study no statistically significant patients with femoral neck fracture; (1)A weight-bearing pain declines
differences were noted at 1-4 weeks post injection. The period where performance, but does not affect SR so much, (2)The patients do not
intra-articular steroid was most efficacious was at two to three weeks. have extremely declined SR even in an early stage. IMPLICATIONS:
Viscosupplementation was said to be most effective at the 5-13 week Declined SR means inappropriate motor cognition, that is, a patient
post injection period. Side effects with viscosupplementation are local can not move as she/he expected to. According to our previous
inflammatory responses at a rate of 0-8%. One study showed that study, patients with hemiplegia showed declined SR in an early
intra-articular steroid could be administereed at 3-monthly intervals stage. In postoperative patients with femoral neck fracture, however,
for two years with no adverse effects when compared with placebo. there are not serious problems about SR. It implies that they can
A subgroup of younger patients with lower grade osteoarthritis on manage to understand their motor changes accordingly and move
the Kellgren-Lawrence scale were said to most likely benefit from as they expected to, even though a weight bearing pain decrease
viscosupplementation. This is contrary to the hypothesis of several their motor performance. KEYWORDS: weight-bearing pain, Auto-
authors who felt that viscosupplementation was an end of the line estimatics, motor cognition. FUNDING ACKNOWLEDGEMENTS:
treatment when all else had failed CONCLUSIONS: Intra-articular unfunded. CONTACT: [email protected]
INTRA-RATER RELIABILITY OF IN-VIVO MEASUREMENTS OF EFFECTS OF MYOFASCIAL RELEASE AND STRETCH
LUMBAR SPINE FORCE-DISPLACEMENT PROPERTIES TECHNIQUES ON RANGE OF MOTION AND REACTION TIME
Stanton T, Kawchuk G; University of Alberta Kuruma H, Takei H, Nitta O, Furukawa Y, Shida N, Kamio H,
Oya S, Yanagisawa K; Tokyo Metropolitan University, Japan
PURPOSE: The purpose of this study was to determine the intra-rater
reliability of postero-anterior measures of spinal force-displacement PURPOSE: The purpose of this study was to investigate the
properties in-vivo. RELEVANCE: The intra-rater reliability of manual effects of myofascial release (MFR), muscle stiffness and stretch
methods to characterize the postero-anterior loading response of techniques in physical therapy on range of motion and reaction
spinal tissues is modest at best. Should the use of technology time. RELEVANCE: MFR and stretch techniques are used in
increase measurement reliability when assessing the spine’s re- physiotherapy technique. However the effects of these techniques are
sponse to postero-anterior loading, the use of this technology in uncertain. PARTICIPANTS: Thirty healthy college students (mean
clinical practice may be warranted. PARTICIPANTS: Twelve female age: 21.0 19–24 yr.) participated to this study. Informed written
and eleven male asymptomatic subjects between the ages of 18- consent had been obtained. The experiment was approved by Tokyo
30 years participated in this study which was approved by the Metropolitan University Ethics Committee. METHODS: Subjects were
University of Alberta. Seven potential subjects were excluded based randomized divided three groups; 1) Myofascial release 2) Stretch 3)
on age, previous injury, and discomfort when prone. METHODS: Control group. All groups were ten persons (five male) and there
An indenter device was placed perpendicularly over the spinous were no significance in age. MFR group was enforced myofascial
process of the 4th lumbar vertebrae in each prone subject. The release to quadriceps areas for eight minutes in supine position.
indentation device consisted of a moveable piston connected in- Stretch group was enforced static stretch of quadriceps for eight
series to a load cell and linear velocity displacement sensor (LVDT). minutes in prone position. Control group was just lying in supine
The piston was moved manually to apply indentation to the spine for eight minutes. Evaluation was measured three devices; active
to a maximum of 100N. The resulting load and displacement of and passive range of motion (ROM) of knee joint, muscle stiffness
the indenter were quantified in real time. Ten indentations were of quadriceps, reaction time of knee extension. Muscle stiffness
then performed at two minute intervals. Subjects were instructed was measured using a durometer (Type FP: Asker co.) at points of
to remain at rest and breathing patterns were standardized. From 10cm, 15cm, 20cm above lateral knee joint space. Reaction time was
the resulting force-displacement data, two variables were calculated: measured using electormyogram (Polygraph RM-7000: Nihon kohden
the mean maximal stiffness (MMS, peak force divided by peak co., Power Lab: AD Instruments co.). Pre-motor time, motor time
displacement) and global stiffness (GS, the slope of the force- and reaction time were measured. ANALYSIS: Statistical analyses
displacement data between 30 and 100 N). ANALYSIS: Given the of differences among three groups were performed using two-way
variability in subject responses to the initial indentation, outcome repeated analysis of variance (ANOVA). For ANOVA model with a
variables were computed for indentations 2-10. From these data, significant effect, paired t-test and one-way ANOVA were performed
intraclass correlation coefficients (ICC) were computed to determine post hoc to localize the effects. RESULTS: In active range and
reliability. Error values (using the difference between consecutive passive range of knee were significantly increased by MFR and
trials) were calculated for each subject using coefficients of variation. stretch. There were no significant difference in muscle stiffness at
Finally, a paired t-test was used to determine if a significant difference the points of 10cm and 15cm. At the point of 20cm, there were
existed between the 2nd and 10th indentations. RESULTS: Both trends to decrease in MFR and stretch. Pre-motor time (PMT)
MMS and GS had ICC values greater than 0.90 (ICC = 0.93 and and reaction time (RT) were significantly decreased in MFR. There
0.91, respectively). Mean error values were calculated to be 7.70% was no significant difference in motor time (MT). CONCLUSIONS:
(+/− 5.33%) for MMS and 6.24% (+/− 4.52%) for GS. Paired t-tests MFR and static stretch improve the range of motion. Only MFR
demonstrated a significant difference between indentation trials 2 and improve the RT. Stretch exercise was the exercise only extend the
10 for GS values only (p = 0.003). CONCLUSIONS: Measurement of muscle length. So stretch techniques improved the ROM but didn’t
spinal stiffness using indentation demonstrated excellent reliability improve RT. MFR techniques applies to fascial restrictions and will
in a single rater. Given that the indentation is performed manually, realign fascial planes, reset the soft tissue proprioceptive sensory
rate-dependant variables such as GS showed greater between-trial mechanism. So MFR improved both ROM and the skill of movements.
variation than MMS which is less influenced the rate of indentation. IMPLICATIONS: If the patient’s have the problem of their joint, it’s
Further research is required in this area to compare the reliability difficult to stretch enough. But MFR is useful for patient’s who have
of stiffness quantification using multiple raters and at different joint problem. This study proved that not only ROM but also skill of
anatomic sites. IMPLICATIONS: Due to the subjective nature of movements were obtained in MFR. KEYWORDS: myofascial release,
manual assessment, technologies able to quantify spinal stiffness stretch, reaction time. FUNDING ACKNOWLEDGEMENTS: None.
in a reliable manner are an important clinical tool in evaluating CONTACT: [email protected]
the effect of therapies aimed at complex musculoskeletal systems ETHICS COMMITTEE: Tokyo Metropolitan University Ethics Com-
such as the spine. KEYWORDS: Stiffness, Indentation, Reliability. mittee
FUNDING ACKNOWLEDGEMENTS: Province of Alberta Graduate
Scholarship. CONTACT: [email protected]
ETHICS COMMITTEE: University of Alberta Health Research Ethics
Board 20-21 Monday 4 June 09:00
THE EFFECT OF FEMORAL STRAPPING ON PAIN RESPONSE,
HIP ROTATION, AND GLUTEUS MAXIMUS ACTIVATION IN
PERSONS WITH PATELLOFEMORAL PAIN
Souza R1 , Selkowitz D1,2 , Powers C1 ; 1 University of Southern
California, Los Angeles, USA; 2 Western University of Heath
Sciences, Pomona, USA
PURPOSE: The purpose of this pilot study was to assess the effects
of femoral strapping on pain response, hip internal rotation, and hip
external rotator muscle activation during dynamic activities in persons a leading university hospital in Denmark. Both their professional
with patellofemoral pain (PFP). RELEVANCE: Recently, it has been lives – all had been forced to withdraw from their jobs due to their
recognized that the patellofemoral joint can be influenced by the illness – and their social roles as fathers, mothers, husbands and
segmental interactions of the lower extremity. [Powers, 2003] Using wives were affected. METHODS: Four semi-structured interviews
dynamic MRI methods under weightbearing conditions, Powers et al. were conducted on the basis of the researcher’s own experience
[2003] demonstrated that the primary contributor to lateral patellar as a physiotherapist treating patients suffering from RA – combined
tilt and displacement in a group of individuals with patellar instability with a literature search in primarily international sociological and
was femoral motion (internal rotation) and not patellar motion. This psychological databases. The interviews were taped and afterwards
finding calls into question the long-held assumption that subluxation transcribed word by word. ANALYSIS: The qualitative data were
is the result of the patella moving on the femur. Given the recent focus analysed from a phenomenological/hermeneutical point of view. The
on the control of hip motion as a possible treatment option for PFP, transcriptions were divided into major themes, and questions related
the S.E.R.F. Strap™ (Don Joy Orthopaedics Inc.) was developed to to the themes were then asked. The results were finally discussed
assist in this effort. This femoral strap consists of thin, elastic material in relation to theories regarding communities of practice (Wenger
that is secured to the proximal tibia, wraps around the distal thigh, 2004) and gender research studies. RESULTS: The analysis and
and is anchored around the pelvis (Fig. 1). The line of action of the interpretation clearly showed the difference between the dilemmas
S.E.R.F. Strap™ is designed to pull the thigh into external rotation. of identity of the two sexes. The crucial dilemma of the men was
It is thought that femoral strapping may augment muscular control at trying to live up to the socially accepted identity of work. For the
the hip as well as improve lower extremity kinematics during dynamic women the essential thing was trying to live up to their families’
activities. PARTICIPANTS: Five subjects with a diagnosis of PFP demands and expectations as regards an unaltered role of traditional
took participated (4 females, 1 male; mean age 32 yrs). METHODS: housewife, at the same time as managing their jobs and the RA.
Pain levels (VAS pain scale), 3D kinematics (8-camera Vicon motion Where the men were supported by their families and therefore
analysis system; 60 Hz), and EMG activity of the gluteus maximus managed to rest and do their exercises, the women didn’t manage
(surface electrodes, 1200 Hz) were obtained as subjects performed to take care of themselves because of the unaltered expectations
a step-down maneuver, a drop-jump task, and ran at 3.5 m/sec. to fulfil their social roles – regardless of their RA. CONCLUSIONS:
Each subject performed all tests with and without femoral strapping. The demands and expectations from the other family members are
ANALYSIS: Data from three trials were averaged for analysis. of great importance, both to men and women suffering from RA
Dependent variables included average pain scores during the step- in the Danish Society. Whether men and women suffering from
down task, peak hip internal rotation, and average gluteus maximus RA, but living in other cultural settings,have the same experiences,
EMG during the stance phase of each activity. Statistically significant could be interresting to find out in future research. IMPLICATIONS:
differences between femoral strapping and no strapping for the Physiotherapists treating patients suffering from a chronic illness
dependent variables were determined using paired t-tests, with an such as RA should ease their attention towards the great importance
a level of 0.05. RESULTS: On average, subjects reported a 50% of the social roles – the expectations and demands – with regard
reduction in pain following the application of the S.E.R.F. Strap™ (Fig. to patients’ ability to take care of themselves when it comes
1). Femoral strapping was found to significantly reduce hip internal to rest and exercise. It is recommended that physiotherapists
rotation during the step down maneuver (9.1º IR vs. 2.5º ER), running involve especially the families of their female patients in the
(8.7º IR vs. 1.0º ER), and the drop jump task (3.8º IR vs. 3.9º ER). treatment. This important implication is well-authenticated by the
When averaged across all conditions tested, gluteus maximus EMG participation domain of the ICF. KEYWORDS: Rehabilitation, Gender
activity was found to increase 178% following the application of the health, Arthritis. FUNDING ACKNOWLEDGEMENTS: The Danish
femoral strap (Fig. 3). CONCLUSIONS: Following the application of Physiotherapy Association. The Danish Arthritis Patient Organisation.
a femoral strap, all subjects reported a reduction in symptoms. This CONTACT: [email protected]
was accompanied by significant reductions of hip internal rotation
and improved external rotator activation for all activities tested. These
data suggest that femoral strapping may be a viable option for the Research Report Poster Display
treatment of PFP. IMPLICATIONS: The results of this preliminary 21-05 Monday 4 June 09:00
study support the premise that patellofemoral joint dysfunction VCEC Exhibit Hall B & C
may have a proximal origin (i.e. hip). KEYWORDS: Patellofemoral AN EVALUATION OF THE EFFECTIVENESS OF PASSIVE
pain, musculoskeletal biomechanics, femoral strapping. FUNDING SHOULDER JOINT MOBILIZATION FOR THE TREATMENT OF
ACKNOWLEDGEMENTS: This work was not funded. SHOULDER PAIN: TWO RANDOMIZED CLINICAL TRIALS
ETHICS COMMITTEE: University of Southern California Yiasemides R, Chen J, Ginn K, Herbert R, Cathers I; University
of Sydney. Sydney Australia
PURPOSE: The aim of these studies is to examine the short
21-01 Monday 4 June 09:00 and longer-term effectiveness of passive mobilizations of shoulder
VCEC Exhibit Hall B & C joints for the treatment of shoulder pain with and without movement
DILEMMAS OF IDENTITY IN PEOPLE WITH RHEUMATOID restriction. RELEVANCE: Shoulder disorders are the most common
ARTHRITIS. A GENDER PERSPECTIVE ON SOCIAL ROLES AND of all peripheral joint complaints and the incidence of shoulder
THE CONSEQUENCES FOR PHYSIOTHERAPY INTERVENTIONS pain is reported to increase with age. Exercise and passive
shoulder region joint mobilizations are commonly used for the
Oredson C; Odense University Hospital, Denmark
treatment of shoulder pain. While there is evidence to support the
PURPOSE: The purpose of this project was to see whether social efficacy of exercise therapy, scientific evidence to support shoulder
roles are of importance in the treatment of people with Rheumatoid region joint mobilization therapy is lacking. PARTICIPANTS: One
Arthritis. RELEVANCE: Patients with Rheumatoid Arthritis frequently hundred and eighty-eight subjects presenting with shoulder pain
struggle with dilemmas of identity due to the problems to live of local mechanical origin will be recruited for two trials – 90
up to the demands and expectations that are attached to their with restricted shoulder movements will participate in one trial and
social roles, which can act as a barrier in relation to be able 98 without restriction will participate in a second trial. Statistical
to follow the recommendations of training. PARTICIPANTS: Two power calculations for each of these trials, indicate that these
middle-aged men and women who all were married and having sample sizes have an 80% chance of detecting a change of 15
children, suffering from longstanding RA, and in ongoing medical points on the Shoulder Pain and Disability Index (SPADI) based
treatment with biological medicine, were intentionally selected from on standard deviations of 24 and 25 respectively, assuming a 10%
loss to follow-up. METHODS: • Two primary outcome measurements grip, postural change and a cycle challenge test. The severity of
will be used: 1) shoulder pain and functional impairment using the disease was evaluated in the MS participants, and the type
SPADI, and 2) subjects’ perceived change in symptoms using a six- of MS and duration since diagnosis recorded. Height and weight
point Likert scale. • All subjects will receive advice and exercises of all participants was measured. ANALYSIS: All demographic and
designed to restore neuromuscular control at the shoulder of proven measured data were analysed descriptively. Two-sample t tests
treatment efficacy. • The experimental group will also receive passive were used to compare differences between MS and control group
joint mobilizations applied specifically to shoulder region joints. means for height, weight, and age. The Wilcoxon signed-ranks test
• After obtaining baseline outcome measurements, subjects will was used to compare differences between group means for all
be randomly allocated to control or experimental groups using a the autonomic test results, as these were not normally distributed.
concealed procedure. • subjects will receive 4 to 8 treatments RESULTS: The thirty-one participants with MS (26 female, 5 male)
during a one-month period at which time outcome measurements had a mean age of 46±8.00 years (32-60 years) and their mean
will be re-assessed by a blinded researcher. • Treatment may then Expanded Disability Severity Scale was 3 (1-6). The mean duration
continue for a maximum of 12 treatments over a maximum of since diagnosis was 10.3 years (0.1–39 years). Thirty-one age-
8 weeks. • Blinded assessment will be repeated 6 months after matched healthy controls (26 female, 5 male) had a mean age
recruitment. ANALYSIS: Two-tailed paired samples t tests will be of 45±9.5 years (24-57). There were no significant differences in
used to compare mean changes in all outcome measurements age, height or weight (p < 0.05) between the two groups. There
between the experimental and control groups. RESULTS: In the were no significant differences between the MS and control group
study involving patients with shoulder pain and restricted shoulder on any of the autonomic tests results (p < 0.05). Of the sample of
movements 63 subjects have been recruited to date – average age thirty-one participants with MS four participants (13%) appeared to
66 years. Thirty of these have received advice and exercises (control have compromised cardiovascular components of their autonomic
group) and 33 advice, exercises and passive shoulder region joint nervous systems on formal testing; however, the results of their heart
mobilizations (experimental group). Five subjects (7.9%) failed to rate responses to the cycle test were comparable with that of the
attend for short term follow-up and 33 of 34 potential subjects (97.1%) control group. CONCLUSIONS: Although autonomic dysfunction was
have completed longer term follow-up. In the study involving patients indicated in 13% of participants with MS there were no significance
with shoulder pain without shoulder movement restriction 44 subjects difference between the MS and control groups on any of the
have been recruited to date – average age 60 years. Twenty-three autonomic tests, including the cycle test. The cycle test protocol
of these have been allocated to the control group and 21 to the used in this study was unable to detect the presence of abnormal
experimental group. One subject failed to attend for short term follow- heart rate responses to exercise and probably requires modification
up and 27 of 29 potential subjects (93%) have completed longer to present a greater challenge to participants’ cardiovascular
term follow-up. CONCLUSIONS: Completion of data collection for system. IMPLICATIONS: A simple clinical test to screen autonomic
both trials is expected 2008. IMPLICATIONS: This robust randomized dysfunction would enable physiotherapists to safely prescribe
controlled clinical trial will provide evidence for the efficacy of passive exercise programmes to adults with MS. Monitoring the heart rate
shoulder joint mobilizations in the management of shoulder pain with responses to exercise is one method of achieving this but the
and without accompanying stiffness. KEYWORDS: Passive joint mo- required exercise protocol still needs to be more rigorously defined.
bilization, shoulder pain, shoulder stiffness,painful arc,impingment, KEYWORDS: autonomic dysfunction,Multiple Sclerosis, screening,
frozen shoulder, capsulitis. FUNDING ACKNOWLEDGEMENTS: exercise. FUNDING ACKNOWLEDGEMENTS: New Zealand Society
Physiotherapy Research Foundation Tagged Grant 2005. CONTACT: of Physiotherapy Scholarship Trust Fund and the Healthcare Otago
[email protected] Charitable Trust. CONTACT: [email protected]
ETHICS COMMITTEE: 1)The University of Sydney – Human ETHICS COMMITTEE: Otago Ethics Committee (a regional health
Research Ethics Committee. 2)Central Sydney Area Health Service – ethics committee in New Zealand), reference number 03/06/05
Research Development Office
VCEC Exhibit Hall B & C FACTORS ASSOCIATED WITH INDEPENDENCY IN ADL AND
VALIDATING A CLINICAL TEST OF AUTONOMIC DYSFUNCTION SOCIAL/LIFESTYLE ACTIVITIES IN MS: ACCOUNTING MOTOR
IN ADULTS WITH MULTIPLE SCLEROSIS AND COGNITIVE FUNCTION, SOCIO-DEMOGRAPHIC FACTORS,
Hale L1 , Nukada H2 , du Plessis L3 ; 1 University of Otago, Dunedin, COPING CAPACITY
New Zealand; 2 University of Otago, Dunedin, New Zealand; Einarsson U1,2 , Gottberg K2 , von Koch L2 , Widén Holmqvist L1,2 ;
3 Dunedin Public Hospital, Dunedin, New Zealand 1 Division of Physiotherapy, Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden;

PURPOSE: The purpose of this study was to validate a simple 2 Division of Neurology, Department of Clinical Neuroscience,
clinical screening test for cardiovascular autonomic dysfunction in
Karolinska Institutet, Stockholm, Sweden
adults with Multiple Sclerosis (MS) by investigating the relationship
between autonomic dysfunction and the heart rate response to a PURPOSE: The purpose of this study was to describe and analyze
simple cycle test. RELEVANCE: Autonomic dysfunction can occur independency in personal and instrumental activities of daily living
in people with multiple sclerosis (MS) causing blunted heart rate (ADL), and frequency of social/lifestyle activities in a population-
and systolic blood pressure responses to routine laboratory-based based sample of people with multiple sclerosis (MS) in Stockholm,
autonomic testing. The presence of autonomic dysfunction should be taking into account motor and cognitive function; socio-demographic
taken into account when prescribing exercise programmes, however factors; and coping capacity. RELEVANCE: One of the important
the routine tests used to assess the autonomic nervous system are health-care services for people with MS in Stockholm is physiother-
not easily applied in the clinical physiotherapy setting; the autonomic apy, for example evidenced-based exercise therapy. Physiotherapists
nervous system is usually only evaluated formally on specific medical are supplying health care services with aims relevant to the lifestyle
referral. PARTICIPANTS: A convenience sample of thirty-one adults of people with MS at every stage of disease severity. Consequently,
with MS and 31 non-disabled, sedentary age-matched adults were there is a great need for a more detailed understanding of factors that
recruited. METHODS: The autonomic function of all participants was might account for differences in functioning among people with MS.
assessed using continuous heart rate and blood pressure responses For this purpose, there is a need to identify: a) target sub-groups
to rhythmic deep breathing, the Valsalva manoeuvre, sustained hand of people with MS, b) realistic goals; and c) the most promising
intervention strategies for the purpose of improving independence stroke. RELEVANCE: A more intricate understanding of how stroke
and participation in social activities. PARTICIPANTS: 166 people impacts muscle performance is needed in order to develop more
with MS. METHODS: Data were collected using measurements and effective strengthening interventions for this population. This study
structured interviews in the home environment of the people with newly identified impairments in eccentric and concentric muscle
MS. Cognitive function was assessed by the Symbol Digit Modalities strength and provides evidence-based recommendations to assist
Test; manual dexterity by the Nine-hole Peg Test; walking ability physiotherapists in designing exercise programs that are specific to
by need for aid/ support when walking10-metres; coping capacity these impairments. PARTICIPANTS: Eighteen subjects with stroke
by the Sense of Coherence scale; independency in ADL by the (6 women and 12 men) were each age and sex matched to one
Barthel Index and the Katz Extended ADL Index; and frequency of of 18 healthy control subjects (6 women and 12 men). On average,
social/lifestyle activities by the Frenchay Activities Index. ANALYSIS: subjects with stroke were 64.9 years of age and control subjects
In uni-variate analyses, differences in proportions were examined by were 63.3 years of age. All subjects were recruited voluntarily from
a chi-square test, and the significance of differences between sub- the community. Subjects with stroke were at least one year post
groups was assessed by the Wilcoxon-Mann-Whitney test or the infarct and able to walk ten metres with or without an assistive
Kruskal-Wallis test. Probability values of <0.001 were considered device. METHODS: An isokinetic dynamometer set at 30 degrees per
statistically significant. In the multi-variate analysis, associations second was used to measure peak maximum voluntary concentric
between potential predictors and outcome variables were assessed and eccentric joint torques of the paretic and nonparetic legs of
using chi-square test and a forward, stepwise logistic-regression subjects with stroke and the nondominant leg of control subjects.
analysis was needed to allow identification of the most important ANALYSIS: Relative eccentric and concentric torque (percentage of
predictive factors. RESULTS: Significantly more favourable results – control subject torque) across all six joint actions was compared using
with regard to ADL and normal frequency of social/lifestyle activities – separate multivariate analyses of variance (MANOVA) for the paretic
were found in the sub-groups: people with MS with normal cognitive and nonparetic legs of individuals with stroke. Significant differences
function; normal manual dexterity; ability to walk without walking were followed by post-hoc paired T-Tests and Wilcoxen Signed Ranks
aid and support; living in a private household; and working. Ability tests for each measured joint action. RESULTS: Relative eccentric
to walk without aid and support, and current employment, were torque was significantly higher than relative concentric torque for
associated with independency in ADL and normal frequency of the paretic (P = 0.032) and nonparetic legs (P = 0.012). Across
social/lifestyle activities. In addition, living together with a partner all joint actions, paretic leg eccentric and concentric torque was
was associated with independence in the Barthel Index; normal 74% and 58% of control torque respectively; five out of six joint
manual dexterity speed with independence in the Katz Extended actions were significant (P = 0.001–0.014). Across all joint actions,
ADL Index; and normal coping capacity with normal frequency of nonparetic leg eccentric and concentric torque was 101% and 87% of
social/lifestyle activities. CONCLUSIONS: The most important factor control torque respectively; four out of six joint actions were significant
associated with independency and normal frequency of daily and (P = 0.001–0.010). CONCLUSIONS: Individuals with chronic stroke
social activities was the ability to walk. There is a great need for demonstrate a relative preservation of eccentric strength in both
effective rehabilitation interventions focusing on cognitive function, the paretic and nonparetic leg muscles compared to concentric
manual dexterity, walking ability, ADL and social/lifestyle activities strength. To increase the generalization of these findings, similar
for people with MS in Stockholm. IMPLICATIONS: Knowledge of studies should be performed for the upper extremity and also during
the relative importance of different contributing factors to indepen- the acute stage of stroke recovery. IMPLICATIONS: Physiotherapists
dency in ADL and frequency of social/lifestyle activities, together should determine both the maximum concentric and eccentric torque
with evidence-based treatments, is essential in setting priorities capabilities to avoid underloading the muscle during the lengthening
and in clinical decision-making, when planning and organizing phase of resisted exercises. In addition, individuals with extreme
physiotherapy and other rehabilitation resources for people with hemiparesis may be able to perform isolated eccentric movements
MS in Stockholm. KEYWORDS: human activities, movement, prior to concentric movements, thus allowing physiotherapists to
multiple sclerosis. FUNDING ACKNOWLEDGEMENTS: The study stimulate muscle activity and strength gains early in the rehabilitation
was funded by grants from the Board of Research for Health process. However, further research is required to determine the
and Caring Sciences and the Health Care Sciences Postgraduate effects of eccentric training in individuals with stroke. KEYWORDS:
School, Karolinska Institutet, the Swedish Association of Persons Stroke; eccentric torque. FUNDING ACKNOWLEDGEMENTS: This
with Neurological Disabilities, the Swedish Research Council and the study was supported by an operating grant from the Canadian
Vardal Foundation. CONTACT: [email protected] Institutes of Health Research and the Michael Smith Foundation of
ETHICS COMMITTEE: Ethical approval for the study was obtained Health Research. CONTACT: [email protected]
from the Ethics Committee of Huddinge University Hospital, (Dnr: ETHICS COMMITTEE: University of British Columbia Ethics Board
164/97). and the Vancouver Coastal Health Approval

RELATIVE PRESERVATION OF ECCENTRIC STRENGTH IN THE CLINICAL ASSESSMENT METHOD OF LEFT UNILATERAL SPA-
PARETIC AND NONPARETIC LEG MUSCLES OF INDIVIDUALS TIAL NEGLECT USING A HEAD MOUNTED DISPLAY SYSYTEM
WITH CHRONIC STROKE Tanaka T1 , Sugihara S2 , Nara H3 , Ishikawa A4 , Ino S5 , Ifukube T5 ,
Lomaglio M1,2 , Eng J1,2 , MacIntyre D1,2 ; 1 Rehabilitation Research Shirogane S6 , Oyama Y7 , Maeda Y8 ; 1 Department of Design,
Laboratory, Vancouver, Canada; 2 GF Strong Rehab Centre, Sapporo City University; 2 Sapporo Shuyukai Hospital; 3 AdIn
Vancouver, Canada Research, Inc.; 4 Department of Physical Therapy, Sapporo
Medcial University; 5 Research Center for Advanced Science and
PURPOSE: It has been well documented that most individuals
Technology, The University of Tokyo; 6 Institute of Rehabilitation
with stroke have reduced isometric and concentric muscle strength.
Science, Tokuyukai Medical Corporation; 7 Tokeidai Memorial
However, reports examining eccentric muscle strength are scarce
Hospital; 8 Hokkaido Univesity
despite its important contribution to functional task performance.
The purpose of this study was to measure and compare eccentric PURPOSE: Unilateral spatial neglect (USN) is a common syndrome
and concentric muscle strength in the paretic and nonparetic ankle, in which a patient fails to report or respond to stimulation from the
knee, and hip flexors and extensors of individuals with chronic side of space opposite a brain lesion, and where these symptoms
are not due to primary sensory or motor deficits. The purpose of this extent does each factor contribute to improvement in ambulatory
study was to analyze an evaluation process system of USN in various capacity following exercise intervention requires further investigation.
visual fields using HMD in order to understand more accurately PARTICIPANTS: A convenience sample of 63 older adults (50
any faults of USN operating in the object-centred co-ordinates. years of age or older) with chronic stroke (stroke onset 1 year
RELEVANCE: Neglect is associated with a poor performance on or more) were recruited from the community. METHODS: This
measures of impairment, as well as on measures of disability in is a secondary analysis of a randomized controlled clinical trial.
ADL. USN is one of the major disruptive factors impeding functional Thirty-two and 31 individuals were allocated to the experimental
recovery and rehabilitation success. PARTICIPANTS: Ten stroke group and control group, respectively. The experimental group
patients (mean age 66.7 years old) participated in this study after underwent a comprehensive exercise program aimed to improve
gaining their informed consent and all subjects had Left USN as cardiopulmonary fitness, balance, muscle strength, and mobility.
diagnosed by a clinical test. Two medical doctors checked for the The control group underwent a seated upper extremity program.
degree of right hemisphere damage of all subjects by CT scan. Both groups of individuals had 3 sessions a week in a community
METHODS: Assessments of USN were performed by the BIT hall for 19 weeks. Ambulatory capacity was measured by Six
(Behavioral Inattention Test) common clinical test (the line bisection Minute Walk Test (6MWT). Cardiopulmonary fitness was indicated
test and the stars cancellation test) and two special tests; the zoom- by peak maximal oxygen consumption (peak VO2 ). Isometric knee
in condition (ZI) condition and the zoom-out condition (ZO) condition. extension muscle strength on both sides was measured by hand-held
The subjects were first evaluated by the common clinical test without dynamometry. Functional balance was measured by Berg balance
HMD and then two spatial tests with HMD. Moreover, we used a scale. All of the above outcomes were measured twice: before the
video-recoding for all tests to analyze each subject’s movements. commencement of the program, and again after the termination
ANALYSIS: An ANOVA or Student’s t test was used as a comparison of the program. ANALYSIS: Analysis of variance (ANOVA) with
between the common clinical test and the two special tests with HMD. repeated measures was used to determine whether there was
Multivariate ANOVA tests were performed in each group and Shėffe a treatment effect on each of the outcome variables (significant
post hoc tests were performed if significant differences were found group by time interaction). Percent change of each outcome variable
at the 5% significance level. RESULTS: For the line bisection test was computed. Pearson’s r correlation coefficient was used to
under the common condition, the mean percentage of the correct determine the degree of association between the percent change
answers at the left side in the test paper was 94.4%. In the ZI of 6MW distance and other outcomes. A significance level of
condition, the left side was 61.8% and the right side was 92.4%. 0.05 was set for all statistical tests. RESULTS: The experimental
In the ZO condition, the left side was 79.9% and the right side group had significantly more improvement than the control group
was 91.7%. There were significant differences among the three in ambulatory capacity, paretic knee extension muscle strength,
conditions. The results of the stars cancellation test also showed and cardiopulmonary fitness (p < 0.05). Balance in both groups
the same tendency as the line bisection test. CONCLUSIONS: The improved and there was no significant between-group difference
results showed that the assessment of USN using a technique of (p > 0.05). The percent change of 6MW distance is significantly
HMD system may indicate the disability of USN in greater detail than correlated with the percent change of peak VO2 , and paretic knee
the common clinical tests. Moreover, it might be hypothesized that extension muscle strength (p < 0.05), but not balance (p > 0.05).
the three dimensional measurement in the USN test may be a better CONCLUSIONS: Increase in ambulatory capacity is related to
indicator for various damages and the occurrence of USN than only improvement in cardiopulmonary fitness and leg muscle strength.
the two dimensional test. It might be hypothesized that the USN test The lack of relationship between improvement of ambulatory capacity
using HMD may display greater accuracy and be able to assess the and that of balance may be due to the relatively high level
occurrence and degree of USN in greater detail than the common of balance pre-intervention (i.e. ceiling effect). IMPLICATIONS:
clinical test. IMPLICATIONS: The assessment of USN using an HMD Treatment approaches to enhance cardiopulmonary fitness and leg
system may clarify the left neglect area which can not be easily muscle strength are important for improving ambulatory capacity.
observed in the clinical evaluation for USN. KEYWORDS: Unilateral KEYWORDS: stroke, ambulation, balance, muscle strength, car-
spatial neglect, head mounted display system, virtual reality, diopulmonary fitness. FUNDING ACKNOWLEDGEMENTS: Natural
clinical assessment. FUNDING ACKNOWLEDGEMENTS: This work Sciences and Engineering Research Council of Canada (Marco
was supported by the grant-in-aid for scientific research from Pang); Heart and Stroke Foundation of Canada (Janice Eng);
HOKKAIDO SMALL BUSINESS SUPPORT CENTER,JAPAN,2005- Canadian Institutes for Health Research (Maureen Ashe, Janice
2006. CONTACT: [email protected] Eng); The Michael Smith Foundation for Health Research (Janice
ETHICS COMMITTEE: sapporo city university Eng, Maureen Ashe); British Columbia Medical Services Foundation
(Maureen Ashe).
ETHICS COMMITTEE: University of British Columbia research
ethics committee; GF Strong Rehabilitation Centre research ethics
24-05 Monday 4 June 09:00 committee
AN EXERCISE PROGRAM FOR PEOPLE WITH CHRONIC
STROKE IMPROVES AMBULATORY CAPACITY: ASSOCIATION
WITH INCREASE IN CARDIOPULMONARY FITNESS AND 25-09 Monday 4 June 09:00
MUSCLE STRENGTH VCEC Exhibit Hall B & C
Pang M1−3 , Eng J2,3 ; 1 Hong Kong Polytechnic University, Hong PERFORMANCE OF PEOPLE WITH A STROKE IN A DUAL –
Kong; 2 University of British Columbia, Vancouver, Canada; 3 GF TASK ACTIVITY
Strong Rehabilitation Centre, Vancouver, Canada Silva de Andrade M1 , Teixeira P1 , Callil Voos M1 , Zanchetta
Castelli L1 , Ribeiro do Valle L2 ; 1 Department of Speech, Physical
PURPOSE: To determine the factors that are associated with im-
Therapy and Occupational Therapy, Faculdade de Medicina,
proved ambulatory capacity in individuals with chronic stroke follow-
Universidade de São Paulo; 2 Department of Biomedical Sciences,
ing a 19-week community-based exercise program. RELEVANCE:
Universidade de São Paulo
Ambulatory capacity is the most striking area of difficulty in
individuals with chronic stroke. Exercise intervention has been PURPOSE: This experiment aimed to investigate the existence of
shown to be effective in improving ambulatory capacity in this negative interaction between a visual and a motor task and to
population. However, ambulatory capacity has multiple determinants evaluate the difference between the performance of people with a
(e.g. balance, muscle strength, cardiopulmonary fitness). To what stroke and control subjects. RELEVANCE: The association of visual
and motor tasks has a high functional importance in daily life activities and recurrence of computer related musculoskeletal disorders.
such as crossing a street. Therefore, it is necessary to verify the DESCRIPTION: A literature search of Pubmed and OVID from
impact of CNS lesions in activities that demand interaction of visual 1990-2005 was conducted using the following inclusionary criteria:
and motor abilities. PARTICIPANTS: Eight volunteers with a stroke exercise protocols could be completed within 10 minutes, rest
(3 women, 5 men; 58.25±4.27 years) and twelve controls (6 women, break parameters were defined, and exercise and rest breaks were
6 men; 55.33±2.05 years), MMSE23. METHODS: The test was analyzed separate from other interventions. Additional articles were
run in a room with reduced illumination, using a computer with the obtained by reviewing references of eligible articles obtained from
applicative MEL2. It consisted on (1) a training session (2) a visual Pubmed and OVID. Eligible articles were appraised by the primary
task; (3) a motor task; (4) both tasks associated. The visual test author. The second author reviewed the appraisals performed by the
measured the accuracy of recognition of two visual targets of 150ms first author. Discrepancies were discussed to achieve consensus.
(bus and/or truck) and were presented simultaneously: one appearing Articles were appraised using the method developed by the American
at the fixation cross and one appearing in one of eight periphery Academy of Cerebral Palsy and Developmental Medicine. A grade of
positions. The volunteers would have to classify if the targets were evidence, as outlined by the Centre for Evidence Based Medicine,
equal or different (32 trials). The answer was typed on adapted was assigned to each intervention based on the aggregate strength
joystick, by the examiner. The number of committed errors and the of all articles for their respective intervention. The grades were
duration of the visual test were registered. The motor task consisted compared to existing clinical guidelines. EVALUATION: Fifteen
on alternating steps from the ground to a 10cm platform, as fast as articles met the inclusionary criteria. These include 3 articles
possible, with the same duration of the visual test. The alternations on exercise, 7 on rest breaks, and 5 articles examining both
were videotaped and counted. ANALYSIS: The number of steps per interventions. Based on the research evidence, both exercise and
second in the absence and the presence of the visual task and the rest breaks were assigned a grade of C. Comparisons between
number of errors in the visual task in the presence or absence of the results of this study and clinical guidelines suggested by the
motor task were analyzed by two ANOVAs (a ≡ 0.05). RESULTS: Occupational Safety and Health Administration and the Official
The speedy of people with a stroke was lower when compared to the Disability Guidelines Treatment in Worker’s Compensation revealed
controls [F1,18 ≡ 24.904; p 0.001]. For both groups, the number of similar recommendations. CONCLUSIONS: Evidence exists support-
steps decreased when associated to the visual task [F1,18 ≡ 6.010; ing exercise and rest breaks as effective interventions to decrease
p ≡ 0.036]. There was no difference in the number of errors in the discomfort in computer tasks. The current evidence suggests no
visual task between people with a stroke and controls [F1,18 ≡ 0.614; additional benefits of exercise over rest breaks alone in reducing
p ≡ 0.443], the performance did not change when the visual was musculoskeletal discomfort during computer tasks. IMPLICATIONS:
associated to the motor task [F2,36 ≡ 0.435; p ≡ 0.651]. The visual Physical therapists need to evaluate the research evidence on
task had 50% of correct answers and was probably considered the efficacy of treatment interventions. Additional well-designed
difficult for both groups. CONCLUSIONS: The speedy of people with randomized controlled trials are needed to strengthen the evidence
a stroke was lower when compared to the controls. For both groups, of exercise and rest breaks as effective interventions in preventing
attention seems to be necessary for performing the motor task. On the development and recurrence of computer related musculoskeletal
the other hand, apparently, performing a motor task does not interfere disorders. Research is needed to determine optimal work-rest
with attention in a visual task for both groups, probably because the schedules and exercise protocols for computer operators. Further
visual task was too difficult. Future experiments will intend to increase studies are needed on subjects who have current computer related
the difference between the shapes of the stimuli in order to make the musculoskeletal disorders and subjects who have a history of com-
visual task easier and verify the impact of the association of motor puter related musculoskeletal disorders. KEYWORDS: Computers,
task to it. IMPLICATIONS: It is important to include speed training to visual display terminal, musculoskeletal discomfort, exercise, rest
improve the control of lower limbs in people with chronic stroke during breaks. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
the physical therapy sessions. The individuals with better speed [email protected]
should also practice dual – task activities (such as visual and motor ETHICS COMMITTEE: Institutional Review Board, Arkansas State
tasks associated). KEYWORDS: perceptual motor performance, University
dual-task, stroke. FUNDING ACKNOWLEDGEMENTS: this work
was unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: This study was approved by the Institute of
Biomedical Sciences Ethics Committee – Universidade de São Paulo 25-17 Monday 4 June 09:00
(Brazil). VCEC Exhibit Hall B & C
TIME DIMENSIONS IN SERVICE WORK AND BODILY
CONSEQUENCES
25-13 Monday 4 June 09:00 Moe S; University of Tromsoe
VCEC Exhibit Hall B & C PURPOSE: Large portions of work life are contigent on availability
THE EFFECTS OF EXERCISE AND REST BREAKS ON and service. In the service professions, information communication
MUSCULOSKELETAL DISCOMFORT DURING COMPUTER technology (ICT) is used as a tool for work. On the one hand, ICT
TASKS: AN EVIDENCE BASED PERSPECTIVE often results in better effiency; on the other hand, availability is in-
creased and results in time pressures for the worker. The purpose of
Barredo R1 , Mahon K2 ; 1 Tennessee State University, College or
this presentation is to investigate the time elements that characterize
Health Sciences; 2 Arkansas State University, Graduate Program
this type of work and the workser‘s movements. RELEVANCE: In
in Physical Therapy
occupational work, knowledge is needed about time dimensions in
PURPOSE: The purpose of this study is to appraise the strength of the various work tasks as well as how these are significant in the
research evidence on exercise and rest breaks on musculoskeletal coping with time pressures and the development of strain injuries.
discomfort during computer tasks and to compare the research PARTICIPANTS: Three female claims representatives, each with
evidence with current clinical guidelines. RELEVANCE: Physical lengthy experience in the field of work procedures and software were
therapists frequently treat patients who have developed computer included. METHODS: Over a period of three months,I performed
related musculoskeletal disorders. Many exercise and work-rest field work in an insurance company. The participants were observed
protocols have been suggested for computer operators. Physical during the performance of routine work and were filmed periodically.
therapists need to educate patients, employers, and the public about Through conversations during the course of the investigation,
effective exercises and work-rest schedules to prevent development information emerged concerning the participant‘s perception of work
tasks, routines and priorities. ANALYSIS: The overall perspective motor performance of the elderly was slower when compared to the
for analysis is body phenomenology, supplemented with terms from young [F1,24 ≡ 69.072; p 0.001]. The motor performance decreased
Bourdieu‘s theory of practice and Hall‘s dimensions of time. This when the motor task was associated to the visual task in both groups.
point of departure is helpful in analyzing dimensions of time in work [F1,24 =37.074; p 0.001]. The elderly committed more errors in the
tasks and in elucidating how time pressure occurs. Film recordings visual task than the young volunteers [F1,24 ≡ 5.057; p ≡ 0.034]. The
provide the basis for microanalyses of work situations, along with association of the motor task did not increase the number of errors
information obtained through conversations with the participants. in the visual task [F1,24 ≡ 0.283; p ≡ 0.600]. CONCLUSIONS: The
RESULTS: At the computer, one‘s attention is continually focused ageing process seems to disturb the performance of dual-tasks. The
on the work at hand. The participants sit in a stand-by position; time elderly were slower in the motor task and committed more errors
must be filled. The claims representatives are required to be available in the visual task when compared to the young volunteers. The
to clients, and communications from outside split up time. Client elderly people maintained performance of 50% in the visual task with
contact entails a double role; it is important, while at the same time it and without the motor concurrent task. In future works we intend to
takes time away from claims casework. CONCLUSIONS: In relational increase the differences between the stimuli to make this task easier.
situations, time cannot be managed, whereas the overriding goal of IMPLICATIONS: Besides practicing motor and visual tasks isolated,
effiency requires the worker to make the best use of time. When the elderly should also practice these tasks associated. The capacity
relational development and productivity are combined, the tasks‘ of association of motor and visual abilities should be assessed in
dimensions of time become incompatible, and compound pressure order to detect deficits in daily life activities, such as crossing a
is experienced. IMPLICATIONS: The fragmentation of work routines street. KEYWORDS: vision, perceptual motor performance, dual-
along with time pressure is a strain over time and can result in task, ageing. FUNDING ACKNOWLEDGEMENTS: this work was
stress reactions. It is important to analyze the tasks‘ dimensions unfunded. CONTACT: [email protected]
of time and to organize work so that unfavourable dimensions ETHICS COMMITTEE: This study was approved by the Institute of
of time are not combined. This is a particular challenge when Biomedical Sciences Ethics Committee – Universidade de São Paulo
working with ICT, as the time-space relationship is neutralized. (Brazil)
KEYWORDS: time, information communication technology, strain.
FUNDING ACKNOWLEDGEMENTS: The study was financed by
The Norwegian Fund for Post-Graduate Training in Physiotherapy.
CONTACT: [email protected] 27-01 Monday 4 June 09:00
ETHICS COMMITTEE: The Regional Committee for Medical VCEC Exhibit Hall B & C
Research Etics, Health Care Region 5, Norway CHARACTERISTICS OF FORWARD LUNGE EXERCISE IN
ELDERLY PERSONS
Research Report Poster Display Koyanagi M1 , Takeoka K2 , Mukai K2 , Higuchi Y3 ,
26-21 Monday 4 June 09:00 Tanaka N1 ; 1 Faculty of Biomedical Engineering,Osaka
VCEC Exhibit Hall B & C Electro-Communication University,Osaka,Japan; 2 Faculty of
Physical Therapy,Shijonawate-gakuen University,Osaka,Japan;
ELDERLY PRESENT IMPAIRED PERFORMANCE WHEN 3 Faculty of Rehabilitation,Osaka prefectural University,Osaka,Japan
EXECUTING A DUAL-TASK ACTIVITY
PURPOSE: Previous researches have revealed that maximum step
Teixeira P1 , Callil Voos M1 , Zanchetta Castelli L1 , Silva de
length of forward lunge (FL) motion in elderly persons was a
Andrade M1 , Ribeiro do Valle L2 , Pimentel Piemonte M1 ;
1 Department of Speech, Physical Therapy and Occupational useful index for physical function and prevention of fall. There were,
however, few scientific reports focusing motion analysis of FL in
Therapy, Faculdade de Medicina, Universidade de São Paulo;
2 Department of Biomedical Sciences – Universidade de São Paulo elderly persons, the changes of motion with aging was still unknown.
The purpose of this study was to clarify the characteristics of
PURPOSE: the aim of this study was to verify the interference forward lunge in elderly persons by motion analysis. RELEVANCE:
between a visual task and a motor task and the differences between Knowledge of the characteristics of FL motion in elderly persons is
the performance of young and elderly people. RELEVANCE: the useful for developing the movement therapy that improves motor
association of visual and motor tasks is common in daily life activities, function, prevents fall. PARTICIPANTS: Twelve elderly persons
such as crossing a street. The risk of accidents is higher in elderly (age 73.4 plusminus 4.9years) and ten young persons(age 20.7
people, consequently it is necessary to identify their deficits in dual- plusminus 1.9years)as control group were participated in this
task activities. PARTICIPANTS: thirteen healthy elderly volunteers study.The subjects gave their informed consent to take part in the
(71.08±2.34 years of age) matched with thirteen young volunteers experiment. METHODS: Twelve elderly persons (age 73.4 plusminus
(25.54±1.26 years of age). MMSE23. METHODS: the test was 4.9years) and ten young persons(age 20.7 plusminus 1.9years)as
run in a room with reduced ilumination, using a computer with control group were instructed to perform the FL with maximum
aplicative MEL2. It consisted on (1) a divided attetion visual task; step length. Center of gravity (COG), joint motion and moment
(2) a motor task of alternating steps as fast as possible; (3) of the lower extremity were analyzed using a motion analysis
both tasks associated. The visual task measured tje accuracy system (VICON512) and force plate (AMTIOR6). ANALYSIS: The
of recognition of two visual targets (bus and/or truck) of 150ms, comparison between two groups was performed by the Mann-
presented simultaneously: one appearing at the fixation cross and Whitney test. The level of statistical significance was set at p-value
one appearing in one of eight periphery positions. The volunteers less than 0.05. RESULTS: Maximum step length and changes of
had to classify if the targets were equal or different. The answer was COG (upwards-downwards, anterior-posterior) decreased in elderly
typed on an adapted joystick, by the examiner. This test had one block group compared with control group. Flexion angle and extension
of 32 trials. The number of errors and the duration of the visual test moment of the hip joint decreased on the stepping leg in elderly
were registered. The motor task consisted on alternating steps from group. Flexion angle of the knee also decreased, but there was
the ground to a 10cm plataform, with the same duration of the visual no statistical difference in extension moment of the knee joint.
test. The experiment was videotaped and the number of alternations Extension angle and moments of the hip, extension moments of
was counted. All subjects were familiarized with the experiment task the knee were decreased on the support leg in elderly group.
before making it. ANALYSIS: The number of steps per second in Dorsiflexion moments of the ankle joint also decreased on both legs
the absence and the presence of the visual task and the number with backward phase. The decrease rate of motion and moment
of errors in the visual task in the absence and the presence of the on hip joint was largest on both legs in comparison to the control
motor task were analysed by two ANOVAs (a ≡ 0.05). RESULTS: The group. CONCLUSIONS: Maximum step length and changes of COG
with FL decreased in elderly group. These changes were mainly Research Report Poster Display
reflected in reduction of motion and moment on the both hip joints. 28-03 Monday 4 June 15:30
IMPLICATIONS: These results suggest that motion and moment of VCEC Exhibit Hall B & C
the both hip joints with FL were specifically decreased in elderly THE EFFECTS OF AN INTERVENTION ON EXERCISE
persons. Movement therapy for stability and mobility of hip joint may ADHERENCE IN OLDER ADULTS DISCHARGED FROM
be useful for improvement of locomotive function, prevention of fall in GERIATRIC DAY HOSPITALS: A PILOT STUDY
elderly persons. KEYWORDS: forward lunge, elderly persons, motion
Ryan-Arbez N1 , Cooper J2 , Harvey D3 , Weinberg L1 ; 1 Department
analysis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
of Physiotherapy, School of Medical Rehabilitation, University of
[email protected]
Manitoba; 2 Department of Occupational Therapy, School of Medical
Rehabilitation, University of Manitoba; 3 Faculty of Education
Research Report Poster Display (Retired), University of Manitoba
PURPOSE: To evaluate the effectiveness of two interventions (home
visits and telephone calls) on self-efficacy of exercise, exercise
RISK FACTORS FOR CERTIFICATION OF LONG-TERM CARE adherence, and mobility of community dwelling older adults following
NEED AND HEALTH DECLINE AMONG ELDERS discharge from Geriatric Day Hospitals (GDH). RELEVANCE: Older
Kage H1,2 , Okuda M2 , Nakamura I1,2 , Kunitsugu I2 , Sugiyama S2 , adult mobility is challenged by the ageing process, chronic diseases
Hobara T2 ; 1 Yamaguchi Health and Welfare College; 2 Department and sedentary lifestyle. Physiotherapist prescribe exercise programs
of Public Health, Yamaguchi University School of Medicine to older adults to improve mobility however adherence to exercise
rates (AER) after discontinuance of physiotherapy treatment is
PURPOSE: To investigate the predictive value of physical perfor- unknown. PARTICIPANTS: Participants who were cognitively intact,
mance measures for long-term care eligibility and functional decline could read and speak English, had been prescribed an exercise
among Japanese elders living at home. RELEVANCE: Physical program for home and were discharged from GDH’s. METHODS:
therapists are frequently involved in assessment of and intervention A mixed method designed was used. Eighteen participants were
with elders at risk for functional decline. Early assessment and randomly assigned to a control, telephone intervention or home
intervention may postpone admission into long-term care services
visit intervention group. All participants were assessed for mobility
as well as functional decline. PARTICIPANTS: 63 community-
(Timed-Up and Go) [TUG], Berg Balance Scale [BBS] and confidence
dwelling subjects aged over 65 years were located through a
to exercise (Self-efficacy for Exercise [SEE] one week after GDH
community-based fall risk reduction program, and volunteered to
discharge. At 4 and 7 weeks after discharge, the interventions
participate in the study. METHODS: Grip strength, 10m gait speed
participants received telephone calls or home visits whereby coun-
at maximum speed, one-leg standing time with eyes open and
selling strategies to improve self-efficacy of exercise were performed.
functional reach were measured before and after a 2-month fall risk
At 10 weeks, all participants were reassessed (TUG, BBS, and
reduction program. One year later, the subjects’ functional status
SEE) and AER were calculated; a qualitative interview was per-
and need certification for long-term care were investigated. (Long-
formed to capture participants perceptions about barriers/facilitators
term care service eligibility is certified on a uniform basis in all
to exercise and outcome expectations for exercise. ANALYSIS:
parts of Japan.) ANALYSIS: Subjects were divided into groups: long-
ANOVA was used to compare group TUG pretest/posttest score
term care eligible group and the long-term care ineligible group/
differences; Kruskal Wallis tests were used to compare group BBS
functional-declining group and functional-maintaining group. (1)One-
leg standing time at baseline was compared between the long- pretest/posttest score differences, group SEE pretest/posttest score
term care eligible group and the long-term care ineligible group differences, and group AER. Spearman’s rank correlation coefficients
using the Mann-Whitney U test. Other values at baseline were procedures tested the relationship between SEE pretest/posttest
compared between the two groups using Student’s t-test. The same score differences and AER, and the relationship between AER
methods were used to compare the functional-declining group and and BBS pretest/posttest score differences. The Pearson product-
the functional-maintaining group. (2)Logistic regression analysis was moment correlation coefficient was used to test the relationship
used to identify the risk factors for long-term care need or functional between AER and TUG pretest/posttest score differences. The
decline. (3)Changes before and after the fall prevention program were criterion for significance was p 0.05. Qualitative analysis used a
analyzed in the same way. RESULTS: (1) Comparison between the constant comparison of emerging themes. RESULTS: Although the
long-term care eligible group and the long-term care ineligible group mean AER = 87.9±57.7%, only 59% of participant were exercising
at baseline showed significant differences in age (P = 0.001), 10m at or above their prescribed rate. No significant difference was
gait time (P < 0.001), one-leg standing time (P = 0.001) and functional found between groups for pretest/posttest score differences of
reach (P = 0.006). In comparing the functional-declining group and SEE, TUG, and BBS or for group AER scores. No significant
functional-maintaining group, there were significant differences in relationships were found between SEE and AER, AER and TUG
10m gait time (P < 0.001), one-leg standing time (P = 0.017) and or AER and BBS. Participants reported that poor health, poor pain
functional reach (P = 0.015). (2) In logistic regression analysis, odds control, poor self-discipline or motivation were barriers to exercise
ratio of occurrence of long- term care eligibility was significantly high adherence. The researcher identified participants’ lack of intention
against 10m gait time when adjusted by sex and age(OR:1.64). Odds to exercise and poor knowledge about exercise also contributed
ratio of functional decline was significantly high against 10m gait time to non-adherence. Furthermore, the researcher found that 45% of
when adjusted by sex and age (OR:2.08), or adjusted by sex, age and intervention participants experienced exercise technique problems.
other performance measures (OR:2.13). (3) The impacts of changes CONCLUSIONS: The quantitative results were inconclusive due to
in performance before and after the intervention on long- term care the low power of the study; however qualitative evidence strongly
eligibility or health decline were not significant. CONCLUSIONS: suggested that the older adults exercise behavior is compromised
10m gait time is an effective predictor for long-term care need after discontinuance of physiotherapy treatment. IMPLICATIONS:
certification and for functional decline. The study did not support the Adherence to exercise and exercise and personal beliefs are mean-
use of changes in performance before and after a fall prevention ingful components of standard clinical physiotherapy assessment and
program as a predictor. IMPLICATIONS: Physical therapists should intervention. The barriers to exercise may be addresssed through
remark gait speed as a predictor for functional decline of elders. long-term provision of physiotherapy for older adults living in the
KEYWORDS: Elders, Predictor, Long-term care need. FUNDING community. KEYWORDS: Older adults, exercise adherence, exercise
ACKNOWLEDGEMENTS: This study was unfunded. counselling. FUNDING ACKNOWLEDGEMENTS: Riverview Health
ETHICS COMMITTEE: Kourei Fukushi department in Ube City Centre, Winnipeg, Manitoba; and Department of Physical Therapy,
School of Medical Rehabilitation, University of Manitoba. CONTACT: 88) and 52% reported a diagnosis of hip OA by their family physician
[email protected] or other health professional, the majority with confirmed radiology
ETHICS COMMITTEE: Health Research Ethics Board, Bannatyne diagnosis. METHODS: Participants were screened by a physiothera-
Campus, University of Manitoba; pist using a standard clinical classification testing protocol for hip OA.
A standardized interview for fall history was performed and subjects
were screened for fall risk using the Timed Up and Go Test (TUG).
Research Report Poster Display ANALYSIS: Quantitative descriptive analyses were performed.
28-13 Monday 4 June 09:00 RESULTS: Forty-five percent of subjects reported one or more falls
VCEC Exhibit Hall B & C in the past year defined as any body part coming into contact with the
FALLS AMONG GREEK ELDERLY POPULATION ADMITTING ground or other lower surface. Ten percent reported two or more falls
AT EMERGENCY DEPARTMENTS (EDS). A SIX-YEAR in the past year. In total, 42 falls were described by 36 participants.
EPIDEMIOLOGICAL STUDY Approximately half of falls occurred in the home with the other half
Strimpakos N, Gogou V, Apostolopoulos S, Spatharakis G, occurring just outside the home or outdoors in the community. The
Meliggas K, Kapreli E, Sakellari V, Gioftsos G; Department Of majority of falls were due to tripping on steps, curbs, obstacles (36%),
Physiotherapy, Tei Lamias, Lamia, Greece or slipping on ice, stairs, loose mats, wet floors (33%). Other reported
known causes included: getting up from a chair or bed,turning quickly,
PURPOSE: To evaluate the incidence of falls and their consequences leg giving away, reaching. Six of the 42 reported falls resulted in
in a Greek elderly representative sample leaving in Central Greek a fracture (14%). Twenty-six percent of subjects reported injuries
region. RELEVANCE: Epidemiologic studies for the incidence of other than fractures. Seventy percent reported near falls occurring
falls in elderly are necessary to further elucidate risk factors for frequently (once a week or more, 30%) or occasionally (less than
falling and to direct preventive strategies. PARTICIPANTS: The once per week but more than once or twice in past year, 40%). Near
records of 204363 patients over 65, admitting the EDs of a local falls were defined as losing balance, slipping or tripping but able
hospital and two health centers in central Greece from January to catch or stop fall before any body part touched the ground. The
2000 to December 2005 were reviewed retrospectively. METHODS: mean score for the TUG test was 13 seconds (range 6.2 sec. to
Information about sociodemographic characteristics, health-related 37.5 sec.). Twenty-five percent of the sample scored 14 seconds or
behaviors, health status, falls and their consequences was collected greater, indicating a higher risk for future falls. Seventy percent scored
based on a structured data extraction form. ANALYSIS: Data was greater than 10 sec. Most healthy community living older adults would
analysed qualitatively as well as quantitatively by using percentages score less than 10 sec. CONCLUSIONS: A sample of older adults
and ratios RESULTS: 1.4% of patients presented at the EDs due to with hip OA reported falls and near falls in the past year. Injuries were
a fall incidence, 23.3% being required hospitalization. The average incurred with these falls including fractures. Tripping accounted for the
patient age was 75.2 (range= 65-102 years); male/female ratio 1:1.7. majority of falls which may be due to leg weakness, loss of motion or
Season was not a discriminative factor of falls. Falls’ aetiology proprioception. IMPLICATIONS: Identifying reasons for falling and fall
was known only in 14.6% cases due to underrecordable data, risk factors in this population are important in order to prevent serious
making any estimation invalid. Based on incidence reports, 736 injury and develop effective physical therapy intervention strategies.
(25.8%) of those falls resulted in fracture. Hip fractures comprised KEYWORDS: accidental falls, hip osteoarthritis, older adult, fall risk.
about 60% of total, while other most common areas were pelvis FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of Health
(13%) and shoulder (10.7%). CONCLUSIONS: Falls in Greek elderly Research; College of Medicine, University of Saskatchewan.
community, in similar with other countries, are a great problem ETHICS COMMITTEE: University of Saskatchewan
resulting some times in serious injuries and functional disability.
Underreporting data in Greek EDs, mainly regarding the causes of
falls, precludes many useful conclusions and prevention strategies,
an issue that has immediately to be resolved. IMPLICATIONS: Fall- 29-21 Monday 4 June 09:00
prevention programs should be directed towards Greek elderly people VCEC Exhibit Hall B & C
and especially women. KEYWORDS: Falls, Elderly, epidemiology. FLUTTER® CAN REDUCE OBSTRUCTION IN CHILDREN WITH
FUNDING ACKNOWLEDGEMENTS: This research as part of the PNEUMONIA
research project «Archimedes II» has been funded by grants from
Lanza F1,2 , Gazzotti M1,2 , Luque A1,2 , de Paula C2 , Souto L2 ,
the EC and the Ministry of National Education and Religious Affairs.
Santos L2 ; 1 Federal University os Sao Paulo/UNIFESP,Sao
Paulo-Brazil; 2 Sao Camilo University Sao Paulo-Brazil
ETHICS COMMITTEE: Ethics Committe, Department of Physiother-
apy, TEI Lamias PURPOSE: To evaluate flutter® and forced expiratory technique
(FET)as desobstruction techniques in children with both clinical
and radiological pneumonia diagnosis RELEVANCE: Flutter® is one
Research Report Poster Display of many methods of chest therapy which can improve secretion
28-17 Monday 4 June 09:00 mobilization, even for children because of its easy, and pleasure
VCEC Exhibit Hall B & C caused on them. A technique to remove the secretion, after the
FALLS AND FALL RISK IN OLDER ADULTS WITH HIP application of desobstruction technique, it is interesting, and forced
OSTEOARTHRITIS expiratory technique (FET) is one of them. Pneumonia is the
most important respiratory infection in childhood and this disease
Arnold C, Faulkner R; University of Saskatchewan, Saskatoon,
results in the increase of mucus transport and the production of
Saskatchewan
pulmonary secretion; this situation can increase airway obstruction
PURPOSE: To determine fall risk, fall history, and circumstances and respiratory distress, it means that chest therapy may be useful.
of falls in older adults with hip osteoarthritis (OA). RELEVANCE: The airway obstruction may be measured by mini-wright peak flow,
It is recognized that pain, loss of range of motion and reduced which measure peak expiratory flow (PEF). PARTICIPANTS: 18
strength,associated with hip osteoarthritis, may increase fall risk. children and teenagers between the ages of 6 and 15 years old,this
PARTICIPANTS: Men and women recruited for a larger intervention study was conducted inside a public hospital. METHODS: This was a
study, over age 65 years, with hip pain present for 6 months or longer randomized case control study. There were 2 groups: the first group
and living independently in the community with no significant medical was submitted to realize flutter for five minutes and FET (at the end of
or neurological conditions were eligible for this study. Of the 80 study flutter technique) until better pulmonary auscultation was noticed, at
participants, 70% were female, mean age was 74 years (range 65 to least 3 times; the control group which only coughed until a enhanced
pulmonary auscultation was noticed, also for at least 3 times. Res- race/ethnicity, or parental level of education. The HINT total scores
piratory rate (RR), PEF and pulmonary auscultation were performed between infants from USA and Canada showed no statistically
twice, before and after each protocol. ANALYSIS: Statistical analysis significant difference. There also were no significant differences
was performed by ordinary ANOVA to compare between the groups, between age, genders and total HINT scores of the infants of color
and repeated analysis to compare in the group, statistica significance: and those who were white. CONCLUSIONS: The hypotheses of no
p < 0.05. RESULTS: There were not any differences between the difference between USA and Canadian infants and USA infants of
characteristics of patients (age, PEF, RR) at the beginning of the various races and ethnicities were confirmed. A follow up study with a
study. There was an increase of PEF in the treated group after flutter larger subject pool would strengthen these results. Additionally, HINT
and FET utilization (186+25 lpmin before treat and 245+38 lpmin af- data for infants of color should be evaluated through comparison
ter, p < 0.05). There were not any changes in the control group before of infants of individual racial or ethnic backgrounds to infants
and after treatment (167, 5+55 lpm, and 193, 7+44 lpm; p > 0.05). who are white to determine the need for specific racial or ethnic
There were not any changes in RR, but the pulmonary auscultation group norms. IMPLICATIONS: Based on the results, there is some
was quality better only in treated group. CONCLUSIONS: Among justification that norms developed from previously collected data on
these patients diagnosed with pneumonia which were submitted to infants from Canada could be appropriately applied in the USA.
flutter and FET, we observed a increase in PEF demonstrating that Larger numbers of subjects should be evaluated to confirm this
chest physiotherapy may improve air flow in the lung when obstruction result. KEYWORDS: infant screening, neuromotor development,
by hyper secretion occurs. IMPLICATIONS: Tis is an easy technique ethnic comparison. FUNDING ACKNOWLEDGEMENTS: University
that the patient can used by yourself and can improve PEF and make of Puget Sound, Tacoma, WA, USA, Enrichment Committee Student
it in a hospital or in ambulatory sistem. KEYWORDS: chest physio- research Awards #SR0543. CONTACT: [email protected]
therapy, Flutter® , pneumonia. FUNDING ACKNOWLEDGEMENTS: ETHICS COMMITTEE: University of Puget Sound Internal Review
None. CONTACT: Fernanda Lanza e-mail: [email protected] Board Committee, Tacoma, WA, USA
ETHICS COMMITTEE: Ethics committee of General Hospital of
Pedreira, Sao Paulo-Brazil
30-01 Monday 4 June 09:00 EFFECT OF MASSED PRACTICE TRAINING ON ANTICIPATORY
VCEC Exhibit Hall B & C POSTURAL ADJUSTMENTS IN CHILDREN WITH CEREBRAL
VALIDITY OF THE HARRIS INFANT NEUROMOTOR TEST FOR PALSY
INFANTS FROM THE UNITED STATES OF AMERICA AND Chang H1 , Liu W1,2 , Lien H1 , Wong A1,2 , Jeng S3 , Hung W4 ;
INFANTS OF DIFFERENT RACES/ETHNICITIES 1 Graduate Institute of Rehabilitation Science, Chang Gung
McCoy S1 , Smith-Blockley J1 , McConkey Bowman A1 , Sanders K1 , University, Kweishan, Taoyuan, Taiwan; 2 Department of Physical
Megens A2 , Harris S3 ; 1 University of Puget Sound, Tacoma, WA, Medicine and Rehabilitation, Chang Gung Memorial Hospital,
USA; 2 Ottawa Children’s Treatment Centre, Ottawa, ON, Canada; Taoyuan Branch, Kweishan, Taoyuan, Taiwan; 3 School and
3 University of British Columbia, Vancouver, BC, Canada Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University, Taiwan; 4 School of Sports Medicine,
PURPOSE: The first purpose was to collect data on the newly
China Medical University, Taiwan
developed Harris Infant Neuromotor Test (HINT) in the United States
of America (USA), and compare it to data previously collected PURPOSE: Children with cerebral palsy (CP) typically develop
in Canada. Secondly, HINT scores from infants of ethnicities inefficient, unsafe and laborious anticipatory postural adjustments
(Hispanic/Latino or not), and races (African American, Asian, Pacific (APA). This study examined APA changes in CP children after
Islander, and of more than one race) were compared to white infants. massed practice reaching a moving target while standing, and
We hypothesized that there would be no difference in HINT scores explored the effect after massed practices with an external postural
between infants from USA or Canada, or across infants of different support. RELEVANCE: This study is related to physical therapy
color. RELEVANCE: The HINT is a screening tool developed to as- management for balance training in CP children. PARTICIPANTS:
sess infant neuromotor development. Although HINT data have been Twelve children aged 3–12 years with spastic CP participated in this
collected in Canada, this is the first study examining data on USA in- study. They were divided into a massed practice only (MA group)
fants and infants of different color. If Canadian norms are appropriate and a massed practice with external postural support group (EX+MA
for infants from USA and infants of color, then we could support the group) according to their functional standing abilities. METHODS: A
use of the test within the USA. PARTICIPANTS: Forty-three healthy pretest-posttest repeated measure study design was used. Children
infants, age 0 to 12 months were recruited for testing from the USA in both groups practiced a functional forward reach task with moving
via convenience and snowball sampling. Infants were from the states target for 60 trials on 3 consecutive days. Assessments took place on
of Washington, Idaho, and Hawaii. Thirty-two infants in the USA four occasions: 3 days prior to practice (1st baseline test), one day
group were compared to 32 age, parental race/ethnicity, and parental prior to practice (2nd baseline test), one day after practice (immediate
education matched infants from Canada. The Canadian data were test), and 3 days after practice (short-term retention test). The APAs
provided by the HINT author. Twenty-eight infants from USA (14 per were recorded by center of pressure (COP) and electromyography
group) were age and gender matched for the comparison of white (EMG) measurements as they reached forward for a stationary target
infants with those of color. METHODS: HINT testing took place either while standing. ANALYSIS: One-factor repeated measure analysis
in the infants’ homes or in healthcare facilities. Data were collected by of variance (ANOVA) and Friedman test were applied to identify
DPT students from the University of Puget Sound, Tacoma, WA. Inter- the changes to APA and speed in reaching the target. Two-factor
rater reliability [ICC(3,1) = 0.715–0.984] was established for all raters repeated measure ANOVA was used to compare changes between
during pilot testing through comparison to a physical therapist trained the MA group and the EX+MA group. RESULTS: Despite the small
and verified as reliable by the HINT author. ANALYSIS: HINT data sample size, children demonstrated more consistent basic spatial
were verified to be normally distributed across groups. Differences parameter, i.e., posterior shift during the APA period following massed
between HINT scores in the USA and Canadian groups and between practice. Moreover, absolute time delay between COPy excursion and
the groups of infants of color and white infants were analyzed via reach movement, representing the relationship between focal move-
independent samples t-tests and Chi-Square tests of independence, ment and postural movement was significantly reduced]. The EX+MA
using an a < 0.05. RESULTS: There were no significant differences group had a significantly increased frequency of posterior APA COPy
between the USA and Canadian groups for subject age, parental excursion, whereas the MA group did not. CONCLUSIONS: The
results demonstrated that the APA development can be facilitated provides knowledge about motor performance in typical children,
by massed practice training in children with spastic CP. No adverse informing our ability to more adequately assess children with impair-
effects during training were noted for either group. IMPLICATIONS: ments, and to optimally direct intervention programs. KEYWORDS:
This massed practice training was clinically feasible and effective children; movement quality;development with age. FUNDING
for children with spastic CP who had Gross Motor Functional ACKNOWLEDGEMENTS: The Financial Markets Foundation for
Classification System (GMFCS) levels I–III. KEYWORDS: massed Children funded this project. CONTACT: [email protected]
practice, anticipatory postural adjustment, cerebral palsy. FUNDING ETHICS COMMITTEE: Medical Research Ethics Committee, The
ACKNOWLEDGEMENTS: The authors would like to thank the University of Queensland
National Science Council of the Republic of China, Taiwan, for
financially supporting this research under Contract No. NSC 93-2314-
B-182A-065. CONTACT: [email protected]
ETHICS COMMITTEE: Institutional Review Board Chang Gung 31-13 Monday 4 June 09:00
Memorial Hospital, Taiwan VCEC Exhibit Hall B & C
THE EFFECTS OF THE MOTHER TALKING ON THE GENERAL
MOVEMENTS OF NEWBORN INFANTS
Nakano H1 , Kihara H2 , Nakano J3 , Shimura Y4 , Konishi Y1 ; 1 Dept.
of Infants’ Brain & Cognitive Development, Tokyo Women’s Medical
University; 2 Dept. of Rehabilitation, Nagano Children’s Hospital;
CHANGES IN QUALITY OF GROSS MOTOR PERFORMANCE 3 The Institute of Statistical Mathematics; 4 Faculty of Education,
FROM 6-12 YEARS OF AGE Saitama University
Watter P, Burns Y, Martin K, Cahill M, Doherty D, Brameld C;
The University of Queensland, Australia PURPOSE: General movements (GMs) are part of the spontaneous
movement repertoire and are the most frequently occurring move-
PURPOSE: This study measured changes in quality of gross motor ments in infants. They occur endogenously without any external
performance in children aged 6-12 years using a clinical measure stimulation and are present from early fetal period until the end of
of movement quality. Gender differences were also explored. the first six months of life. This study investigated how their mother
RELEVANCE: While physiotherapists evaluate a child’s ability to or a nurse talking influenced the patterns of GMs in newborn preterm
perform a particular movement, it is equally important to consider infants. RELEVANCE: One of the important roles of physical therapist
the quality of the movement performed. Quality of movement is to promote a good relationship between a mother and an infant
performance relates to ease and efficiency of movement, affecting in the Neonatal Intensive Care Unit (NICU). The parent hopes to
the child’s ability to participate adequately in typical activities of daily know how to build up a good relationship with their infant for his
living. For example, if a child’s movement looks different then others good development in the future. This study gives a measure of
may exclude her/him from group activities, and if s/he fatigues due mother infant interaction by observing movement patterns of GMs.
to motor inefficiency, s/he cannot sustain participation. This study PARTICIPANTS: Twelve low-risk newborn infants born preterm (23-
described simple criteria which many physiotherapists use when 33 weeks postmenstrual age at birth) participated in this study.
assessing children’s quality of movement, and evaluated the change METHODS: Before observing GMs, we recorded the voices of the
in these in typical children between 6 and 12 years of age. This mother of each infant and a nurse on compact disks. Reflective
knowledge will provide a basis for comparison when assessing chil- markers were attached to the infants’ wrists and ankles and the
dren with motor impairment, and evaluating intervention outcomes. infants were videotaped from above while in the supine position
PARTICIPANTS: A sample of convenience, 508 children (294 girls, when they were moving spontaneously without any stimulation at
214 boys, was recruited from schools representing private and public 35-41 weeks of postmenstrual age. We also filmed their movements
sectors, city/ suburban, and higher/ lower socioeconomic areas within during the presentation of talking by their mothers or the nurse.
the greater Brisbane area, Queensland, Australia. Children were ANALYSIS: Using a two-dimensional image analysis system, we
included if they: were within 3 months of their 6th −12th birthday, digitized the movement pattern and analyzed the data statistically
participated in standard curriculum in school, were well on the day to assess the pattern of GMs in addition to using Prechtl’s evaluation
of testing, and provided informed signed consent. Children were method. We analyzed the first differences of the original time series
excluded if they had a known diagnosis likely to affect performance, data using autocorrelations and estimated spectral density functions
sensory loss, a history of severe sprain in the last 12 months or any adopting AR time series models. RESULTS: Eleven out of the 12
fractures. METHODS: Quality of performance during five gross motor participants significantly reduced their movement speed and variance
tasks was rated on a 1-3 scale for: jump a line (forward/ back and side of movements and sometimes stopped their movements on the
to side directions), astride jump, face stand maneuver, target foot ac- presentation of talking by their mothers or a nurse, as compared
curacy and standing long jump. Task order was randomized. Standard to the non-stimulation period. We used the Wilcoxon signed-rank
instructions, practice and rest periods were given. Sixty-two children test to ascertain these results. No obvious change in the GMs was
distributed across all age groups were re-tested after one week for found between non-stimulation and the mother talking by observing
reliability purposes. ANALYSIS: Cronbach’s Alpha Intraclass Correla- estimated spectral density. CONCLUSIONS: We found that infants
tion (ICC) evaluated test-retest reliability of each task. Kruskal-Wallis reduced their movements when they listen to their mothers or a
tests determined the effect of age and gender on test scores for each nurse talking. This suggests that it is useful for the facilitation of
task, with p set at 0.05. RESULTS: ICC ranged from r= 0.6- 0.8. Age mother infant interaction to talk to the infants when they are in a
influenced the quality of motor performance in all tasks (chi squares stable state. We found no clear qualitative change in GMs between
= 63-112, all p’s = 0.001), with the standing long jump just significant non-stimulation and the mother talking. This result suggests that
(chi square =12.4, p = 0.05). Gender influenced the quality of motor some parts of the system that generate GMs in newborn infants
performance in the jump tasks only (chi squares = 9.5-54.7, p’s = are not affected by social interactions at this time. IMPLICATIONS:
0.001- 0.002), with girls generally better than boys. CONCLUSIONS: Physical therapists working in the pediatric area are able to
In typical children, the study demonstrated improvement in movement support parent to understand their infant more and facilitate mother
quality on all tasks between 6-12 years, and the superiority of girls’ infant interaction by observing the movement patterns of general
performance quality over boys for the jump tasks. Further studies movements. KEYWORDS: General Movements, Mother talking,
utilizing the criteria with client groups will demonstrate whether preterm infant. FUNDING ACKNOWLEDGEMENTS: unfunded.
they differentiate between client and typical groups, and if they ETHICS COMMITTEE: the ethics committee of Nagano Children’s
are useful for treatment prescription. IMPLICATIONS: The study Hospital
Research Report Poster Display was to determine if community service learning was a venue for
31-17 Monday 4 June 09:00 impacting the community’s understanding of the scope of physical
VCEC Exhibit Hall B & C therapy. RELEVANCE: To be an effective first contact practitioner,
EFFICACY OF AN INTERDISCIPLINARY OUTPATIENT PAIN the public must have a clear understanding of the scope of the
MANAGEMENT PROGRAM physical therapy profession. A review of the literature revealed
Scascighini L, Litschi M, Walti M, Sprott H; University Hospital Zurich, that the perception of physical therapy has been studied in Great
Department of Rheumatology and Institute of Physical Medicine Britain, Hong Kong, and Australia but not in the United States.
PARTICIPANTS: Fifty three residents of an urban community and
PURPOSE: To investigate the effect of an interdisciplinary outpatient 8 community agency outreach workers and program directors who
pain program (IOPP) in a population with chronic pain syndromes. were community service learning partners of an urban university
RELEVANCE: Numerous inpatient and outpatient pain manage- located in the northeast United States were included in this study.
ment programs exist worldwide to treat chronic pain conditions. Community residents who participated were predominately elders
Unfortunately, this therapeutic approach is usually introduced at (mean age 62.5, range 35-95 years) living within the same urban
a very late stage and often as the last choice when other area and volunteered to participate. METHODS: This mixed design
interventions have failed. The long-term improvements are scarcely study featured data triangulation, including a review of the literature
reported in the literature. PARTICIPANTS: Patients with persisting regarding community perception of physical therapy, a community
pain conditions showing psychosocial strain who completed an resident survey, and community partner focus group and interview.
IOPP. Between April 2001 and December 2005 176 patients (ICF- Community residents were queried about their understanding of
b280) were included. The gender distribution was 32.1% male and physical therapy. Community partners were asked three open-ended
67.9% female, (age 43 years ±9.6, range 20 to 67). METHODS: questions in focus groups or interviews. ANALYSIS: Transcripts of
The IOPP is a multi-professional, bio-psychosocial oriented pain the focus groups and interviews were coded to reveal common
program on an outpatient basis. The patients undertook an intensive themes, trends, key words, and specificity of responses. Coding was
schedule, composed of different therapeutic units consisting of group accomplished individually by each researcher and then collectively.
and individual therapy two mornings a week for a duration of Descriptive statistics and chi square analysis were performed
8 weeks. Current pain intensity, best, worst, and average of the on the survey data. RESULTS: Sixty four percent (64%) of
last week, were rated in an 11-point numeric rating scale (NRS). community residents reported they had seen a physical therapist;
Supplementary validated questionnaires were completed covering 36% participated in weekly community service learning physical
principal outcomes, including the German version of Pain Disability activity programs; and 89% knew that one needed to be licensed
Index (Hermann et al.1995), cognitive and behavioral coping to practice physical therapy. Only 45% of the residents knew that
strategies and psychological impairment (Verarbeitung chronischer physical therapists needed a college education. Community partners
Schmerzen, Geisser et al. 1999), the Marburger questionnaire reported an improved understanding and positive perception of the
about well-being (Basler 1999) and the questionnaire concerning physical therapy profession through community service learning. A
the processing of chronic pain (Fragebogen zur Erfassung der review of the literature revealed that the impact of service learning
Schmerzverarbeitung-FESV, Geisser et al. 2001). ANALYSIS: We on community perceptions of physical therapy has not been studied
analyzed the participants in a single, prospective cohort design with in much detail. CONCLUSIONS: This pilot study may be one of
measurements at baseline, post-treatment, 3, 6, and 12 months. the first to investigate public perceptions of physical therapy in
Paired samples t-tests with a two-tailed significance level of p < 0.05 the United States. Community partners and residents who have
were calculated to compare the means across the follow- up times. been exposed to physical therapy may have a better understanding
RESULTS: All mentioned variables, excepted pain intensity (NRS), of the profession than those who have not. Community partners
improved significantly immediately after the program. Whereas, after and residents who have been exposed to physical therapy through
the 1 year follow-up, most of the parameters returned to the baseline community service learning have a positive understanding of the
values. Solely the subscale “Psychological impairment” remained benefits of exercise on their health and a more positive relationship
statistically significantly better compared to baseline (p < 0.05). with the university. IMPLICATIONS: Community service learning
CONCLUSIONS: This study provides evidence for short-term effect appears to be an educational pedagogy to help physical therapists
of an outpatient interdisciplinary program in chronic pain patients. move towards their emerging role as first contact practitioners as
Moreover, our results suggest that periodical quality assessment it may increase consumer awareness of physical therapy services.
may have important consequences for further multidisciplinary Further studies addressing the public’s perception of physical therapy
interventions. Indeed, this would allow to reflect and objectify the are essential if we are to be recognized by consumers and other
quality of the therapeutic offer and therefore help in focusing and health care professionals as direct entry into the health care system.
optimizing the goals of the patients as well the contents of the KEYWORDS: community service learning, community perceptions,
program IMPLICATIONS: The findings of this quality assessment physical therapy. FUNDING ACKNOWLEDGEMENTS: This work
has led the IOPP team to introduce a refresher appointment with was unfunded.
the patient at 4 months post-intervention to attain, modify or set new ETHICS COMMITTEE: Institutional review board approval for this
goals. Further strategies to achieve sustained long-term effects are project was obtained through Northeastern University’s Division of
needed. KEYWORDS: chronic pain, interdisciplinary treatment, out- Research Integrity.
patient, quality assessment. FUNDING ACKNOWLEDGEMENTS:
No funding. CONTACT: [email protected]
VCEC Exhibit Hall B & C PHYSIOTHERAPISTS’ JOB SATISFACTION IN ISHIKAWA
PARTNERSHIP PERSPECTIVES: CHANGING THE IMAGE OF PREFECTURE, JAPAN
PHYSICAL THERAPY IN URBAN NEIGHBORHOODS THROUGH Araki H1 , Ogiwara S2 ; 1 Department of Medical Rehabilitation
COMMUNITY SERVICE LEARNING Services, Kariya Toyota General Hospital, Kariya, Aichi, Japan;
2 The University of Kanazawa, Kanazawa, Ishikawa, Japan
Golub-Victor A, Lowe S, Fitzpatrick D, Freeman E; Northeastern
University, Boston, Massachusetts, United States
PURPOSE: Healthcare professionals are prone to burnout. One
PURPOSE: The primary purpose of this study was to examine the factor for this may be job dissatisfaction. The purpose of this study
community’s perception of physical therapy. A secondary objective was four-fold: 1) to provide evidence to show whether or not clinicians
in Ishikawa Prefecture were satisfied with the level of professional PDR scale would therefore be conducive to future research on PDR
practice of physiotherapy; 2) to find out which factors caused in Japan. PARTICIPANTS: A convenience sample of 144 out of 237
satisfaction or dissatisfaction; 3) to determine if the statements physiotherapy clinicians in Toyama Prefecture, Japan, participated.
presented in this study were considered relevant and appropriate METHODS: The PDR scale was used in the form of a mailed
as a measure for job satisfaction in clinical practice; and 4) to survey. It contained 17 Likert-type statements to be responded
contrast the findings of this study with those of the Speakman et al’s. to within a five-point range, from ‘strongly agree’ to ‘strongly
RELEVANCE: This study would help contribute to our knowledge disagree.’ ANALYSIS: The reliability of the scale was assessed
of the positive and negative aspects in daily working conditions of as homogeneity, and its validity as construct validity using the
physiotherapists. PARTICIPANTS: A convenience sample of 352 Spearman’s rank correlation coefficient, followed by the calculation
physiotherapists in Ishikawa Prefecture participated in a mailed of the Cronbach’s alpha reliability estimates. As for construct validity,
survey. METHODS: A questionnaire using the Japanese version of the responses to all of the statements were submitted to a factor
the Speakman’s scale sought the clinicians’ responses to 10-item analysis; in this case, a principal component analysis with varimax
statements related to their job concerning paperwork, challenge, rotation. The number of factors was determined by using the factor
physical demand, professional autonomy, fulfillment, and stress. scree plot. We then carried out a second-order factor analysis using
Specifically, the respondents were asked to rate their level of the factors from the first-order factor analysis. This was followed by
agreement or disagreement for each of the statements on the seven- the calculation of the alpha reliability coefficients in order to verify the
point Likert-type scale. In order to examine the relevance of the 10- internal consistency of each of the factors. In addition, convergent
item statements in regards to physiotherapists the respondents were validity was addressed by using the stepwise multiple regression
then asked to indicate how important they felt that the statement analysis on the respondents’ background as the independent variable
related to their job satisfaction on a seven-point scale of importance. and the PDR scale as the dependent variable. This was accompanied
ANALYSIS: Using the chi-square test, tests of independence by the use of the two-tailed Mann-Whitney U test. RESULTS: The
were carried out between gender and professional experience and rate of return was 61.2%. The women-to-men ratio was equal with 72
between gender and professional status. We also used the two- men and 72 women. Fourteen out of the 17 statements were found
tailed Mann-Whitney U test to analyse the difference between gender to have significant item-to-total correlations. The Cronbach’s alpha
and professional status. In addition, the Kruskal-Wallis test was estimate for the scale was 0.76. Some evidence for construct validity
employed to compare among the groups the influence of their length was found in the four-factor solution, which explained 45.7% of the
of professional experience, and this was accompanied with the use total variance. Factors derived from Spearman’s rank correlation and
of the Steel-Dwass test as required. RESULTS: The final sample factor analysis were ‘understanding,’ ‘desire to learn,’ ‘collaboration,’
consisted of 183 (52.3%) questionnaires. The degree of agreement and ‘stand-in,’ with the rate of contribution (Cronbach’s alpha) being
with the scale was moderate (range: 3.0-5.6), though the respondents being 24.39% (.70), 10.96% (.78), 5.54% (.72), and 4.83% (.69),
considered themselves to be engaged in rewarding work. The respectively. Strong evidence for construct validity was demonstrated
causes of their job dissatisfaction were excessive paperwork and in the scale’s ability to differentiate between individuals whose age
physical/mental stress. The degree of importance for the scale as a ranged from 20 to 30 years old and those older than 40 years of age
measure of job satisfaction was also moderate (mean score: 4.9), as with a mean score of 51.2 vs. 46.7. Convergent validity, as a form of
opposed to that of their American colleagues who rated it high when construct validity, was also supported for the scale. CONCLUSIONS:
Speakman et al. conducted their study in 1996. CONCLUSIONS: The PDR scale has been proven to be a reliable instrument for a
The respondents were able to find the positive aspects of their group-level comparison in the current study population and can be
job despite feeling stressed and discontented. They also may have considered a reliable and valid measure of documenting trends of
found the ‘hygienes’ factors such as salary and fringe benefits to importance in regards to PDR in Japan. IMPLICATIONS: The PDR
be of more importance for their daily job satisfaction. The results scale can be used for cross-sectional as well as longitudinal studies of
should be interpreted in terms of culture and mores, differences in PDR. KEYWORDS: Physiotherapist-doctor relationship (PDR) scale,
healthcare systems and the time period in which the studies were Reliability, Validity. FUNDING ACKNOWLEDGEMENTS: This work
conducted. IMPLICATIONS: The findings provide us with possible was unfunded, and ethics approval was not required. CONTACT:
clues as to the solving of work-related problems, such as ones that [email protected]
concern the recruitment and retention patterns of physiotherapists
vis-á-vis job dissatisfaction in the workplace. KEYWORDS: Job
satisfaction, Japanese version of the Speakman’s scale, Physiothera-
pist. FUNDING ACKNOWLEDGEMENTS: This work was unfunded, 35-21 Monday 4 June 09:00
and ethics approval was not required. CONTACT: EBreha@toyota- VCEC Exhibit Hall B & C
kai.or.jp HOW DOES THE USE OF VIDEO INFLUENCE THE
THERAPEUTIC SITUATION UNDER INVESTIGATION?
Research Report Poster Display Hauksdottir N; University of Tromso, Norway
33-01 Monday 4 June 09:00 PURPOSE: In a recent study, I described, analysed and discussed
VCEC Exhibit Hall B & C bodily and verbal communication in treatment. In this presentation
RELIABILITY AND VALIDITY OF A PHYSIOTHERAPIST-DOCTOR I want to focus on how video as a tool for assisting observa-
RELATIONSHIP SCALE tion of physiotherapy practice affected the investigated practice.
RELEVANCE: Qualitative studies of physiotherapy practice as it
Sakamoto N, Ogiwara S; The University of Kanazawa
unfolds in the relation between the physiotherapist and the patient,
PURPOSE: A client’s expectation focuses on the expertise and are vital in todays research. The vast body of research seems
competence of each healthcare professional. One factor that to be within EBP and quantitative studies, which then are given
demonstrates whether the expertise offered by the professional the power to define what is “good” and “updated” practice. That
benefits a client is the viable working relationship among them. leaves experienced based knowledge and physiotherapy practice
The physiotherapist-doctor relationship (PDR) scale measures as it actually is out of focus. We still need to explore practice
the affective attitude component in this relationship. This study itself. To do so, qualitative studies, and methods like observation
focuses on the reliability and validity of this scale. RELEVANCE: and video are useful. What considerations are then to be made?
Psychometric measures must possess high reliability and validity. How should the researcher handle questions like: One or more
In addition, precision instruments must be standardised and proven cameras? The observer in or out of the room? What parts of the
viable to enable evidence-based study of PDR. Verification of the situation should be in focus of the camera? The answers to these
questions will have an impact on the situation you are observing participating in an outcome studies from the Department of Pediatric
and on the data you get. And: How does the observation influence Physical Therapy & Exercise Physiology of this hospital. Healthy
on the situation and on the therapists decisions? PARTICIPANTS: children were recruited by family and friends of the researchers.
One physiotherapist working with outpatients in a big hospital, ANALYSIS: Skewness in the patient population was assessed
considered as an “expert”, treating two different patients. METHODS: with the Pearson skewness statistic. Discriminative validity between
Two sequences in neurological physiotherapy were observed and different subgroups was examined by analyses of variance (ANOVA).
videotaped. Afterwards the physiotherapist was interviewed while we ANOVA’s were corrected with Bonferoni test for multiple post hoc
were watching the video together. ANALYSIS: The video footage comparisons. All analyses were performed with SPSS 11.5 (SPSS
was thoroughly analysed and described in text. The interview was Inc, Chigago, III). RESULTS: Median Bleck scores (A: 9.0; B: 4.5;
used as a comment to what was observed in the situation and C: 9.0; D; 9.0.) differed significantly between the four groups. Mean
on video. RESULTS: Many studies have concluded that observing ASKp-NL (A; 76.3; B: 61.7; C: 94.0; D; 86.6) (p < 0.001) and mean
by video does not influence the observed situation. In my study ASKc-NL (A: 82.4; B: 69.2; C: 95.2; D: 94.0) (p < 0.001) differed
however, I found that the participants were very much aware of the significantly. Age was not correlated with both ASK-NL versions.
observer, and that they concentrated on not to show their awareness. Boys scored not significantly better than girls. CONCLUSIONS:
The interview stated that some of the physiotherapists decisions Both versions of the ASK-NL can discriminate between children
regarding treatment actually were influenced, and that some aspects with musculoskeletal conditions and children without musculoskeletal
of the treatment were paid more attention to. CONCLUSIONS: conditions and between children with neurological conditions and
Observation and the use of video will to some extent influence on the children without neurological conditions. IMPLICATIONS: The Dutch
situation that unfolds between the two parts, and on the treatment language versions of the ASKc-NL and ASKp-NL are valid generic
given by the physiotherapist. By looking further into these decision functional outcome measures ready use in for clinical practice
making processes and aspects,one will understand more about what and disability research. KEYWORDS: Functional Outcome; Physical
physiotherapists emphasise during practice, and what their profes- Activity; Childhood. FUNDING ACKNOWLEDGEMENTS: not appli-
sional beliefs are. IMPLICATIONS: In qualitative research studies, cable. CONTACT: [email protected]
using open observation and video the observer should be aware of
HOW the therapeutic situation is influenced by being looked into,
as this might give an insight into the physiotherapists professional
beliefs. KEYWORDS: Qualitative studies, video, communication, 36-05 Monday 4 June 09:00
physiotherapy practice. FUNDING ACKNOWLEDGEMENTS: Fond VCEC Exhibit Hall B & C
for etter og videreutdanning av fysioterapeuter, Norway. Tromso APPLICATION OF RASCH ANALYSIS TO THE KOREAN
University College, Norway. CONTACT: [email protected] VERSION OF THE GROSS MOTOR FUNCTION MEASURE
ETHICS COMMITTEE: Norsk samfunnsvitenskapelig datatjeneste, Park S1 , Velozo C1 , Yi C2 , Kwon H3 , Kwon O2 , Ahn D4 , Jeon H2 ;
Norway 1 University of Florida, Gainesville, USA; 2 Yonsei University, Wonju,
Korea (South); 3 Daegu University, Daegu, Korea(South); 4 Inje

Research Report Poster Display University, Kimhae, Korea(South)
36-01 Monday 4 June 09:00 PURPOSE: The purpose of this study was to investigate the item-
VCEC Exhibit Hall B & C level psychometrics of a Korean translation of the Gross Motor
DISCRIMINATIVE VALIDITY OF THE DUTCH VERSION OF THE Function Measure (GMFM) using Rasch analysis. RELEVANCE: The
ACTIVITIES SCALE FOR KIDS (ASK-NL) translated GMFM is the most widely used outcome measure in Korea.
Unfortunately, the translation is based on an earlier version of the
van der Net J1 , Stukstette M1 , Takken T1 , Engelbert R1 , Young N2 ,
GMFM and there is little evidence that the translated instrument
Helders P1 ; 1 University Children’s Hospital UMC at Utrecht, The
shows good psychometric characteristics. PARTICIPANTS: The
Netherlands; 2 Laurentian University, Sudbury,ON, Canada
participants were 206 Korean children with cerebral palsy diagnosed
PURPOSE: To determine discriminative validity of the Dutch version by physician. Their mean age was 4.9 years (range: 8 months to
of the ASK (ASK-NL) between different childhood chronic conditions. 14.5 years). METHODS: The Korean GMGM user’s manual was
RELEVANCE: The ASK is a generic self report measure to re-translated to reflect the most recent changes to the English
describe and evaluate change in the level of daily life capabilities version. The final translation was based on unanimous agreement
and performance in children 5-15 years (Young 2000). The ASK of 29 Korean physical and occupational therapists on both the
provides insight in children’s capabilities and level of performance manual text and item definitions. GMFM data for 206 children with
that are important for healthcare professionals for their clinical cerebral palsy were then collected by the 29 therapists across 11
reasoning process by formulating and evaluating treatment goals. outpatient rehabilitation facilities in Korea between August 2004
PARTICIPANTS: In order to investigate the discriminative validity and April 2005. ANALYSIS: The Winsteps software program was
of the ASK-NL, 97 children above the age of 7 years and a good used to assess whether the Korean version of the GMFM fit the
understanding of the Dutch language were selected. The children Rasch measurement model. RESULTS: The re-translated version of
were classified in four distinct diagnostic groups: A] musculoskeletal the GMFM demonstrated good internal construct validity showing a
conditions (n=32, e.g. Osteogenesis Imperfecta, Achondroplasia, person separation reliability of 0.99 (analogous to Cronbach’s alpha).
Juvenile Idiopathic Arthritis and Dermatomyositis), B] neuromuscular The GMFM has a person separation index was 12.7 which indicates
conditions (n=28, e.g. Spina Bifida, Cerebral Palsy, Sjögren Larsson), that the instrument separates the sample into 17.3 statistically
C] miscellaneous conditions affecting physical functioning (n=23, e.g. significant strata. Ninety-six percent (85/88) items fit the Rasch
severe Haemophilia, renal insufficiency, congenital heart disease). model. The items, “Supine: Lift head 45 degrees,” “Supine: Flexes
D] A group of healthy children (n=14). Informed consent of all right hip and knee through full range,” “Supine: Flexes left hip and
children was obtained. The local board of ethics approved this knee through full range” showed high infit statistics. In general,
study. METHODS: In all children the level of ambulation was the order of item difficulty of the remaining 85 items showed a
classified according the modified Bleck criteria (1981). All children logical item difficulty hierarchy with the “lying and rolling” items being
filled out the ASK-NL, both the capability and the performance the easiest and the “jumping and hopping” items being the most
version, supervised by their physiotherapist (MS), at a school for difficult. CONCLUSIONS: The Korean version of the GMFM shows
special education ‘Ariane de Ranitz’, Utrecht, The Netherlands outstanding item-level psychometric qualities. IMPLICATIONS: This
or by their physiotherapist on a regular outpatient clinic of the study suggests that the translated GMFM produces valid measures
Children’s Hospital Utrecht, The Netherlands (JN, RE), or when of gross motor ability in children with cerebral palsy and furthermore
appears to be sensitive in differentiating children with different Research Report Poster Display
gross motor abilities. KEYWORDS: Cerebral palsy, Rehabilitation, 37-13 Monday 4 June 09:00
Treatment Outcome. FUNDING ACKNOWLEDGEMENTS: This VCEC Exhibit Hall B & C
study was unfunded. CONTACT: [email protected] INVESTIGATION OF SLEEP POSITION AS A MANAGEMENT
OPTION FOR OBSTRUCTIVE SLEEP APNOEA
Skinner M1,2 , Kingshott R2 , Filsell S3 , Taylor R2 ; 1 Centre for
Physiotherapy Research, School of Physiotherapy, University of
37-09 Monday 4 June 09:00 Otago, Dunedin, New Zealand; 2 Respiratory Research Unit, Dunedin
VCEC Exhibit Hall B & C School of Medicine, Dunedin, New Zealand; 3 Tom McKendrick
CHANGES IN FUNCTIONAL WALKING DISTANCE AND Sleep Laboratory, Dunedin Hospital, Dunedin, New Zealand
HEALTH-RELATED QUALITY OF LIFE AFTER GASTRIC BYPASS
SURGERY PURPOSE: The study aimed to investigate prevention of sleep in
the supine position as a management option for subjects diagnosed
Tompkins J1 , Bosch P2 , Chenowith R2 , Swain J1 , Tiede J1 ; 1 Mayo
with positional obstructive sleep apnoea (OSA). RELEVANCE: OSA
Hospital, Scottsdale, USA; 2 AT Still University, The Arizona School
is a common health problem in adults affecting 4% of males and 2%
of Health Sciences, Mesa, USA
of females world wide. OSA is often poorly diagnosed and patients
PURPOSE: The primary purpose of this study was to measure left untreated are at a higher risk of developing cardiovascular
distances walked in a six minute walk test (6MWT) and scores on the disease. It is estimated that over 50% have positional OSA where
RAND 36-Item Survey (RAND-36) prior to undergoing gastric bypass the apnoea-hypopnoea index (AHI) in supine lying is twice as high
surgery (GBS), and at 3 and 6 months post-GBS. A secondary as the AHI in the non-supine position. Despite clinical symptoms
purpose was to assess the relationship between perception of health- such as disturbed sleep patterns and daytime hypersomnolence,
related quality of life (QOL) and functional capacity before and after the overall AHI in subjects with positional OSA may not reach a
GBS. RELEVANCE: Many individuals undergo weight-loss surgery threshold that justifies management using continuous positive airway
in an effort to manage morbid obesity. Prior to undergoing GBS pressure (CPAP) therapy and patients may thus be advised just to
patients are given recommendations regarding post-surgery lifestyle avoid sleeping on the back. Few studies have been reported on the
modifications, including the need to exercise regularly, yet specific role of sleep position for the management for adults with positional
recommendations are generally not made. Currently, little research OSA. PARTICIPANTS: Twenty one adult volunteers diagnosed with
is available on changes in functional capacity as a result of weight- positional OSA where the AHI in the non-supine position was
loss surgery, particularly during the first six months following GBS. less than 10/h, were included in the study. METHODS: The study
This information is needed in order to prescribe exercise programs was a cross-over design using two therapies: thoracic anti-supine
for individuals after GBS. PARTICIPANTS: Subjects included 26 band (TASB) and CPAP, undertaken on an intention-to-treat basis.
individuals (24 females and 2 males) with a mean age of 44 ±6.3 Subjects were randomly allocated to have 4 weeks using each device
years and a mean body mass index (BMI) of 45.5 ±6.9 who were during sleep, with a 1-week washout period between therapies. An
undergoing roux-en-y gastric bypass surgery. METHODS: Prior to overnight sleep study to measure AHI, sleep position and respiratory
surgery (pre-GBS), then at 3 and 6 months post-GBS, subjects parameters was completed at the end of each period. Subjects also
completed the RAND-36 and performed a 6MWT. Rating of perceived completed standardised questionnaires on sleep-related symptoms
exertion (RPE) was measured during the 6MWT using the Borg and quality of life, and self-report diaries. ANALYSIS: Paired T-
RPE scale. ANALYSIS: Separate, repeated measures analyses of tests were used to analyse respiratory data obtained from the
variance (ANOVA) were used to compare BMI, 6MWT distance, overnight sleep studies with the two therapies and data from the
RPE (final, minute 6 score), global RAND-36 score, as well as
questionnaires. RESULTS: All subjects completed the study. At
physical functioning and general health perceptions subcomponents
baseline the mean AHI was 21.86±12.22/h, range 6.00-51.20/h. and
of the RAND-36, at each time point. Planned comparisons were
mean AHI in supine lying was 58.18±27.58/h, 19.30-113.30/h. The
conducted using simple effects contrasts. Pearson product moment
mean AHI with the TASB device, (11.98±14.13/h, 0.20-52.56/h), was
correlations were calculated to determine the association between
significantly higher than the mean AHI on CPAP (4.99±3.80, 0.80-
BMI and 6MWT, and RAND-36 and 6MWT. SPSS 14.0 was used
15.00/h), (p < 0.02). From individual data, 15/21 subjects (74%) on
to conduct all analyses. RESULTS: Mean pre-GBS walk distance
TASB therapy and 19/21 subjects (90%) on CPAP therapy had an
was 55% ±14 of normative values established for healthy adults.
overall AHI 10/h. The TASB device was successful in reducing the
Subjects had a significant increase in 6MWT distances at 3 and 6
months post-GBS, representing 68% ±12 and 75% ±13 of normal sleep period in the supine position to 10% of total sleep time in
values for this age range. These changes were accompanied by a 17/21 subjects (81%). Mean results for sleep-related symptoms and
significant decrease in final RPE at both 3 and 6 months post-GBS, in quality of life parameters were not significantly different between
comparison to pre-GBS. Improvements in QOL were demonstrated the two therapies. CONCLUSIONS: Management of positional OSA
as measured by significant changes in all RAND scores at both 3 by prevention of sleep in the supine position was successful in the
months post-GBS and 6 months post-GBS. 6MWT distance was majority of subjects studied. However outcomes with CPAP therapy
inversely correlated with body mass index at all time points. There were superior to TASB therapy as measured by improvements in
was a significant positive correlation between the 6MWT and the AHI. IMPLICATIONS: The clinical implications of the partial success
global RAND score at 3 months and at 6 months post-GBS only. with TASB therapy are important. Results provide objective evidence
CONCLUSIONS: Individuals who undergo GBS experience marked that supports trialling the anti-supine device to prevent sleep in the
improvements in functional capacity within a short period of time, supine position for subjects with positional OSA. Also, sleep position
and this is associated with enhanced QOL. In spite of these changes may be considered as an alternative management for positional OSA
post-GBS, subjects continue to have functional walk distances that in subjects who are non-compliant with CPAP therapy, or who are
are 75% of age-matched peers within a normal weight range. symptomatic but have a low overall AHI. KEYWORDS: sleep position;
IMPLICATIONS: Patients would benefit from the development of obstructive sleep apnoea; continuous positive airway pressure.
individualized exercise programs post-GBS, with close monitoring FUNDING ACKNOWLEDGEMENTS: Otago Respiratory Research
to adjust and progress the exercise prescription. KEYWORDS: Trust; University of Otago School of Physiotherapy. CONTACT:
Obesity, exercise, function, health-related quality of life. FUNDING [email protected]
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] ETHICS COMMITTEE: Lower South Regional Ethics Committee,
ETHICS COMMITTEE: Mayo Hospital IRB; ATSU-Mesa IRB Dunedin, New Zealand
THE PAIN EXPERIENCE IN PEOPLE WITH CHRONIC FATIGUE MOTION ANALYSIS OF E3 FITNESS GRIPS™ USED WHEN
SYNDROME(CFS) / MYALGIC ENCEPHALOMYELITIS(ME) RUNNING
Marshall R, Paul L, Wood L; Glasgow Caledonian University, Lewis C, Hreljac A, Summers S, Williams B, Vojkufka J; Calfornia
Glasgow, Scotland State University, Sacramento Sacramento USA
PURPOSE: CFS/ME is a neurological condition with unknown PURPOSE: Running is associated with a high incidence of injury.
aetiology and pathophysiology. It is widely accepted that fatigue Techniques or devices that could improve running biomechanics and,
and pain are the two most common symptoms and, it has been therefore, reduce running injuries are greatly needed. The e3 Fitness
suggested that pain is more debilitating than fatigue. Yet, only a grips™ are marketed as a device that helps prevent running injuries.
few studies have been conducted into the chronic pain caused The e3 Fitness grips™ have not been scientifically studied. The
by CFS/ME. Therefore, the aim of this study was to examine purpose of this study was to evaluate the efficacy of the e3 Fitness
the pain experience of people with CFS/ME. RELEVANCE: The grips™ as determined by changes in body alignment. RELEVANCE:
management of pain is one of the core principles of physiotherapy; PT’s must keep abreast of technology that relates to patient care
therefore, it is important that clinicians are knowledgeable about the and the evidence of it’s effectivness PARTICIPANTS: 21 recreational
pain experienced by those with CFS/ME. PARTICIPANTS: There and competitive runners with a mean age of 23 years old were
were 42 people recruited to this study, including seven people recruited. Subjects ran regularly at least 6 miles per week prior
who were severely affected and were either housebound or bed to participation. None of the subjects had sustained injury within
bound. The mean age of participants was 47.8(±9.8) years old. the 6 months prior to the study. METHODS: 3D Motion System
The duration of illness ranged from 14 months to 26 years and analysis was used in order to collect and analyze static and dynamic
three months. Participants were recruited via local CFS/ME support position of reflective markers located on shoulders, the sternum
groups and CFS/ME charities. All recruits successfully passed a and both anterior inferior iliac spine (ASIS). A series of pulsing
diagnostic screening questionnaire that was based on the CDC infrared strobe lights that operated at a sampling frequency of 60Hz
criteria (Fukuda, 1994)and the Canadian Guidelines (Carruthers et illuminated the position of the markers at discrete time intervals,
al, 2003). METHODS: This study was of a prospective, descriptive, and an array of six cameras positioned in a U-shaped pattern in
cross-sectional design. All participants were required to complete a front and along the sides of a Quinton Q55 series 90 treadmill.
structured subjective interview that included Visual Analogue Scales Each Subject ran on a the treadmillwith the e3 Fitness grips TM
(VAS) to measure pain intensity, mood and sleep disturbance. The in their hands; with sham grips in their hands or without handgrips.
interview was one method amongst a battery of pain assessments to Motion analysis was used to determine change in shoulder level,
examine the pain experience. ANALYSIS: The information collected pelvis level and combination of the two. Following three minutes
from the interviews was coded and entered into SPSS 14.0 for data of running, kinematic data was collected for 5 seconds. Analysis
analysis and descriptive statistics were incorporated to explore pain of kinematic data was restricted to motions occurring in the frontal
characteristics. RESULTS: The screening questionnaire revealed and sagital plane. ANALYSIS: The means and standard deviations
that 47.6% of participants experienced all five pain based symptoms for the three levels of the independent variable were calculated. A
from the CDC criteria (Fukuda, 1994). All participants felt pain on repeated measures design was used and a single factor ANOVA
rest, and on the day of the interview 77.1% reported muscle pain to was completed for each level of the independent variable, clavicle
be the most painful symptom at that time. When experiencing pain angle (F = 0.080, P = 0.923), waist angle (F = 0.715, P = 0.493, and
21.3% of participants experience further difficulties with concentration combined angle (F = 0.123, P = 0.885). A probability level of P < 0.05
and memory. The mean VAS measurement for current pain intensity was selected to determine statistical significance. RESULTS: No
was 44.5mm (95% CI: 37.8 to 51.2), the mean VAS measurement significant difference was found in any joint angles measured when
for pain intensity over the preceding 24 hours was 59.1mm (95% CI: compared across the three running conditions. Subjective response
52.4 to 65.9). 38 participants reported both standing and walking to the three conditions was mixed. CONCLUSIONS: The e3 Fitness
were the most painful activities. Heat was the factor that helped ease grips™ did not significantly change the biomechanics of the runners
pain for 26.8% of participants. Pain was reported to be worse in the when comparing use of the e3 Fitness grips™ to carrying mock
mornings by 45.3% of this sample. CONCLUSIONS: This research grips and to carrying nothing. Subjective response to the 3 running
provides objective data to support anecdotal and clinical reports of conditions indicated a small margin that preferred running with the e3
the pain experience in those with CFS/ME. Future work could further Fitness grips™ over running without anything in their hands. Further
investigate emerging trends such as 24 hour pattern, pain triggers studies might investigate the use of other and/or additional forms of
and the use of heat to ease pain. IMPLICATIONS: Physiotherapists scientific analysis to measure variables of running while using the
need to be aware of important factors such as, how they interact e3 Fitness grips™. IMPLICATIONS: At this point in time physical
with the patient, the time of day, duration of assessments and form therapists do not have the evidence to recommend the e3Fitness
of treatment offered with regards to managing chronic pain in people grips™ as a preventitive measure for running. Standard guidance
with CFS/ME. KEYWORDS: Pain, CFS/ME, Assessment. FUNDING such as proper shoe fit, running surface and style include suggestions
ACKNOWLEDGEMENTS: The funding for this research was jointly that physical therapists can give their running patients. KEYWORDS:
provided by Glasgow Caledonian University and ME Research UK. running injuries prevention. FUNDING ACKNOWLEDGEMENTS:
CONTACT: [email protected] unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: The ethics committee at the School of Health ETHICS COMMITTEE: CSUS Institutional Review Board
and Social Care at Glasgow Caledonian University approved this
research.
ENTHESIS PAIN PREVENTION IN JUNIOR HIGH SCHOOL DOMESTIC VIOLENCE AGAINST WOMEN AS A GLOBAL
SOCCER PLAYERS – FACTORS ASSOCIATED WITH HEIGHT CONCERN: A SYSTEMATIC REVIEW OF INTERVENTIONS AND
GROWTH VELOCITY CURVE, TIGHTNESS, AND ALIGNMENT PHYSIOTHERAPIST’S POTENTIAL ROLE
Nakazawa R1 , Sakamoto M1 , Nakagawa K1 , Inomata N1 , Smidova J1 , Hatlova B1 , Dean E2 ; 1 Faculty of Sport and Physical
Kusama Y2 ; 1 Gunma University Graduate School of Medicine; Education, Charles University, Prague, Czech Republic; 2 School of
2 Maebashi Kise Junior High School Rehabilitation Sciences, University of British Columbia, Vancouver,
Canada
PURPOSE: The enthesis pain, which occur frequently among young
athletes, may be caused by height growth velocity and excessive PURPOSE: 1. To systematically review the international literature
tightness and alignment of the lower extremities. The purpose of this related to interventions addressing the consequences of domestic
study was to examine factors related to the occurrence of enthesis violence (DV) perpetrated against women. 2. To examine the
pain by long-term longitudinal investigation and measurement in physiotherapist’s potential role in addressing consequences of DV.
junior high school soccer players, while intervening for its prevention. RELEVANCE: DV crosses economic and professional groups as
RELEVANCE: This research report is helpful to early prevention of well as cultures. DV is a complex problem associated with social,
injury among young athletes. PARTICIPANTS: The subjects were psychological, and physical health consequences. Interventions
107 male soccer players who played on the extramural soccer team of for survivors of DV need to reflect this complexity, in conjunc-
three junior high schools in Gunma. Ages ranged from 12 to 15 years. tion with comprehensive team work. Psychological and physical
METHODS: The presence or absence of enthesis pain, the height consequences are related, and are reflected in the survivors’
growth velocity, muscle tightness (iliopsoas, quadriceps, hamstrings, overall health status. Physical discomfort can impact psychological
hip adductors and gastrocnemius), and alignment (Q-angle, leg- status and social integration. A role for physiotherapy may be
heel-angle, and heel-flour-angle) were longitudinally investigated, indicated. PARTICIPANTS: A total of 87 study citations were
and stretching was instructed periodically. The measurements were screened according to stringent inclusion and exclusion criteria.
performed a total 6 times once a month. This study was approved Citation sources included: the American Psychiatric Association,
by the Ethical Review Board of the Japanese Society of Physical Amnesty International, CINAHL, European Council, Google Scholar,
Fitness and Sports Medicine. ANALYSIS: The height growth velocity Medline, PsychINFO, PubMed, Social Abstracts, United Nations,
curve was prepared using the cubic spline curve of SPSS. The and World Health Organization. METHODS: A literature review of
phases were determined according to Murata’s classification, and studies describing interventions for women survivors of DV and their
the phase at the onset time of enthesis pain was investigated. outcomes was conducted based on established systematic review
To investigate the association between the occurrence of enthesis procedures (Edgar, 2003). Definitions of DV used in the studies
pain and each measurement item were compared (paired t-test) were also reviewed. Review inclusion criteria were studies of: 1.
between before and after appearance/disappearance of enthesis adult women survivors of DV (age range 18-60 y) regardless of
pain in 3 groups of subjects who underwent all of the 1st, 3rd their heritage and marital status, and 2. women in heterosexual
(intermediate), and final measurements; Subjects developed enthesis relationships (with or without children), and further the studies
pain, subjects with disappeared of enthesis pain, and subjects needed to include 3. the results of a controlled trial or clinical
with repeated appearance and disappearance of enthesis pain study, and 4. an intervention and assessment of the outcomes.
(Wilcoxon test). And, to investigate changes with time in muscle ANALYSIS: Of 87 citations, 10 met the study inclusion criteria. The
tightness and the effect of intervention, muscle tightness on the interventions and their outcomes, and the definitions of DV reported
1st measurement was compared with that at each time point were recorded. RESULTS: 1.Studies meeting criteria were published
(paired t-test). RESULTS: The time of enthesis pain occurrence between 1991 and 2005. 2.Six studies evaluated interventions
was consistent with phase II of the height growth velocity curve including social support, personal counseling, and empowerment
in many cases. On comparison between before and after the coaching. 3.Three studies evaluated cognitive behavioral therapy.
appearance/disappearance of enthesis pain, no association was 4.One study evaluated hospital-based intervention including physical
noted between the muscle tightness and occurrence of enthesis pain. and psychological health status monitoring, individual nurse assis-
But, on comparison of changes with time in muscle tightness, the tance, and social counseling. 5.Often, no standard definition was
tightness of the right quadriceps significantly increased. A significant reported, or inconsistent definitions were used. CONCLUSIONS:
increase in the Q-angle was also noted when enthesis pain appeared. The field of DV as an area of study is in its infancy, and is
Furthermore, the tightness of the bilateral iliopsoas, hamstrings, hip relatively obscure in physiotherapy literature. The lack of use of
adductors, and gastrocnemius had significantly improved on the final a consistent definition in the literature limits the evaluation and
measurement. CONCLUSIONS: Since height rapidly increases and usefullness of prevalence data, and interpretation of intervenion
the growth of bones and muscles/tendons is imbalanced in phase studies. Methodological limitations of the studies to date limit
II, the onset time of enthesis pain most frequently corresponded to drawing conclusions. The relative effectiveness of interventions
phase II. In addition, the long-term longitudinal evaluation of muscle related to psychological and physical needs of women survivors
tightness may help to predict the occurrence of enthesis pain. This of DV warrants systematic study based on stringent mixed mode
study showed the necessity of the long-term longitudinal evaluation of research approaches. IMPLICATIONS: 1.The complexity of the
muscle tightness, suggesting that there is a possibility of intervention phenomenon of DV and its social, psychological, and physical health
for prevention, as well as treatment in the field of physical therapy consequences, suggests that interventions for survivors of DV need
for sports injuries in the growth period. IMPLICATIONS: For physical to reflect this complexity, and the involvement of an interdisciplinary
therapy practice KEYWORDS: growth period, enthesis pain, injury team. Physiotherapy that combines social and psycho-physical
prevention. FUNDING ACKNOWLEDGEMENTS: The authors deeply approaches warrants being considered in addressing the needs of
thank the presidents, teachers, and soccer club members of each survivors of DV. 2.Standardized means of evaluating DV needs to
junior high school who cooperated in this study. We also thank be established (i.e. the use of an established standard definition
the physical therapists for their cooperation in the measurement. and standard prevalence measure) to provide a baseline for
CONTACT: [email protected] research related to DV to examine its unique dimensions and
ETHICS COMMITTEE: This study was approved by the Ethical interpret the validity of intervention investigations. KEYWORDS:
Review Board of the Japanese Society of Physical Fitness and Sports Domestic violence; intimate partner violence; domestic violence
Medicine. survivors; battered women; abused women; intervention; treatment.
FUNDING ACKNOWLEDGEMENTS: The study was conducted with and already fitted amputees (mean age=36). 25% of them were
the support of the School of Rehabilitation Sciences, University of trans-femoral amputees. METHODS: This randomised study was
British Columbia, Canada. CONTACT: [email protected] carried out in a clinical environment, within the premises of the
International Committee of the Red Cross, in southern Myanmar. The
amputees in the experimental group received a three day programme
Research Report Poster Display built around 7 specific exercises, lasting approximately one hour
01-03 Monday 4 June 10:30 altogether. Trans-tibial amputees were tested the first day they were
VCEC Exhibit Hall B & C fitted and then 2 days later; trans-femoral amputees were tested
EFFECTS OF EXERCISE AND ELECTROACUPUNCTURE ON when walking out of the parallel bars and 4 days later. ANALYSIS:
THE RECOVERY IN THE CEREBELLAR INJURED RATS BY Effects were assessed on: 2-minute walk test, physiological cost
3-ACETYLPYRIDINE index (PCI), amount of weight bearing on both legs, 5 questions
Park S1 , Rho M2 , Park R3 ; 1 Department of Physical Therapy, of the Functional Measure for Amputees questionnaire and the
College of Rehabilitation, Daegu university, Daegu, Korea; Timed Up and Go test. ANOVA and logistic regression statistic
2 Department of Physical Therapy, College of Health Science, tests were performed with SPSS software; level of significance
Catholic University of Pusan, Busan, Korea; 3 Department of Physical was set at p = 0.05 RESULTS: The experimental group showed
Therapy, College of Rehabilitation, Daegu university, Daegu, Korea significant improvement in the 2-minute walk test (p = 0.02), in the PCI
(p = 0.02) and in the maximal weight bearing test on the amputated
PURPOSE: The purpose of this study was to investigate the effects of leg (p = 0.04). The other tests were not statistically different.
exercise(Ex) and electroacupuncture(EA) on the recovery in the cere- Qualitative results confirmed amputees and therapists’ satisfaction
bellar injured rats by 3-Acetylpyridine(3AP). 3AP induces cerebellar about the intervention and the testing. CONCLUSIONS: Despite
injury which is chemoablation of the inferior olive. RELEVANCE: limited means, research remains feasible in a developing country; this
It is related to physical Therapy practice. PARTICIPANTS: Twenty study has demonstrated that physiotherapy is effective in improving
five male Sprague-Dawley rats were divided 5 groups: normal functional performance of lower limb amputees and therefore has
control, 3AP control and three experimental groups(Ex, EA, Ex with its place in every rehabilitation centre. IMPLICATIONS: Even limited
EA groups). METHODS: 3AP was administered intraperitoneally in physiotherapy training is beneficial to lower limb amputees and
volume of 2 ml/kg body weight. Each experimental group was treated therefore should be implemented systematically whithin rehabilitation
from 6days after being injured with the Ex(Rotarod, 20Rpm, 20min), centres. Minimum assessment and testing give a good appreciation
EA(Es-160, ITO, Japan, 2 Hz, 15min), Ex with EA everyday during of the patient performance. KEYWORDS: Lower limb amputees;
the 2 weeks. EA was applied to Zusanli point which is located at Physiotherapy training; 2 minutes walk test; Developping countries.
the anterior tibial muscle between tibia and fibula. Maximal Height FUNDING ACKNOWLEDGEMENTS: International Committee of the
Vertical Jump(MHVJ) was tested at pre-treatment on 1st day and Red Cross.
on 7th, 14th day after treatment on the cerebellar injured rats by ETHICS COMMITTEE: following ICRC ethic rules
3AP. After 2 weeks, the rats were sacrificed and we observed
the concentration of brain derived neurotrophic factor(BDNF) of the
serum. ANALYSIS: Statistics used by SPSS for Win 12.0 took Research Report Poster Display
a one way ANOVA to compare the MHVJ and BDNF between 01-11 Monday 4 June 10:30
each groups. The significance level was 0.05. RESULTS: The VCEC Exhibit Hall B & C
results of this experiment were as follows: MHVJ was increased EFFECT OF INSPIRATORY MUSCLE TRAINING FOR PEOPLE
significantly in the Ex, EA and Ex with EA groups compared WITH CYSTIC FIBROSIS: A SYSTEMATIC REVIEW
with the 3AP control group(P < 0.05). The concentration of BDNF
Reid W1 , Geddes L2 , O’Brien K3 , Brooks D3 , Crowe J2 ; 1 School of
of the serum was significantly decreased in the Ex, EA and Ex
Rehabilitation Sciences, Division of Physical Therapy, University of
with EA groups than 3AP control group(P < 0.05). CONCLUSIONS:
British Columbia, Vancouver, BC, Canada; 2 School of Rehabilitation
The results of this study showed that dynamic exercise and
Science, McMaster University, Hamilton, ON, Canada; 3 Department
electroacupuncture to Zusanli point have an effect on recovery in
of Physical Therapy, University of Toronto, Toronto, ON, Canada
cerebellar injured rats IMPLICATIONS: It may be suggested that the
application of exercise and electroacupuncture promote functional PURPOSE: To perform a systematic review to examine the effects of
recovery following cerebellar injury. KEYWORDS: 3-Acetylpyridine, inspiratory muscle training (IMT) for adults living with cystic fibrosis
Cerebellar injury, Exercise, Electroacupuncture, BDNF. FUNDING (CF). RELEVANCE: IMT can reduce dyspnea and improve exercise
ACKNOWLEDGEMENTS: We don’t have any funds. CONTACT: tolerance in people with chronic obstructive pulmonary disease,
[email protected] however, evidence supporting its benefits for people with CF is less
well defined. PARTICIPANTS: Adults (>18 years) living with CF.
METHODS: A systematic search examining IMT for adults living with
Research Report Poster Display CF was performed using electronic databases from their inception
01-07 Monday 4 June 10:30 to December 2005 according to Cochrane Collaboration protocol.
VCEC Exhibit Hall B & C Reference lists were hand-searched. Personal contact was made with
SHORT-TERM EFFECT OF PHYSIOTHERAPY REHABILITATION authors to follow-up on missing information. Inclusion criteria included
ON FUNCTIONAL PERFORMANCE OF LOWER LIMB randomized controlled trials among adults with stable CF, published
AMPUTEES: A RANDOMISED TRIAL in English, comparing IMT to sham, no intervention, or other
interventions. To determine if the studies met the inclusion criteria,
Rau B1 , Bonvin F1 , De Bie R2 ; 1 International Committee of the
two investigators reviewed abstracts independently. Data were
Red Cross; 2 Maastrich University
independently abstracted from included studies by two investigators
PURPOSE: The objective of the trial was to evaluate the effective- using standardized data abstraction forms. Methodological quality of
ness of a short and intensive physiotherapy programme versus usual included studies was assessed. ANALYSIS: Meta-analyses using
care, mainly consisting of walking. RELEVANCE: Little research has random effects models wherever possible were performed using
been done so far in the field of young traumatic lower limb amputees. RevMan computer software. RESULTS: Thirty-one studies were
Needs are important, as in conflict areas, around 15’000 persons retrieved, of which two met the inclusion criteria. Both studies
suffer yearly of new traumatic amputations. PARTICIPANTS: Fifty- compared different intensities of IMT to sham or no intervention, and
eight male unilateral lower limb amputees were randomized over used different starting intensities and progression. One study used
intensive care (N=29) and usual care (N=29). Groups included firstly the Threshold trainer® . The other used an electronic manometer
connected to a laptop computer with custom software. Two meta- correlation. RESULTS: Compared to baseline value, a significantly
analyses were performed for forced expiratory volume in 1 second decrease of MVC (27.4±7.1 Kg vs 26.5±7.1 Kg, p < 0.001) and
(FEV1 ) (litres) and forced vital capacity (FVC) (litres) and showed Twq (12.6±2.6 Kg vs 10.0±2.5 Kg, p < 0.001) were observed after
no change between the IMT group compared with the sham or no the training session. A significant correlation was found between
intervention group. No other meta-analyses could be performed due MVC and Twq at baseline (0.762, p < 0.001) and between the fall
to differences in the outcomes measured. Results from individual in MVC and the fall in TWq 15 minutes post training (r = 0.688,
studies showed improved inspiratory muscle endurance (%Pimax) p < 0.05). Nine patients (±64%) developed contractile fatigue after
(de Jong 2001), inspiratory muscle strength (maximum inspiratory training. In these patients, MVC and Twq were significantly decreased
pressure) and sustained maximal inspiratory pressure (Enright 2004), after training (14±5% and 26±6%, respectively p < 0.001). Training
for the IMT group compared with the sham/no intervention groups. session failed to induce contractile fatigue in five patients. In these
One study found no difference in dyspnea (Borg scores) or exercise patients, it was no significant difference in MVC pre-post training
capacity (maximal oxygen consumption, workload) (de Jong 2001). and Twq was significantly decreased after training session(10±14%
One study measured anxiety and depression (Hospital Anxiety and p < 0.05). CONCLUSIONS: We conclude that contractile fatigue may
Depression Scale) and found improvements for the IMT group occur after a standardized training session in some patients with
compared with the no intervention group (Enright 2004). No change COPD but not in all. IMPLICATIONS: The absence of contractile
in quality of life (Chronic Respiratory Disease Questionnaire) was fatigue during training in ±35% of patients could explain why, in some
reported (Enright 2004). CONCLUSIONS: The literature on IMT for patients with COPD, rehabilitation fails to improve exercise tolerance.
people living with CF is sparse. Meta-analyses were limited due to KEYWORDS: Pulmonary, Exercise, Musculo-skeletal. FUNDING
a small number of included studies and variability in the outcomes ACKNOWLEDGEMENTS: D.S is a postdoctoral fellow of IRSC
measured. Improvements among individual studies were reported Canada and T.T. is a postdoctoral fellow of F.W.O. Vlaanderen.
for outcomes of inspiratory muscle endurance, inspiratory muscle CONTACT: [email protected]
strength and anxiety and depression. IMPLICATIONS: Studies to ETHICS COMMITTEE: ethics committee of Gashuisberg hospital
date provide limited evidence to support the benefits of IMT for (Universitaire ziekenhuizen leuven, Belgium)
adults with stable CF. IMT may improve inspiratory muscle function,
however, the benefit of IMT towards inducing other training effects
that impact activities of daily living and quality of life requires further
investigation. Important future areas of study include exploring criteria 02-19 Monday 4 June 10:30
for selecting patients with CF who might benefit from IMT and, the VCEC Exhibit Hall B & C
impact of IMT on measures of daily function and health related SHORT AND LONG TERM OUTCOME OF CARDIAC
quality of life. REFERENCES: Dejong et al. Resp Med 2001;95:31- REHABILITATION PROGRAM: A PROSPECTIVE COHORT STUDY
36; Enright et al. Chest 2004; 126:405-411. KEYWORDS: inspiratory Neeleman-van der Ste K1,2 , Hendriks H1,2 , Hoeps K3 ,
muscle training; respiratory muscles; obstructive lung disease. Schieferstein J3 , Bernards A1,3 , de Bie R2 ; 1 Dutch Institute of Allied
FUNDING ACKNOWLEDGEMENTS: Funding for this research was Health Care (NPi); 2 Centre for Evidence Based Physiotherapy
provided by the Ontario Lung Association and the Canadian Lung (CEBP) Maastricht University, Department of Epidemiology;
Association. CONTACT: [email protected] 3 University of Arnhem and Nijmegen (HAN), Department Physical
Therapy
Research Report Poster Display PURPOSE: To determine short and long term benefit of physical
02-15 Monday 4 June 10:30 therapy care as part of a multiprofessional cardiac rehabilitation
VCEC Exhibit Hall B & C program according the Dutch multi- and monodisciplinary clinical
EFFECT OF A TRAINING SESSION ON CONTRACTILE FATIGUE practice guidelines. RELEVANCE: Cardiovascular diseases are the
IN PATIENT WITH COPD number one cause of death in the Netherlands. The amount of
patients to be referred to a multidisciplinary cardiac rehabilitation
Saey D1 , Troosters T2 , Gosselink R3 , Gielissen S3 , Knoops A3 ,
program increases enormously in the last decade. The benefits
Decramer M1 ; 1 Department of Pulmonology, University Hospital
of exercise training for subjects with cardiac problems short time
Leuven, Leuven, Belgium; 2 Research Centre for Cardiovascular
after surgery are well established in general, but little is known
and Respiratory Rehabilitation; 3 Faculty of Kinesiology and
about effects of rehabilitation for subjects treated according the
Rehabilitation Sciences
Physical Therapy Guidelines on short as well as long term
PURPOSE: Contractile fatigue may occur after acute exercise in after the program. PARTICIPANTS: Subjects older than 18 years
patients with chronic obstructive pulmonary disease (COPD) and with (acute) myocardial infarction, coronary artery bypass grafting,
may limit exercise performance. However, the effect of a training percutane transluminal coronary angioplasty, heart valve surgery and
session on contractile fatigue is still unknown and could influence corrected congenital cardiac diseases, referred for phase II cardiac
the response to rehabilitation in patients with COPD. The purpose rehabilitation were included. Exclusion criteria were: other cardiac
of this study was to determine whether contractile muscle fatigue diseases, insufficient knowledge of Dutch language and not able to
occurs after a training session in patients with COPD. RELEVANCE: conduct ergometry or treadmill testing. Permission was obtained by
A clinical perspective of this study is to investigate the prevalence and written informed consent. METHODS: Immediately after publication
the role of muscle fatigue during a rehabilitation program in COPD. the Dutch Clinical Practice Guidelines for Physical Therapy in Cardiac
PARTICIPANTS: Fourteen patients with moderate to severe COPD Rehabilitation, they were implemented in five cardiac rehabilitation
(FEV1: 39±17% of predicted) involved in an outpatient rehabilitation centers by two-day training sessions. Subjects were asked to
program for one month performed a standard rehabilitation training participate directly after referral. Physical therapy treatment was
session including walking, knee extension, stair climbing and cycling. based on patient specific purposes and consists of one or more
METHODS: Maximal voluntary contraction (MVC) and quadriceps modules following the guidelines (exercise, information, psycho-
potentiated twitch force (Twq) measured by magnetic stimulation, educational, relaxation). Data (subject characteristics, diagnosis
were evaluated before and 15 minutes after training session. Muscle including risk factors treatment, post-rehabilitation, after care and the
fatigue was defined as a fall in Twq15% baseline value. ANALYSIS: Patient Specific Complaints questionnaire (PSC)) were collected at
Results are reported as mean ± SD. A statistical level of significance the start of rehabilitation (T0), end of the rehabilitation program (T1;
of 0.05 was used for all analyses. A paired t-test was used to short term) and three years after rehabilitation (T2; long term). A PSC
test the significance of changes in MVC and Twq with training. consist of three visual analogue scales. Subjects choose three daily
Association between variables was evaluated using a Pearson’s activities (in which they are most limited at T0) to score at T0, T1
and T2. ANALYSIS: Collected data are described presenting means (6.0±3.8 days) than for Group A (6.7±4.8 days). The time taken
± SD. Differences are analyzed using paired t-tests. RESULTS: to the walking for 20m was shorter in Group B (4.25±1.0days)
Participants (n=88) mean treatment duration was 7.5±3.5 weeks (T0- than for Group A (4.76±1.0days).There was no significant difference
T1) and mean follow up was 3.2±0.3 year (T1-T2). PSC-scores were between the groups for the number of patients with atelectasis
3.1 better at T1 than T0 (2.6±1.7 versus 5.7±2.3: p0.05). Long or the length of hospital stay. CONCLUSIONS: The addition of
term result slightly decreased 0.6 (T2: 3.2±2.2) (P0.05). Subjects early mobilisation to chest physiotherapy had a beneficial effect
with many (3-7) risk factors tend to have worse long term PSC- on reducing the need for supplemental oxygen in these patients.
scores than subjects with few (0-2) (T2: 3.9±2.8 versus 3.3±2.6), but These outcomes support the benefits of early mobilization as part of
differences are not significant. Subjects with Diabetes (4.3±2.5) and post operative physiotherapy management. IMPLICATIONS: Early
inactive subjects (4.2±2.4) have worse PSC-scores than subjects mobilisation is effective for oxygenation. This effect will reduce
without Diabetes (2.9±2.1) and active subjects (2.8±2.1) (p0.05). chest complications.We are confident that the further study for
CONCLUSIONS: Subject specific activities at long term follow up physiotherapy undergoing major surgery patients will prove the result
are strongly better than at the start of rehabilitation, however, they of this syudy. We will research increase number of patients further.
rather decrease at long term compared to short term outcome, but KEYWORDS: postoperative physiotherapy, mobilisation, esophagec-
are still considerable and significant. Subjects with many risk factors tomy. FUNDING ACKNOWLEDGEMENTS: The author would like to
have worse long term results than patients with few. Maintenance of thank Chief surgeon.Masakazu Takagi,Shizuoka General Hospital,for
active lifestyle is major factor for long term success. IMPLICATIONS: his advice. CONTACT: [email protected]
Health care providers role in after care programs is to inform and ETHICS COMMITTEE: The present study was approved by
educate subjects about the impact of risk factors on health, the the Shizuoka General Hospital Institutional Committee on Human
importance to continue risk management, including advise and assist Research.
about movement programs, and to monitor sudden decreases in
individual complaints and activities. KEYWORDS: Cardiac rehabil- Research Report Poster Display
itation guidelines. FUNDING ACKNOWLEDGEMENTS: This study
was supported by the Netherlands Heart Foundation and the Royal
Dutch Physical Therapy Association.
ETHICS COMMITTEE: The Medical Ethics Committee of Deventer EXPECTATIONS OF CLINICAL INSTRUCTORS WITH REGARDS
Hospital and Rehabilitation Foundation Limburg/Hoensbroeck Reha- TO STUDENT CLINICAL PERFORMANCE
bilitation Centre granted permission. Reus L; University of Puerto Rico
PURPOSE: Describe expectations and experiences of clinical
Research Report Poster Display instructors with regards to the clinical performance of master’s entry-
02-23 Monday 4 June 10:30 level students enrolled in a physical therapy program. RELEVANCE:
VCEC Exhibit Hall B & C Research findings based on the clinical faculty perceptions are
THE EFFECT OF MOBILISATION ON THE MANAGEMENT OF fundamental for the development, design and implementation of the
PATIENTS FOLLOWING OSEAPHAGECTOMY clinical education component of the curriculum. PARTICIPANTS:
Nineteen active clinical instructors who complied with established
Ogiso H, Takagi M, Ishii Y, Sibuya T, Suzuki K, Masuda T;
eligibility criteria participated in the study. METHODS: A qualitative
Shizuoka General Hospital, 4-27-1 Shizuoka City 4200881, Japan
design was used. Four focus groups were conducted following a
PURPOSE: To compare the outcomes of early mobilization in systematic protocol: demographic data was collected from each
addition to chest physiotherapy with chest physiotherapy alone in participant; all sessions were recorded with additional notes taken by
the management of patients post oesaphagectomy. RELEVANCE: an assistant moderator; questions were sequenced by the moderator
The establishment of an effective method to reduce compli- to allow maximum insight; a recall of the performance instrument
cations is regarded as an important problem in physiotherapy. components and dimensions was done by the moderator; electronic
PARTICIPANTS: Random sampling. Patients have randomized by recordings were transcribed to allow for reconstruction of critical
surgeon. METHODS: Forty patients undergoing oesaphagectomy parts of the focus groups during the analysis phase; debriefing
were enrolled into a prospective randomized controlled study. There between moderator and assistant moderator ocurred immediately
were no differences in mean age, preoperative respiratory function after the interviews; the researcher shared preliminary reports with
tests, body mass index or time under anaesthetic. All patients participants. ANALYSIS: A transcript-based analysis was used and
received standardised instructions on deep breathing exercises and a consisted of examining and categorizing the evidence and identifying
demonstration of post-operative chest physiotherapy. Post-operative important themes expressed by participants. The transcripts, coupled
chest physiotherapy consisted of modified postural drainage and with the observer notes, provided rich descriptions of constructs
breathing exercises. Twenty patients (Group A) had post-operative verified by participants. RESULTS: Important themes emerged from
chest physiotherapy supervised twice daily by the physiotherapist. the analysis: Students exhibit appropriate theorical foundations
The other 20 patients (Group B) were randomised to receive the and require supervision with regards to clinical skills and the
chest physiotherapy twice a day as well as instructions on the psychomotor domain irrespectively of the level of clinical practice.
importance of early mobilisation and high sitting at 70º for 30 Clinical instructors described and contextualized different levels
minutes at a time. Mobilisation and high sitting was done twice in of supervision of the students’clinical performance. Contextual
the morning and twice in the afternoon. We made a guideline for descriptions and differentiations by clinical instructors were related
early mobilisation and high sitting at 70º. This guideline consist of to performance areas such as safe practice, needed levels of
vital signs (ECG,BP,SpO2,dizziness, etc) Outcome measures were, supervision and complexity of the enviornment. Students require
the ratio of partial pressure of arterial oxygen/oxygen concentration clinical instruction and supervision in particular areas unknown to
(PaO2/FiO2) taken early morning on postoperative day 3; time on them or with limited exposition. A consensus was evidenced with
oxygen; incidence of atelectasis noted on chest X-ray; and days regards to changes in degree of monitoring as student progresses
to discharg.The time taken to the walking for 20m. ANALYSIS: A through-out the clinical education experience. Clinical instructors
non-paired Student’s t-test was used to compare the data between expressed high expectations with regards to red flag items labeled
the two groups. Significance was set at p < 0.05. RESULTS: The in the clinical performance instrument; they allow for student skill
PaO2/FiO2 ratio (mean ± standard deviation) was significantly higher development through-out the clinical experience. Upon the students’
for Group B (164.1±49.8) than for group A (148.7±64.8) p < 0.02. final week of clinical practice, irrespectively of the level of practice, the
The duration of supplemental oxygen was shorter for Group B clinical instructors’ expectations reflected an entry-level performance,
particularly in the areas of education, patient management and amongst the 28 behaviours received for round 1. Round 2 achieved
professional conduct. The development of patient goals is a critical good consensus enabling 21 agreed very important behaviours to
area which requires close supervision during the first three to four be taken into round 3. The ranking process in round 3 afforded good
weeks of full-time clinical practices, and guidance during the final consensus(W=0.200, df20, p < 0.001)and highlighted the importance
week of the clinical experiences. The performance dimensions of of for example, a critical approach to practice. The case study
quality, supervision, efficiency and complexity of tasks emerged as facilitated further insight into the construct by identifying advanced
the most discussed dimensions. A consensus was evidenced with clinical reasoning as the most important behaviour for the specialist
regards to the use of support personnel; students must delegate physiotherapy. This was then subdivided into core components for
tasks to enhance effective, efficient and safe physical therapy example, adaptability of practice. CONCLUSIONS: The general
patient care. CONCLUSIONS: The contextual aspects emerged as behaviours agreed by course leaders were also reflected in the
fundamental in the exploration of the clinical performance evaluation findings from the case study, with the case study data exploring
of master’s entry-level students. Rich descriptions of critical and the key behaviours further as specific components of specialist
essential expected behaviors during clinical education experiences practice. IMPLICATIONS: Through methodological triangulation, this
emerged. IMPLICATIONS: Delivery of physical therapy services study has identified behaviours indicative of the construct of Masters
to particular populations and its relationship with specific contexts level clinical practice in general terms and for a specialist area. It
require further research to allow more profound discussion with would be valuable to develop this work further by exploring several
regards to students’clinical performance and challenges of the cases to enable analytic generalization, and to evaluate the variation
clinical education experiences as perceived by clinical educators. across different specialities and different countries. KEYWORDS:
KEYWORDS: Expectations; clinical performance evaluation; clinical Masters, specialist, clinical. FUNDING ACKNOWLEDGEMENTS:
instruction. FUNDING ACKNOWLEDGEMENTS: The research was School of Health Sciences, University of Birmingham, UK and Ma-
sponsored by the Uiversity of Puerto Rico College of Health Related nipulation Association of Chartered Physiotherapists, UK. CONTACT:
Professions at the Medical Sciences Campus. [email protected]
ETHICS COMMITTEE: Institutional Review Board of the Office of ETHICS COMMITTEE: School of Health Sciences, University of
Research at the University of Puerto Rico Medical Sciences Campus Birmingham, UK

AN EXPLORATION OF THE CONSTRUCT OF MASTERS LEVEL IMPLEMENTATION OF NEEDS-BASED INTERACTIVE
CLINICAL PRACTICE CONTINUING EDUCATION FOR RURAL PHYSIOTHERAPISTS
Rushton A; University of Birmingham, Birmingham, UK WITH ENHANCED ACCESS: A CASE STUDY
Schoo A1 , McNamara K2 , Stagnitti K3 , Dunbar J1 ; 1 Greater
PURPOSE: This study explored the behaviours indicative of the
Green Triangle University Department of Rural Health, Flinders
construct of Masters level clinical practice. RELEVANCE: Growing
and Deakin Universities; 2 School of Pharmacy, Monash University;
emphasis on Masters level provision worldwide continues to be 3 Occupational Science and Therapy, Deakin University
facilitated by the migration of education into Universities and the
requirement for Continuing Professional Development. Paralleling PURPOSE: This study evaluated the usefulness of a rural Continuing
this has been the development of specialisation in clinical practice. Education (CE) program that incorporated interactivity as well as
These factors have contributed to a proliferation of Masters courses the delivery of education. RELEVANCE: Mandatory professional
aiming to develop specialist clinical practice. PARTICIPANTS: A total development, effective and evidence-based practicing, enhanced
population sample of all course leaders of Masters courses in the rural career options and workforce retention require access to CE.
UK assessing clinical practice (n=48) were invited to participate in Interactive and adult learning formats have been effective for CE.
a Delphi survey, with 38 participants agreeing. Purposive sampling PARTICIPANTS: All physiotherapists (n = 75) in south west Victoria
selected the ‘case’ of a specialist physiotherapy course within one were invited to participate in the CE program. The 2004/2005 CE
university. METHODS: The study is framed within the philosophical program for physiotherapists was developed on the basis of findings
tradition of phenomenology. It used a mixed methods approach of two professional needs surveys. Results showed preference for
combining quantitative and qualitative data, using methodological CE on Wednesdays early in the evening and for musculoskeletal
triangulation to contribute to an understanding of the construct. topics more than neurological or cardiothoracic topics. In addition to
The conceptual framework was informed by two prior stages: a workshop program conducted in a central regional town, evidence-
a critical analysis of the literature relating to clinical education, based research skills and clinical management training was also
and a descriptive survey of current practice in Masters courses offered on-site. The 2005/2006 program offered access to video
aiming to develop clinical expertise. Consensus of Masters level conferencing technology (VCT) with 384kbps-bandwidth. METHODS:
behaviours indicative of the construct was explored through a A questionnaire was sent to each physiotherapist to assess the
Delphi survey. Round 1 asked for behaviours indicative of the relevance of the 2004/2005 program. Primary outcomes were
construct. In addition, an in-depth case study using multiple methods attendance, perceived clinical relevance and efficacy. A secondary
from the qualitative paradigm, including documentary analysis, semi outcome was the perceived effect on clinical skills. Each CE session
structured interviews, and participant observation was employed. was evaluated using 7-point Likert scales. VCT users (n-15) during
ANALYSIS: Data from round 1 of the Delphi were analysed through 2005/2006 were sent a fourth survey to explore acceptance of
content analysis, which subsequently informed the behaviours in VCT for the delivery of CE. ANALYSIS: Descriptive statistics using
round 2, where participants rated the importance of each behaviour Excel (Microsoft) and SPSS statistics packages. RESULTS: Modes
on a scale of 1-5. Round 3 asked participants to rank the importance and median scores were 7, with seven being rated as highly
of the different behaviours to the construct. Descriptive analysis and successful. Measurement of attendance showed that more than
the use of Kendall’s coefficient of concordance enabled interpretation two-thirds (68.6%) attended at least one workshop conducted in a
of consensus in rounds 2 and 3. For the case study, analytic local clinic, 57.2% attended four or more sessions in the centre
categories were derived from the data using a constant comparative of the region and 22.9% attended at least one of the two courses
process until saturation of the data were achieved. Theoretical conducted in 2004/2005. Moreover, 68.6% reported that attending
propositions were then developed. RESULTS: The response rate the program had made some effect on their therapeutic skills
for the Delphi study was very good. There was good consensus and 20% perceived a large effect. The fourth survey (2005/2006
VCT users) showed that most participants reported increased CE reported they followed through on some or all of the items on their
participation rates due to VCT and 4-5 CE sessions were attended reflection learning plans. A small percentage, (12%) disagreed that
(mean 4.7) using this medium. The maximum distance prepared the exercise of completing weekly reflections facilitated their ability
to attend CE by VCT (20-100km) and proportion of CE requested to direct their own learning and improve their performance. The
via VCT (20-80%) varied. There was 100% agreement on the SDLRS significantly improved over the internship (mean difference
satisfactory standard of CE via VCT and participants intended to 6.8±9.9; p<0.05). It took an average of 7 minutes for faculty
increase utilisation of VCT. Some found that face-to-face attended to review each student’s reflection and the students reported no
CE was slightly more beneficial than VCT, others perceived no significant electronic difficulties during the study. CONCLUSIONS:
difference. Reported VCT problems relate to sound, overheads, and This study demonstrated that an electronic reflective practice exercise
learning practical skills. CONCLUSIONS: Needs based interactive during a 3 week clinical internship was feasible and positively
CE was well supported by the rural physiotherapists and perceived impacted the learners’ perceived reflective practice skills and self
as clinically useful. VCT was perceived as an acceptable method directed learning readiness. Future directions include following
to increase attendance. IMPLICATIONS: Use of adult learning the depth of their reflections and SDLRS measure across the
principles, an interactive workshop format, VCT broadcasts at a curriculum. IMPLICATIONS: Simple electronic reflective practice
minimum frequency of 384kbps, and including VCT users seem exercises can benefit reflective practice skill development as required
to have benefited the rural physiotherapists. Further studies are for practice. Feedback from students’ peers can be utilised to facilitate
needed to establish the effect of CE on clinical practice. Findings reflective practice skill development in students. KEYWORDS:
can not be generalised to other professions or to physiotherapists in reflective practice, education. FUNDING ACKNOWLEDGEMENTS:
non-rural areas. KEYWORDS: Continuing education, adult learning, This project was supported by the Department of Physical Therapy.
videoconference technology. FUNDING ACKNOWLEDGEMENTS: Dina Brooks is supported by the CIHR New Investigator Award.
Victorian Department of Human Services in Australia. CONTACT: CONTACT: [email protected]
adrian.schoo@flinders.edu.au ETHICS COMMITTEE: University of Toronto Health Sciences II
ETHICS COMMITTEE: Flinders University Social and Behavioural Research Ethics Board
VCEC Exhibit Hall B & C LOW-LEVEL LASER IRRADIATION PROMOTES THE RECOVERY
IMPACT OF AN ELECTRONIC REFLECTIVE PRACTICE FROM DISUSE MUSCLE ATROPHY IN RATS
EXERCISE ON SELF-DIRECTED LEARNING AMONG PHYSICAL Nakano J1 , Okita M2 , Araki K3 , Kataoka H4 , Sakamoto J4 ,
THERAPY STUDENTS Yoshimura T1 ; 1 Nagasaki University Graduate School of Health
Mori B1,2 , Batty H2,3 , Brooks D1 ; 1 Department of Physical Sciences, Nagasaki, JAPAN; 2 Faculty of Care and Rehabilitation,
Therapy, University of Toronto, Toronto, Canada; 2 Centre for Faculty Seijoh University, Nagoya, JAPAN; 3 Department of Rehabilitation,
Development, University of Toronto, Toronto, Canada; 3 Department Nagasaki KITA Hospital, Nagasaki, JAPAN; 4 Department of
of Family and Community Medicine, University of Toronto, Toronto, Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, JAPAN
Canada
PURPOSE: It is known that Low-level laser (LLL) irradiation
PURPOSE: To evaluate the feasibility of an electronic reflective promotes the regeneration of blood capillaries. Recent research has
practice exercise during a clinical internship and assess its effect demonstrated that LLL irradiation also induces muscle satellite cell
on students’ reflective practice skills and self-directed learning proliferation in vitro. Muscle satellite cells and capillaries play an
readiness. RELEVANCE: A goal of Physical Therapy curricula is important role in the growth and regeneration of muscle. The aim
to facilitate development of future health care professionals who of this study was to investigate the effect of LLL irradiation on the
will demonstrate reflective practice, as demonstrated by their ability recovery from disuse muscle atrophy in a rat model. RELEVANCE:
to accurately self-assess, identify their learning gaps and direct The biostimulating effects of LLL irradiation, particularly on muscle
their own learning. Students need the opportunity to develop these tissue, are still unclear. This study provides information on the effects
skills during their curriculum. PARTICIPANTS: Eighty-four MScPT of LLL irradiation on muscle tissue. PARTICIPANTS: Ten adult male
Physical Therapy students completed a weekly reflection paper rats, aged seven weeks, were randomly divided into two groups: the
within their first 3 week clinical internship. METHODS: Following normal condition (NC, n = 5) group and the hindlimb suspension
ethics approval from the University of Toronto Health Sciences II (HS, n = 5) group. METHODS: In the HS group, disuse muscle
Research Ethics Board, a pre-post intervention study was employed. atrophy was induced by HS for 14 days. Over the same period,
Students were asked to write a reflective piece and submit it the rats of the NC group were raised normally. After 14 days, the
electronically on three occasions: week 1, week 2, and week HS treatment was discontinued. All the rats in both groups then
3. The first reflection was reviewed by faculty, the second by received LLL irradiation to the right gastrocnemius (experimental
a peer, and the third was self-reviewed. Three main outcomes side) through the skin, whilst under anesthesia. The LLL irradiation
were assessed: first, faculty rated the depth of reflection papers; (Ga-Al-As; 830 nm, 60 mW, 3 min) was repeated daily during
second, a reflective practice exercise survey was completed by the normal rearing over 14 days. One hour before the administration
students upon completion of the internship; third, the self-directed of LLL irradiation, 5-bromo-2’-deoxyuridine (BrdU, 40 mg/kg) was
learning readiness scale (SDLRS) was completed pre- and post- injected subcutaneously for the labeling of the nuclei of proliferating
internship. ANALYSIS: Frequency distributions were used to analyse cells. The left gastrocnemius (control side) was treated as the
the results from the survey. A paired t-test was used to analyse control in both groups. At the end of the experimental period, the
the results from the SDLRS. RESULTS: All 84 students completed gastrocnemius were extracted. The muscle tissue was divided into
the reflective practice exercise. Sixty-six students completed the red gastrocnemius (deep layer) and white gastrocnemius (superficial
survey and 17 completed the SDLRS pre- and post-internship. Initial layer) and these were examined separately. In a histochemical
reflection papers were rated at a descriptive (23%), descriptive- examination, the muscle fiber diameters of each fiber type were
analytical (28%) or analytical level (33%). Eighty-six percent rated measured and the number of capillaries was counted. The nuclei
faculty feedback as helpful and 92% rated peer feedback as helpful. that incorporated BrdU were localized by immunohistochemistry
Students reported they were confident (99%) with the reflective and the BrdU-positive nuclei of the muscle cells and satellite cells
practice process for their third reflection. Importantly, 97% of students were counted. The experimental protocol was approved by the
Ethics Review Committee for Animal Experimentation of Nagasaki study revealed that nine sessions of LLLT in addition to exercise
University (Nagasaki, Japan). ANALYSIS: Statistical analyses were is effective in the management of lateral epicondylitis in pain relief
performed using a one-way analysis of variance with multiple and improving the grip strength and subjective rating of physical
comparisons. RESULTS: In the white gastrocnemius of the HS and function in short term and 3-week follow-up period. IMPLICATIONS:
NC groups, the number of capillaries on the experimental side had This study provides evidence that LLLT is effective for the
increased significantly compared with that on the control side. In the management of lateral epicondylitis. KEYWORDS: low level laser
red gastrocnemius of the HS group, the number of BrdU-positive therapy, lateral epicondylitis. FUNDING ACKNOWLEDGEMENTS:
nuclei on the experimental side had increased significantly compared None. CONTACT: [email protected]
with that on the control side. In the red and white gastrocnemius ETHICS COMMITTEE: The Hong Kong Polytechnic University
of the HS group, the muscle fiber diameters on the experimental
side had increased compared with those on the control side. In
contrast, the muscle fiber diameters in the NC group did not differ
between the experimental and control sides. CONCLUSIONS: The
results of this study suggest that LLL irradiation can promote the Research Report Poster Display
recovery from disuse muscle atrophy and that this mechanism is 10-03 Monday 4 June 10:30
related to the proliferation of muscle satellite cells and capillaries. VCEC Exhibit Hall B & C
IMPLICATIONS: Low-level laser therapy can be considered as one ELECTROMYOGRAM IN MANUAL MUSCLE TESTING OF A
of the potential approaches to the treatment of atrophied muscles. TRUNK FLEXOR
KEYWORDS: Low-level laser, muscle, disuse atrophy. FUNDING
ACKNOWLEDGEMENTS: The funding source of this study was the Kasahara S1 , Ishigaki T2 , Takahashi M1 , Miyamoto K1 ; 1 Dept. of
General Research Fund of Nagasaki University (Nagasaki, Japan). Health Sci., Hokkaido Univ. Sch. of Med.; 2 Dept. of Rehabiritation,
CONTACT: [email protected] YamanotedoriYagi Hospital
ETHICS COMMITTEE: Our experimental protocol was approved
by the Ethics Review Committee for Animal Experimentation of PURPOSE: Muscle strength in patients with the physical impairment
Nagasaki University (Nagasaki, Japan). is usually evaluated clinically using manual muscle testing (MMT).
The method of the detection and grading of the muscle weakness
of the trunk muscle using MMT is different from that of the
Research Report Poster Display limbs. To clarify the evidence of the grading of the trunk flexor in
08-19 Monday 4 June 10:30 MMT, we examined by the analysis with electromyogram (EMG).
VCEC Exhibit Hall B & C RELEVANCE: This study relates to the physical therapy practice
EFFECTS OF LOW-LEVEL LASER THERAPY IN THE based on the evaluation of muscle strength. PARTICIPANTS: Ten
MANAGEMENT OF LATERAL EPICONDYLITIS: A RANDOMIZED healthy volunteer males with a mean age of 20 years participated.
CONTROLLED TRIAL Informed consent was obtained from each subject. METHODS: The
surface EMG activity was recorded from rectus abdominis (RA).
Cheing G1 , Lam L2 ; 1 Department of Rehabilitation Sciences, The
Hong Kong Polytechnic University; 2 Physiotherapy Department, In current study we examined three gradings of the trunk flexor
Queen Elizabeth Hospital, Hong Kong during using Daniel’s method and Kendall’s method: (1) Normal,
(2) Good, and (3) Fair. ANALYSIS: The raw data of EMG from
PURPOSE: Lateral epicondylitis is a common musculoskeletal RA was rectified and calculated the integration value (IEMG). Then
pain condition characterized by inflammatory response induced by the percentage of the maximum voluntary contraction (%MVC) was
overuse of the tendon with an association of fibroblastic and vascular calculated. The muscle activity of Rectus femoris (RF) in MMT also
degeneration. The clinical features are pain and tenderness over were calculated to compare with that of RA. Sampling rate was
the lateral elbow, which may also result in reduction in grip strength 1Kz. The mean and standard deviation was compared between
and impairment in physical function. The objective of the study was gradings of each method. Student-t test was used to compare
to examine the effectiveness of 904nm low-level laser therapy in the significant difference. The required %MVC for each grading
the management of lateral epicondylitis. RELEVANCE: Low level was compared with one-way ANOVA. The significant level was
laser therapy (LLLT) has been shown effective in its therapeutic p < 0.05. RESULTS: The value of %MVC during using Daniel’s
effects in tissue healing and pain control. Recent clinical trials also method was 64.4±18.5 (Normal), 54.6±20.9 (Good), and 50.5±20.5
showed its efficacy in the management of this condition in reducing
(Fair). The value of %MVC during using Kendall’s method was
pain and improving grip strength and subjective rating of physical
32.7±14.1 (Normal), 36.0±13.5 (Good), and 30.9±16.9 (Fair). In
function. Various studies have been done but controversial findings
both methods there was no significant difference for the value of
were reported. In particular, there is a lack of common consensus on
%MVC between grading of the trunk flexor. The value of %MVC
the choice of optimal treatment parameters. PARTICIPANTS: Thirty-
during using Daniel’s method consistently showed larger than that
nine subjects suffering from lateral epicondylitis were recruited in
during using Kendall’s method (p < 0.05). There was a significant
the study. METHODS: A randomized, single-blind, placebo-controlled
clinical trial was carried out. Subjects were randomly assigned to difference for the value of %MVC between grading in RA and
receive either active (laser group) or sham irradiation (placebo group) RF (p < 0.05). CONCLUSIONS: This research verified evaluation of
treatment for 9 sessions. All subjects received a standardized home the trunk flexor in MMT using EMG for the healthy youth male.
exercise program. The outcome measures including mechanical pain From these results, it is shown that there is no change of the
threshold, maximum grip strength, pain at maximum grip strength muscle activity in the grading of MMT used for the muscle strength
using Visual Analogue Scale (VAS) and the subjective rating of evaluation of the trunk flexor in the youth male. Clinicians should
physical function using the Disabilities of the Arm, Shoulder and carefully estimate the muscle weakness in the trunk flexor using MMT.
Hand (DASH) questionnaire were assessed at Session 1 (baseline), IMPLICATIONS: This study provided a problem as estimating the
Session 5, Session 9 (last treatment session) and 3 weeks after the trunk muscle weakness by using the clinical method. Therefore,it is
treatment completed. ANALYSIS: Repeated measures ANOVA was possible that the muscle strength evaluation by using MMT affect the
used. RESULTS: Significantly greater improvements were seen in plan and effect of physical therapy training. KEYWORDS: MMT, Trunk
all outcome measures with the laser group than with the placebo Flexor, Evaluation. FUNDING ACKNOWLEDGEMENTS: Unfunded.
group in all subsequent sessions (p < 0.0125), except in the two sub- CONTACT: [email protected]
sections of DASH, which was found no significant difference until ETHICS COMMITTEE: The Ethical Committee of the College of
at the 3-week follow-up session (p = 0.002). CONCLUSIONS: This Medical Technology at Hokkaido University.
GLUTEUS MAXIMUS ACTIVATION DURING FOUR MODALITIES COMPARISON OF FOOT-GRASPING FUNCTION AND
OF THERAPEUTIC EXERCISE QUADRICEPS FEMORIS MUSCLE FUNCTION BETWEEN THE
Teixeira-Salmela L, Sakamoto A, Goulart F, Faria C, Guimarães C, DOMINATE AND NON-DOMINANT LEG
Gomes P; Department of Physical Therapy, Universidade Federal Tanaka S1 , Murata S2 , Kai Y3 ; 1 kokura Rehabilitation School;
de Minas Gerais 2 Department of Physical Therapy, Faculty of Health Care Science,
PURPOSE: To evaluate the electromyographic (EMG) activity of Himeji Dokkyo; 3 Technical School of Medical and Welfare
the gluteus maximus muscle during four modalities of therapeutic Ryokuseikan
exercise, often employed in clinical practice. RELEVANCE: The PURPOSE: While the superiority of the dominant hand is obvious,
gluteus maximus acts effectively in the transfer of loads from the evaluation of the superiority of the dominant foot or leg has been
pelvis to the lower limbs, contributing to the stability of the sacroiliac insufficient. In this study, we defined the leg with which one kicks
joint. Many studies have shown reduced activity of this muscle in the ball (functional limb) or takes off in the broad jump (weight-
patients with low back pain. Therefore, it is important to know which bearing limb) as the dominant limb, and the quadriceps femoris
are the best exercises to activate this muscle. PARTICIPANTS: muscle strength, foot-grasping strength, and times to their peaks
Thirty-one healthy young subjects (16 men and 15 women, aged were compared between the dominant and non-dominant legs.
24.5±3.47 years) were recruited from the community. METHODS: RELEVANCE: Comparison of the lower limb functions between the
EMG activity of the gluteus maximus was recorded as the subjects dominant and non-dominant legs clarifies the objective of lower limb
performed four modalities of therapeutic exercise, involving active physiotherapy, and makes effective physiotherapeutic approaches
prone hip extension at four positions: with knee extension, knee possible. PARTICIPANTS: Thirty bilateral lower limbs of 15 healthy
flexion, lateral hip rotation and knee extension, and lateral hip adult males (mean age22.4±5.7years, mean height 170.2±5.4 cm,
rotation and knee flexion. All exercises were randomly assigned and mean weight62.3±8.7kg) were studied. METHODS: The quadriceps
three trials were obtained for each modality with a two-minute rest femoris muscle strength and time to its peak were measured using a
interval between trials. The amount of EMG activity of the gluteus BIODEX3 (Sakai Medical Co., Ltd.). The foot-grasping strength and
maximus was recorded with active, bipolar surface electrodes. The time to its peak were measured with our original foot-grasping force
EMG signals were full wave rectified and low-pass and high-pass meter (ICC = 0.953). ANALYSIS: The quadriceps femoris muscle
filtered with cut-off frequencies of 500 and 10Hz, respectively, and strength, foot-grasping strength, and times to their peaks were
were recorded at the sampling rate of 1,000Hz. The maximum compared between the dominant and non-dominant legs by paired
voluntary isometric contraction (MVC) from the gluteus maximus was t-test. RESULTS: Comparison between the functional and non-
used to normalize EMG data. ANALYSIS: Descriptive statistics and functional limbs showed no significant difference in the quadriceps
tests for normality and homogeneity of variance were calculated femoris muscle strength (147.7±26.5Nm, 137.3±24.5Nm) or time to
for all outcome variables. Repeated measures ANOVAs followed its peak (0.24±0.08sec, 0.23±0.06sec). There was also no significant
by pre-planned contrasts were used to investigate differences in difference in the foot-grasping strength (17.3±4.9kg, 17.4±5.1kg)
the amount of gluteus maximus activity (%MVC) during the four or time to its peak (0.7±0.3sec, 0.6±0.2sec). Comparison between
modalities of exercise, at a significance level of a<0.05. RESULTS: the weight-bearing and non-weight-bearing limbs showed no sig-
The analysis revealed that the gluteus maximus showed the highest nificant difference between the quadriceps femoris muscle strength
MVC activity during the exercises performed with knee flexion (142.2±24.6Nm, 142.7±27.5Nm), time to its peak (0.22±0.06sec,
(23.1±21.2%), followed by those associated with lateral hip rotations 0.25±0.08sec), foot-grasping strength (16.8±5.35kg, 17.9±4.5kg),
with both knee extension (22.5±10.3%) and flexion (21.2±11.9%). or time to its peak (0.59±0.3sec, 0.7±0.3sec). CONCLUSIONS:
The exercises performed with knee extension were the ones which The absence of a significant difference in the foot-grasping function
showed the lowest levels of EMG activity (12.7±8.6%). In addition, or quadriceps femoris muscle function between the dominant and
significant differences were found only for exercises performed non-dominant lower limbs suggests that the necessary to consider
with knee extension, when compared to those with knee flexion the effect of dominance is small in physiotherapeutic assessment
(p = 0.04), lateral hip rotation and knee extension (p < 0.0001), and or treatment of the lower limbs. IMPLICATIONS: In patients with
lateral hip rotation and knee extension (p = 0.013). These findings unilateral lower limb dysfunction, restoration of the function of the
indicated that both the addition of knee flexion and/or lateral rotation affected limb to the level of the intact limb was suggested to
were effective in activating the gluteus maximus. CONCLUSIONS: be a valid treatment objective. KEYWORDS: dominant legs,foot-
Exercises performed with knee flexion or lateral rotation, or their grasping function,quadriceps femoris muscle function. FUNDING
combination, may be effective choices for activating of the gluteus ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
maximus muscle. The gluteus maximus showed the lowest activation [email protected]
when hip extension was only performed with knee extension.
IMPLICATIONS: This study analyzed gluteus maximus activity
during four modalities of therapeutic exercise and the findings may Research Report Poster Display
contribute to future directions of physical therapy in clinically-based 11-15 Monday 4 June 10:30
practice. KEYWORDS: Gluteus maximus, therapeutic exercises, VCEC Exhibit Hall B & C
electromyography. FUNDING ACKNOWLEDGEMENTS: Brazilian THE CONTRIBUTION OF GOLF TO DAILY PHYSICAL ACTIVITY
Government Agency (CNPq). CONTACT: [email protected] RECOMMENDATIONS
ETHICS COMMITTEE: Ethics Board Committe of the Universidade
Federal de MInas Gerais Kobriger S, Smith J, Hollman J, Smith A; Mayo Clinic Rochester,
MN United States
PURPOSE: Primary purpose was to determine the number of
steps an adult golfer takes during a round of golf and to what
extent this number is influenced by gender and skill level of the
golfer. RELEVANCE: Several authors have promoted the goal of
10,000 steps each day as part of a general physical activity plan.
According to the National Golf Foundation, approximately 26 million
Americans participate in golf. Several studies have established
that regular golf participation may enhance fitness. Quantifying to 0.05. RESULTS: After the intervention period, the persons
the number of steps adults take in a typical 18-hole round will with burnout had significantly improved their balance and walking
assist golfers and health care practitioners in the integration of golf capacity. In addition, significantly lower burnout scores and less sleep
participation into daily physical activity totals in the fight against disturbances were found. CONCLUSIONS: Qi Gong seems to be
obesity. PARTICIPANTS: Forty-two subjects at least 18 years of reasonably efficient in order to improve physical and psychological
age, (12 men and 30 women) aged 30 to 80 years (mean ±SD variables in persons with burnout. IMPLICATIONS: Qi Gong can
age, 55±13 years)with an established United States Golf Association be used by physiotherapists, as a part of rehabilitation program
(USGA)-certified handicap with no medical conditions that precluded for persons with burnout. KEYWORDS: Burnout, physical therapy,
normal golf participation or completion of the study walked three complementary therapies. FUNDING ACKNOWLEDGEMENTS: This
municipal golf courses. METHODS: During each round of golf, study was funded by the Swedish Council for Working Life and Social
subjects wore an electronic pedometer (Omron HJ105, Healthcare, Research, the Västerbotten’s County Council and the Swedish Social
Inc, Bannockburn, Ill) on the subject’s belt or waistband of their Insurance Agency. CONTACT: [email protected]
slacks or shorts. The pedometer was set at zero on the first tee, ETHICS COMMITTEE: The Research Ethics Committee of Umeå
and a reading was recorded after the golfer exited the 9th green. University approved of the study (Um dnr 02-311)
This procedure was repeated on the 10th tee, and the step count
data were recorded when the golfer left the 18th green. Data were
collected in this manner to avoid variability in the golfers’ activities
between the 9th green and 10th tee. ANALYSIS: Post-data collection 13-03 Monday 4 June 10:30
statistical analysis was performed using a mixed-model analysis of VCEC Exhibit Hall B & C
variance to determine whether step counts might vary significantly by DOES THE DIFFERENCE IN CRUTCH LENGTH MAKE ANY
course, age, sex, or handicap. RESULTS: The mean ±SD number EFFECTS ON ENERGY CONSUMPTION AND HANDLING
of steps taken per 18-hole round of golf for all 3 courses was DIFFICULTY?
11,948±1781. CONCLUSIONS: Although individuals vary in their Kurosawa K1 , Ohta H2 , Okuyama F3 , Maruyama H4 ; 1 School
risk factors for disease and daily activity requirements, accumulating of Nursing and Rehabilitation Sciences at Odawara,International
10,000 steps per day while consuming a nutritious diet is likely to lead University of Health and Welfare,Kanagawa Japan; 2 Sakura Hospital,
to improved health. IMPLICATIONS: Despite the observation that Aichi, Japan; 3 Hasuda Nursing Home; 4 School of Health Sciences,
previous research has questioned the intensity of golf in the context International University of Health and Welfare, Tochigi, Japan
of physical exercise, our data clearly indicate that golf partication
can contribute considerably to an overall daily physical activity plan. PURPOSE: In three-point gait and non-weight-bearing (NWB) gait
KEYWORDS: golf, exercise. FUNDING ACKNOWLEDGEMENTS: using standard crutches (Japanese crutch), the experiment was
Funding for the pedometers was provided by the Mayo Clinic Sports undertaken to understand the effect of changes in crutch length
Medicine Center. on Physiological cost index (PCI: indicator of efficiency), probe
ETHICS COMMITTEE: Mayo Foundation Institutional Review Board reaction time (Probe RT: indicator of attentional demand) and Borg
scale. Mullis R, et al. reported that no difference was observed in
energy efficiency between the standard length of forearm crutch and
Research Report Poster Display that length ±2.5cm. Effects of changes in lengths were studied,
11-23 Monday 4 June 10:30 in terms of Probe RT as well as PCI and Borg scale, by making
VCEC Exhibit Hall B & C the length difference of ±4 cm for crutches commonly used in
THE EFFECTS OF QI GONG IN PERSONS WITH BURNOUT Japan. RELEVANCE: The study will make an important reference
material on determining the length of crutches in clinical area.
Stenlund T1 , Slunga Birgander L1 , Lindahl B2 , Ahlgren C3 ;
1 Department of Public Health and Clinical Medicine, Occupational PARTICIPANTS: Eleven healthy college students (11 males 19 to 26
years old) participated in the present study. All were free of neurolog-
Medicine, Umeå University, Sweden; 2 Department of Public Health
ical and orthopaedic disorders. METHODS: Three-point gaits were
and Clinical Medicine, Behavioral Medicine, Umeå University,
done with crutches in standard length and those in standard length
Sweden; 3 Department of Community Medicine and Rehabilitation,
±4cm on treadmill in constant speed (2.5km/hr). The subjects were
Physiotherapy, Umeå University, Sweden
instructed to walk on a treadmill and to say “pa” immediately on recog-
PURPOSE: The aim of this study was to evaluate the effectiveness nizing photo-stimulation (Nihon Koden.co SMP-3100) given from the
of Qi Gong in rehabilitation for persons with burnout. RELEVANCE: front. Probe-RT was measured at the time interval between the photo-
Qi Gong is a complementary therapy, used by physiotherapists in stimulation and vocal response. PCI was calculated by dividing, by
rehabilitation programs for different conditions, e.g. in the care for walking speed, the difference between heart rate on exercise during
the elderly. Persons with burnout report both psychological and walking on treadmill and the heart rate at rest before starting the task.
physical exhaustion. Therefore, Qi Gong could be a useful measure The heart rate was determined by using a Nihon Koden.co.CEC6301
to enhance both their mood and their physical activity. To our heart monitor and counting R-R intervals for 15 seconds, from 3
knowledge, no studies have evaluated Qi Gong for persons with minutes 45 seconds to 4 minutes after the start of walking, and
burnout. PARTICIPANTS: One hundred and thirty-six persons (96 the converted value per minute was used as representative value.
women and 40 men) with a mean age of 41.6 ±7.4 years and ANALYSIS: Effects of differences in lengths of crutches on PCI,
with documented stress related disease and burnout, were invited Probe RT and Borg score respectively were analyzed using variance
to participate in a randomized controlled study – REhabilitation for analysis of repeated measurement. RESULTS: No significant effect
STress related disease and burnout (REST). To be included in of lengths of crutches was observed on PCI (F=0.64, p > 0.01),
the REST study, participants should be 25-55 years of age, have Probe RT (F=2.34, p > 0.01) and Borg score (F-3.24,p > 0.01).
been on sick leave for burnout 25% of their working hours during CONCLUSIONS: It was shown that the length difference of ±4cm in
3-24 months previous to inclusion, and have an average score crutches did not have the effect on efficiency and psychological cost.
4.6 on the Shirom-Melamed Burnout Questionnaire. METHODS: It is clarified that it is important, in applying crutches to patients,
Qi Gong in groups, led by a physiotherapist trained in Qi Gong, to adjust crutch height for patients to handle easily, but that some
were held once a week during one year. Data on burnout, sleep centimeters difference in the height does not have to be cared.
disturbances and physical variables were assessed at baseline IMPLICATIONS: These are profitable information for the selection of
and after the intervention period. ANALYSIS: Difference between crutches in clinical. KEYWORDS: crutch length; attentional demand;
baseline data and data after the rehabilitation period were analyzed PCI. FUNDING ACKNOWLEDGEMENTS: The authors would like to
using Students paired T-test. The level of significance was set thank the subjects for their participation in this study.
DEVELOPMENT AND TESTING OF A NOVEL GAIT ANALYSIS ALTERATION IN LOWER LIMB KINEMATICS AND KINETICS IN
SYSTEM USING WIRELESS TRI-AXIAL ACCELEROMETRY AND INDIVIDUALS WITH KNEE OSTEOARTHRITIS DURING STAIR
EMG IN A PORTABLE SYSTEM CLIMBING
Castel C1 , Fujiwara T2 , Palermo F3 , Morozumi K4 , Draper D5 ; Protopapadaki A1 , Drechsler W1 , Cramp M1 , Coutts F2 , Scott O1 ;
1 Accelerated Care Plus Reno NV, USA; 2 The Koriyama Institute 1 University of East London, London, UK; 2 Queen Margaret
for Health Sciences, Koriyama, Japan; 3 Washoe Medical Center University College, Edinburgh, UK
Rehabilitation Hospital, Reno NV, USA; 4 Hachiohji Health
PURPOSE: This study investigated lower limb kinematics and
Cooperative Shiroyama Hospital, Tokyo, Japan; 5 Brigham Young
kinetics during stair ascent and descent in knee osteoarthritic
University, Provo, UT, USA
patients. It was anticipated that individuals with knee osteoarthritis
PURPOSE: A wireless, easy to use gait analysis system, not (OA) would have altered joint kinematics and kinetics during stair
requiring video analysis or force plates, has the potential to provide ascent and descent. RELEVANCE: Comprehensive analysis of knee
an easy to use tool for routine clinical rehabilitation use. We have OA on functional mobility is required to establish primary changes
developed a wireless tri-axial accelerometer and EMG system with a that affect joint function and secondary compensatory actions in
sampling frequency of 1 KHz which can be placed on body for gait the lower limb. To date, few studies have investigated knee kinetics
and movement analysis. The project is a joint collaboration between and kinematics (Hinman et al., 2002; Kaufman et al., 2001 in
The Research Institute of Health Science & Education, Japan and knee OA patients. The aim of this ethically approved study was
Accelerated Care Plus Corp., USA. The purpose of this study is to to monitor changes in hip, knee and ankle angles and moments
develop the instrument and investigate the test-retest reproducibility during stair ascent and descent in knee OA. PARTICIPANTS:
of gait analysis using new wireless type equipment. RELEVANCE: Fourteen patients with knee OA; 6M, 8F, mean (SD), age 66.71
Physical Therapy evaluation for movement and gait is changing from (6.93) years and fourteen elderly healthy subjects 5M, 9F, age 67
static to dynamic, and from two to three dimensions. The need for a (7.58) years with no history of lower limb injuries, back or pelvis
portable telemetry system, which can data download into portable pathology, systemic or neuromuscular disease participated in the
recording media through Bluetooth, was also identified. Tri-axial study. All were able to go upstairs and down stairs without using
accelerometry has been used for movement analysis in the research a handrail. METHODS: The stair case consisted of four steps
literature, however, a wireless tri-axial accelerometer combined with (rise height 18 cm, tread length 28.5 cm). Kinematic and kinetic
EMG and a heel pressure sensor is novel. PARTICIPANTS: 5 healthy data of the lower limb was collected using a ten camera Vicon
male subjects (24-36 years old) participated in this pilot study. We motion analysis system (Oxford Metrics LTD, UK) and one Bertec
obtained the informed consent from all subjects (in accordance Force Platform (Model MIE Ltd, Leeds, UK) positioned on the
with the ethical standards for human medical studies laid down in second stair step. ANALYSIS: Key variables included for analysis
Declaration of Helsinki). METHODS: 5 subjects were measured at were: temporal characteristics, hip/knee/ankle angles, and external
three different gait speeds over a fixed distance during two trials hip/knee/ankle moments, during stair ascent and stair descent.
on sequential days. Each subject was prepared for measurement One way ANOVA was performed to determine possible significant
and the equipment installed. A smooth 12 meter surface was used differences between knee OA patients and controls. Statistical
with three meters at beginning and end of the track to allow for significance was defined as p < 0.05. RESULTS: During stair ascent,
acceleration and deceleration. EMG was measured on the right- subjects with knee OA showed: significantly reduced knee flexion
side Vastus medialis and Biceps femoris long head. The calcaneal angles (p < 0.05), external knee extension moment (p < 0.05), external
pressure sensor used a make and break foot switch. The Tri- ankle dorsiflexion moment (p < 0.0001) and stride velocity (p < 0.001)
axial wireless accelerometer was secured on the Lumbar spine and significantly increased stride time (p < 0.001), weight acceptance
third and right knee patellar tendon. The subjects were instructed (p < 0.001) and stance phase (p < 0.001). During stair descent,
to walk 12 meter track four times with a fast, intermediate, and subjects with knee OA showed: significantly reduced knee flexion
slow speed, for a total of 12 tests. The data was transferred to angles (p < 0.001), external ankle dorsiflexion moment (p < 0.05) and
Notebook-size personal computer (Bioelectric Information Multi-Task stride velocity (p < 0.0001) and significantly increased stride time
Analysis Research Program BIMUTAS KISSEI COMTEC Co., Ltd (p < 0.0001), weight acceptance (p < 0.001), stance phase (p < 0.001)
Japan Installed) with a Bluetooth wireless device. Data analysis was and single support phase time (p < 0.05). CONCLUSIONS: Indi-
carried out by evaluating RMS accelerometry, as well as single cycle viduals with knee OA showed marked differences in knee joint
vertical and lateral RMS accelerometry data averaged over ten gait angles, knee joint moments, ankle joint moments and temporal
cycles at each speed. RMS and integrated EMG data was evaluated characteristics during stair climbing when compared with healthy
over the same parameters. ANALYSIS: The Interclass correlation age and gender-matched control subjects. The results of this study
coefficient by SPSS for Windows Ver 12.0 was used for the data demonstrated that knee OA patients alter their stair climbing patterns
analysis RESULTS: The test-retest reproducibility was compared. possibly to meet the increased demands of stair locomotion that
The wireless type 3-axis accelerometer and EMG equipment data occurs as a result of the disease. IMPLICATIONS: The data
is reliable and reproducible and gait speed and stride length can be provided in this study may serve as guidance to develop effective
assessed. The system may also be used to evaluate dynamic balance rehabilitation protocols to restore optimal locomotor function for knee
based on our initial findings. CONCLUSIONS: It is possible to have OA patients. KEYWORDS: Kinematics; kinetics; knee; osteoarthritis;
high reliability for practical clinical assessment of gait without force stair climbing. FUNDING ACKNOWLEDGEMENTS: Funding from
plate and video technology. IMPLICATIONS: We developed a new State Scholarship Foundation of Athens (Greece) supported this
wireless type tri-axial accelerometer and EMG system with a high study. CONTACT: [email protected]
sampling frequency of 1 kHz that may provide a low cost reliable ETHICS COMMITTEE: NHS Research Ethics Committee and the
gait assessment method for clinical use. KEYWORDS: Wireless; University of East London research Ethics Committee.
Tri-axial accelerometer; EMG; Test-Retest reproducibility. FUNDING
ACKNOWLEDGEMENTS: The study was funded by The Research
Institute of Health Science & Education, Japan and Accelerated Care
Plus Corp. Reno Nevada USA.
ETHICS COMMITTEE: Informed Consent of the subjects per US
FDA IDE Protocol Accelerated Care Plus Corp.
Research Report Poster Display active conditions. RELEVANCE: Antero-posterior translation of the
14-15 Monday 4 June 10:30 humeral head on the glenoid fossa occurs during passive shoulder
VCEC Exhibit Hall B & C flexion and extension. The direction of this translation is in the
RANGE OF MOTION AND ITS RELATION TO AGE AND BODY direction of movement of the humerus i.e. anterior translation
SIDE occurs during shoulder flexion and posterior translation during
extension. The magnitude of humeral head translation decreases
Macedo L1,2 , Magee D1 ; 1 University of Alberta; 2 University of Sydney
during active flexion and extension resulting in the shoulder joint
PURPOSE: The objectives of this study were to compare the range being more centred and, seemingly reinforcing the relevance of
of motion (ROM) between 4 different age groups: 18 to 29, 30 to neuromuscular control in providing shoulder joint stability. However,
39, 40 to 49, and 50 to 59 and to compare the range of motion simulated muscle forces of moderate magnitude have been unable
between body sides (right and left). RELEVANCE: ROM is generally to prevent antero-posterior translation of the humeral head in ‘in
assumed to reduce with age because of numerous changes occurring vitro’ studies. ‘In vivo’ studies are required to determine the precise
during the aging process. There is sufficient data in the literature to role of shoulder muscles in maintaining dynamic antero-posterior
conclude that there is a decrease in ROM from birth to 18 years of stability at the shoulder. PARTICIPANTS: The dominant shoulder
age. However, there is not insufficient data on the changes occurring of 15 normal subjects (18 to 50 years)was tested. Normal shoulder
after maturity. The findings in the literature regarding the difference in function was defined as: 1) no shoulder symptoms in the past two
range of motion between sides are controversial. Many papers have years 2) no treatment for shoulder symptoms 3) normal range of
found differences in ROM between sides but these differences have motion and scapulohumeral rhythm 4) symptom-free on maximal
been minimal or are not consistent between studies. PARTICIPANTS: isometric rotation strength testing. METHODS: Electromyographic
Ninety “healthy” Caucasian women were assessed in this study. (EMG) activity was recorded from supraspinatus, infraspinatus and
There were 30 in the 18 to 29 group, and 20 in the other groups (30 to subscapularis using bipolar intramuscular electrodes. RC muscles
39, 40 to 49 and 50 to 59) The sample size calculation was performed were chosen because of their significant role in providing dynamic
using a= 0.01, effect size= 0.25 and power = 0.96. METHODS: The stability at the shoulder joint. Eight maximal, voluntary, isometric
ROM was measured for ankle, knee, hip, shoulder, elbow and wrist contractions into shoulder flexion, extension, internal and external
using the protocol of Norkin and White and a standard goniometer. rotation were performed in random order. Resistance was provided
The order of the joints, motion, sides and active or passive motion manually for a period of 5 seconds and each test was performed
tested were randomly selected. All measurements were taken once three times. ANALYSIS: The mean across the three trials of the
actively and once passively for each joint on each side. ANALYSIS: maximum of the rectified and low pass filtered EMG for each test
A ROM analyses between body sides and age groups was performed for each subject was determined. The mean EMG activity for each
using a two-way ANOVA with a Tukey post hoc test. A conservative muscle in each test position for all subjects was then calculated.
value of p < 0.01 was used to avoid a type error I. RESULTS: RESULTS: Activity levels in subscapularis during the maximum
There was no difference in active and passive ROM between age isometric extension test were similar to those during maximum
groups. However, there was a decrease of range of motion with age isometric internal rotation, with minimal activity in supraspinatus
for: hip flexion, hip external rotation, shoulder external rotation and and infraspinatus. Activity levels in infraspinatus and supraspinatus
elbow extension especially when comparing the younger group (18- during the maximum isometric flexion tests were similar to those
29) with the older group (50 to 59). The results of the differences during maximum isometric external rotation, with minimal activity in
between sides showed a statistical significant difference for 29 of subscapularis. CONCLUSIONS: The high activity in posterior RC
the 60 motions measured. CONCLUSIONS: There was a significant muscles during maximal flexion tasks suggests that these muscles
decrease in ROM for some motions and even though there was not are functioning to prevent the anterior translation of the humeral
a significant difference between all age groups, a trend towards a head that accompanies shoulder flexion when performed passively.
decrease in ROM with age could be seen. A significant difference Similarly, the anterior portion of the RC is functioning to prevent
was present when comparing the younger age group with the older posterior humeral head translation during active extension. Contrary
age group. The results regarding differences between sides lead to the results of ‘in vitro’ studies these results suggest that RC
to the conclusion that there is a significant difference between muscles have a major role to prevent sagittal plane torque producers
sides for some specific ROM, however, the implications of these from destabilizing the shoulder joint in the antero-posterior direction.
changes are still unknown. Clinical studies are needed to define IMPLICATIONS: The results of this study indicate that: 1) high load
the clinical implications of the ROM changes between age groups shoulder flexion and extension tasks require levels of activity in
and between sides. IMPLICATIONS: The significant decrease in the RC muscles similar to high load rotation tasks; 2) RC muscles
ROM with age should be taken in consideration when treating on the side away form the direction of movement prevent antero-
patients in the older age groups. The use of the opposite side as posterior translation at the shoulder joint; 3) abnormal RC activity
reference for comparisons in clinical practice may be inappropriate patterns are likely to play a major role in antero-posterior instability
and alternatives such as normative databases should be taken at the shoulder. KEYWORDS: shoulder, rotator cuff, emg, shoulder
in consideration. KEYWORDS: range of motion, goniometer, age, instability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
body sides. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
[email protected]
ETHICS COMMITTEE: Health Research Ethics Board – Panel B from
the University of Alberta and received approval on July13th of 2005 Research Report Poster Display
14-19 Monday 4 June 10:30 PILLOW SHAPE AND CERVICO-THORACIC SPINE POSTURE IN
VCEC Exhibit Hall B & C SIDE SLEEPERS
DYNAMIC ANTERO-POSTERIOR STABILITY AT THE SHOULDER Gordon S1,2 ; 1 University of South Australia, Adelaide, Australia;
JOINT – WHAT IS THE PRECISE ROLE OF THE ROTATOR CUFF 2 James Cook University, Townsville, Australia
MUSCLES?
PURPOSE: To determine how foam pillows of the same content
Ginn K1 , Boettcher C1 , Cathers I2 ; 1 Faculty of Medicine, University but different shape, contour or regular, support the cervical spine
of Sydney; 2 Faculty of Health Sciences, University of Sydney in the side lying position. RELEVANCE: Despite many anecdotal
PURPOSE: To investigate the role of the rotator cuff (RC) muscles recommendations for the use of contour pillows, to support the
in maintaining antero-posterior stability at the shoulder joint during cervical spine at night, no known previous studies have investigated
the effect of contour pillow shape on the posture of the cervical the scores were stable. The mean discrimination score following
spine in the side lying position. A previous study identified that injection of local anaesthetic was 0.689, which was almost identical
76% of foam contour pillow users reported preference for the side to that found for the control leg (0.687), and this difference was
sleep position (Gordon unpublished thesis). PARTICIPANTS: Ninety- not significant (t 20 df = 0.17, p = 0.87). Following injection of
five subjects who reported preference for the side sleep position normal saline, the mean discrimination score was 0.674, (0.682
with one pillow who were aged over 18 years were recruited for in the control leg), the difference again not being significant (t
the study. METHODS: Subjects were required to lie on their side 20 df = −0.25, p = 0.80). There was no significant difference in
in a standardized position on an innerspring mattress. Reflective control for saline versus control for local anaesthetic (means 0.682
markers were placed on the external occipital protuberance and and 0.687 respectively), and saline versus local anaesthetic mean
the spinous processes of C2, C4, C7 and T3. Digital images discrimination scores (0.674, 0.689) were also non-significant (t =
were recorded at zero and 10 minutes whilst supported by a −1.1, p = 0.275). CONCLUSIONS: At commonly used doses and
foam regular shaped pillow and then by a foam contour pillow. volumes, there does not appear to be any deleterious effects of intra-
ANALYSIS: All anatomical landmarks in each digital image were articular local anaesthetic or capsular distension (2mls) on movement
digitised using the Image Tool (UTHSCSA) program. Descriptive discrimination at the ankle joint, implying the absence of detectable
statistics (mean, range and standard deviation) were used to proprioceptive risk associated with the use of local anaesthetic in the
describe the slope and angle measures at zero and 10 minutes. clinical setting. IMPLICATIONS: The confirmation of intra-articular
Comparative statistics (t-tests and univariate ANOVA) were used injections utilising ultrasound guidance and at clinically relevant
to determine relationships between slope and angle measures doses and volumes, suggests that there is little impact from this
and pillow shape. RESULTS: Although the foam contour pillow procedure on the angular discrimination function of the ankle joint.
produced steeper slopes at each spinal segment than the foam Where exercise interventions or sports performance may take place,
regular pillow these differences were not significant. Nor were ankle joint anaesthesia appears to have no effect on proprioception
significant differences identified in the angles produced at adjacent in movement discrimination. KEYWORDS: Ankle injury, propri-
spinal segments when comparing these pillows. CONCLUSIONS: oception, local anaesthetic. FUNDING ACKNOWLEDGEMENTS:
Regular and contour shaped pillows of the same foam do not Australian Sports Commission, Canberra Australia. CONTACT:
support the cervical spine in a significantly different manner while [email protected]
side lying. IMPLICATIONS: The choice between a foam contour ETHICS COMMITTEE: Australian Institute of Sport Ethics Committee
or foam regular pillow cannot be validated in terms of side
lying cervico-thoracic spine posture. KEYWORDS: pillows, cervical
spine, posture. FUNDING ACKNOWLEDGEMENTS: Dentons for
providing the regular and contour shaped foam pillows. CONTACT: 16-07 Monday 4 June 10:30
[email protected] VCEC Exhibit Hall B & C
ETHICS COMMITTEE: Ethics approval supplied by the ethics EFFICIENCY OF IMMEDIATE POSTOPERATIVE INPATIENT
committee of the University of South Australia. PHYSICAL THERAPY FOLLOWING TOTAL KNEE
ARTHROPLASTY: AN RCT ISRCTN49658674
Research Report Poster Display Lenssen T1 , Crijns Y1 , Waltje E1 , van Steyn M2 , Geesink R2 ,
16-03 Monday 4 June 10:30 van den Brandt P3 , de Bie R3 ; 1 department of physical
VCEC Exhibit Hall B & C therapy, Maastricht University Hospital, Maastricht, Netherlands;
2 department of Orthopaedics, Maastricht University Hospital,
MOVEMENT DISCRIMINATION AFTER INTRA-ARTICULAR maastricht, Netherlands; 3 depasrtment of epidemiology, Maastricht
LOCAL ANAESTHETIC AT THE ANKLE JOINT University, Maastricht, Netherlands
Waddington G1 , Adams R2 , Down S3 ; 1 University of Canberra;
2 University of Sydney; 3 Australian Institute of Sport PURPOSE: The main goal of physical therapy treatment (PT) in the
clinical stage following total knee arthroplasty (TKA) is to prepare
PURPOSE: To determine the effect of intra-articular local anaesthetic patients for discharge from the hospital as soon as possible after
on movement discrimination at the ankle joint related to potential their operation. Although aggressive rehabilitation is believed to
proprioceptive safety issues. RELEVANCE: The impact on clinical be important, evidence of effects of different exercise programmes
safety of dampening articular mechanoreceptor feedback at the following TKA is limited. This led to the question whether the
ankle is unknown. Athletes receiving intra-articular local anaesthetic intensity of PT (once versus twice daily) following TKA affects
may be at increased risk of sustaining further ankle injury when short-term recovery, measured as range of motion. RELEVANCE:
undertaking exercise after joint injection. PARTICIPANTS: Twenty- Various authors have described aggressive rehabilitation schemes
two subjects (44 ankles) aged 18-26, from tertiary education incorporating more than one PT treatment session per day in the
institutions and AIS staff. METHODS: Measurements of active clinical phase following total knee surgery. Aggressive rehabilitation
movement discrimination were recorded for both ankles before and is believed to be important in preventing postoperative contracture of
after injection of either local anaesthetic (lignocaine hydrochloride the soft tissue and in gaining better range of motion. Nevertheless
2% without adrenaline – intervention arm) or normal saline (control evidence of effects of different exercise programs following TKA
arm). ANALYSIS: Using the ROC subroutine in SPSSv.13 for is limited. PARTICIPANTS: A consecutive series of 43 patients
Windows, ROC curves were drawn with the stimulus pair entered who received a primary TKA at the University Hospital Maastricht,
as the state variable and the response given entered as the the Netherlands, was invited to participate between 1 January
continuous variable. Mean area under these curves was used as and 1 June, 2004. Subjects were considered eligible for the study
a discrimination score, with a possible maximum of 1.0 for perfect if they signed an informed consent form. Patients undergoing
discrimination, and 0.5 representing chance responding. A repeated knee revision surgery were excluded as were patients over 85
measures analysis of variance (ANOVA) was undertaken on the years of age, patients with co-morbidity influencing gait and
data, examining differences between the conditions, between left patients who did not understand or speak Dutch. METHODS: A
and right ankles, and for any interactions. RESULTS: There was randomised controlled trial (ISRCTN49658674)compared an exercise
no significant difference in mean discrimination scores between regimen of two physical therapy sessions per day with a similar
left and right ankles after the three occasions. [F(1,20) = 0.46, programme administered once daily. Primary outcome measure was
p = 0.51]. There was a rise of 0.028 AUC units [F(1,20) = 8.52, ROM. ANALYSIS: Statistical analyses were blinded and performed
p = 0.008] in mean scores between the initial and second visits, according to the ‘intention-to-treat’ principle. Post treatment scores
implying a learning effect after which on occasions two and three as well as differences between pre- and post treatment scores were
compared with regard to all outcome measures. Group differences The breakdown of disease severity was Stage 1 in 1 case, Stage
and 95% confidence intervals (CI) were computed for all outcome 2 in 16 cases, and Stage 3 in 2 cases according with the
measures. Student’s t-test was used for continuous data to determine osteoarthritis of the knee classification of Yokohama City University.
differences between the two treatment groups. Chi-square tests were The average value of physical activity by acceleration intensity
used for analyses of categorical data and when continuous data was net energy expenditure (1653.7±122.6 Kcal/day), movement
were not normally distributed. RESULTS: Of the 55 subjects who volume (189.9±92.4 Kcal/day), and step counts (8253.3±3799.4
were scheduled for surgery between January and June 2004, 43 steps/day). The JKOM score correlated with physical activity; net
were included in the study. 9 patients refused to participate and 3 energy expenditure (r = −0.64), movement volume (r = −0.62) and
were excluded because they had relevant co-morbidities. Twenty-one step counts (r = −0.63). CONCLUSIONS: In general, although the
patients were randomly assigned to the experimental group, 22 to knee extension strength for the walking of healthy people was
the control group. At the time of hospital discharge, there was no considered to be 40% or more, subject’s knee extension strength was
detectable difference between the experimental and control groups approximately 37%. Women with osteoarthritis of the knee had loss
in range of motion nor on any of the secondary outcome measures of extension strength of the knee, and had step counts higher than
(functional status, length of stay after surgery, pain over the last 24 age-matched healthy women. These results suggest that decreased
hours, satisfaction with treatment, satisfaction with the intermediate extension strength of the knee and high step counts were considered
treatment results and global perceived effect). CONCLUSIONS: This as a characteristic of early stage osteoarthritis of the knee. We
study shows that in our setting twice daily PT sessions do not conclude that decreased extension strength of the knee and high
produce different results as daily PT sessions. It may be questioned step counts may be an exacerbation factor in osteoarthritis of the
whether multiple daily therapy sessions are needed as an in-hospital knee. IMPLICATIONS: Even if an improvement of symptoms by
PT regimen in OA total knee patients. Future research needs to treatment is obtained, QOL is not necessarily high. In management
focus on the detection of subgroups of patients that may need more after treatment, it is important to evaluate the physical activity and
care. IMPLICATIONS: In our Hospital standard twice daily visits were to make an improvement of QOL. KEYWORDS: physical activity, os-
changed into once daily PT sessions. Further PT care is tailored to teoarthritis of the knee, QOL. FUNDING ACKNOWLEDGEMENTS:
individual patients needs. KEYWORDS: Total knee arthroplasty; in N.A. CONTACT: [email protected]
hospital treatment; efficiency; randomised controlled trial. FUNDING
ACKNOWLEDGEMENTS: The study was not externally funded.
ETHICS COMMITTEE: Masstricht hospital and Maastricht University 17-19 Monday 4 June 10:30
medical ethics committee VCEC Exhibit Hall B & C
ANALISYS OF PASSIVE AND ACTIVE ANTERIOR TIBIAL
TRANSLATION AND ISOMETRIC PEAK TORQUE IN SUBJECTS
WITH AND WITHOUT ACL INJURY
VCEC Exhibit Hall B & C Vasconcelos R3,4 , Arakaki J3 , Simão A3 , Oliveira A1 , Paccola C1 ,
Bevilaqua-Grossi D2 ; 1 Associate Professor, Department of
RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND QUALITY Biomechanics, Medicine and Rehabilitation of Locomotor Apparatus,
OF LIFE IN OSTEOARTHRITIS OF THE KNEE Ribeirão Preto School of Medicine, University of São Paulo
Watanabe H1 , Kamiya K2 , Hamazaki N2 , Kazumasa M2 , Suda K2 , (FMRP-USP), Ribeirão Preto, SP, Brazil; 2 Full Professor, Department
Obara S2 , Hendona T2 , Aikawa J3 , Fujita M3 , Urabe K3 , Itoman M3 ; of Biomechanics, Medicine and Rehabilitation of Locomotor
1 Kitasato University School of Allied Health Sciences Faculty of
Apparatus, Ribeirão Preto School of Medicine, University of São
Rehabilitation, Sagamihara, Kanagawa, Japan; 2 Department of Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; 3 PhD Candidate,
Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Department of Biomechanics, Medicine and Rehabilitation of
Japan; 3 Department of Orthopaedic Surgery, Kitasato University Locomotor Apparatus, Ribeirão Preto School of Medicine, University
School of Medicine, Sagamihara, Kanagawa, Japan of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; 4 Orthopaedic
Physical Therapist, Orthopaedic Departament, knee and shoulder
PURPOSE: Osteoarthritis of the knee is one of the most common
surgery group, Celso Pierro Hospital, Campinas, SP- Brazil
diseases in elderly women. Osteoarthritis of the knee is characterized
by pain, disability and loss of physical function. However, there are PURPOSE: The aim of this study was to evaluated the anterior tibial
few reports on the relation between physical activity and activities translation (ATT) and isometric peak torque in individuals with acl
of daily living (ADL) or quality of life (QOL) in individuals with rupture performing isometric contraction in open kinetic chain in a
osteoarthritis of the knee.This study evaluated physical activity in angle that provoke substantial ATT. RELEVANCE: There is a lack
osteoarthritis of the knee with gonalgia and showed the relationship of studies reporting the simultaneously measurement of ATT and
between physical activity and QOL. RELEVANCE: Recently, the isometric peak torque in subjects with acl injury PARTICIPANTS:
clinical outcome after physical therapy is not only an improvement It was evaluated 20 male subjects (31.1±7.45 years) with acl total
of physical function but also QOL in my own lifestyle is needed. We rupture and 20 control subjects (22.2±3.15 years). The subjects
consider being important to evaluate relationship between physical was divided in 4 groups ACLD (acl deficient knee), ACLC (acl
activity and QOL as aspect of physical therapy. PARTICIPANTS: contralateral knee), DOM (dominant leg control group), NDOM (non
Participants were 19 elderly women who got the content to physical dominant leg control group). METHODS: To measure the passive
activity evaluation in the participant in the Kitasato Knee classroom knee laxity of all groups the manual maximum test (MMT) was
in 2005. METHODS: Evaluation contents were physical function performed using a kt 1000. The kt 1000 also was used to measure the
(extension strength of the knee, range of motion of the knee, amount of (ATT) while the subjects perform three maximum isometric
10m gait time, knee alignment), body composition (body mass voluntary contractions at 30 o (MIVC) in a Isokinetic dynamometer
index, %body fat, lean body mass), disease severity and physical The knee extension isometric peak torque data was simultaneosly
activity using the accelerometer monitoring system (lifecorder EX). collected from all groups during the MVIC at 30 o ANALYSIS:
The physical activity was calculated as a net energy expenditure, Students t tests was used to evaluate differences between the
movement volume and step counts. QOL was evaluated using four groups in the ATT obtained during passive knee laxity. To
the Japan Knee Osteoarthritis Measure (JKOM). ANALYSIS: We evaluate differences in the peak torque and active anterior translation,
calculated a spearman correlation coefficient using the Stat View intergroup statistical analyses were performed by the method of
Ver5 and analyzed the correlation between the physical activity analysis of variance (ANOVA) with repeated measurements and,
and JKOM score. The significance defined as p < 0.05. RESULTS: if necessary, the technique of contrast formation in data analysis.
A p 0.05 significance level was adopted. RESULTS: The results analysis for the focus groups was conducted by two researchers
demonstrated that significant greater passive (15.91±2.82 SD), and independently. The Delphi was analysed by percentage agreements.
active (11.21±2.4 SD) ATT was observed in the ACLD group The level of agreement was set at 70% and a 5% above and below
compared with the ACLC (7.74±2.04 SD), (7.13±2.3 SD), DOM was re-considered based on analysis via Kendall’s coefficient of
(7.42±2.18 SD), (7.08±2.3 SD) and NDOM (7.39±2 SD), (7.04±2.1 concordance. Items over 75% agreement (categories of Agree and
SD) Groups. The passive ATT values were significant greater than Strongly Agree) were included, items below 65% were excluded,
the active ATT in the ACLD group (p < 0.05). The isometric peak and items between 65-75% agreement were re-considered in the
torque at 30º was significant lower (p < 0.05) in the ACLD group second round. RESULTS: 3 sections were identified in all focus
(100.32±20.36) compared with the ACLC (112.17±24.65), DOM groups; History, Physical Examination and Cultural Features. 5
(111.54±28.80), NDOM (109.77±32.66) groups. CONCLUSIONS: categories from History were developed (Present Symptoms, History
The greater values of ATT observed in the passive knee laxity of Symptoms, Function, Psychosocial, Medical History), 7 categories
compared with the active knee laxity associated with decreased from Physical Examination (Observation, Neurological Examination,
peak torque values in the ACLD group at 30º could be due to a Active & Passive Movements, Muscle Features, Palpation, Special
protective mechanism caused by chances in coactivation patterns Tests), and 3 Cultural categories (Health Professionals’ Attitudes,
of the quadriceps and hamstrings in subjects sustaining acl injury Patients’ Attitudes, Health System). Regarding the Delphi, 125
IMPLICATIONS: The Knowledgement acquire with this data could questionnaires were returned in the first and 111 in the second
provide insights for the development of acl reabilitation protocols round (83% & 74% response rate respectively). CONCLUSIONS:
because different artrokinematics was observed in the angle of 30 o 66 clinical features rated by the sample as important discriminatory
of knee flexion possible causing overloads in secondary restraints items in LBP assessment, and another 10 important in diagnostic
in acl deficient knees performng open kinetic chain exercises practice cultural features were obtained. IMPLICATIONS: It may
KEYWORDS: knee, electromyography, acl, exercise. FUNDING be that these clinical features are ‘discriminatory’ for different LBP
ACKNOWLEDGEMENTS: This work was supported through grants subsets. To verify this, these clinical items should be tested in
conferred to the authors by the Brazilian government agency, CAPES. a Greek LBP sample and attempt to statistically identify whether
CONTACT: [email protected] any subgroups are formed. As for the cultural factors, whether the
ETHICS COMMITTEE: The study was approved by Human subjects elements identified possess a strong cultural impact across Greece
Review board Ribeirão Preto School of Medicine, University of São remains to be seen. KEYWORDS: Classifying low back pain, clinical
Paulo factors, cultural factors. FUNDING ACKNOWLEDGEMENTS: This
research was funded with the MACP’s Elsevier Science Award for
Research in Manipulative Physiotherapy. CONTACT: [email protected]
ETHICS COMMITTEE: Ethical Committees of a) Technological
17-23 Monday 4 June 10:30 Educaitonal Institute (T.E.I.) of Lamia, Greece & b) University of
VCEC Exhibit Hall B & C Manchester, UK.
CLINICAL AND CULTURAL FACTORS IN CLASSIFYING LOW
BACK PAIN PATIENTS WITHIN GREECE: AN INVESTIGATION
AMONGST GREEK HEALTH PROFESSIONALS
E1,2 ,
Billis McCarthy C3 ,Stathopoulos I4 ,Kapreli E1 ,
Pantzou P5 , VCEC Exhibit Hall B & C
Oldham J2 ; 1 Department of Physiotherapy, Technological
Educational Institute (T.E.I.) of Lamia, Greece; 2 Centre for DEVELOPMENT OF A MANUAL THERAPY TOOL WHICH
Rehabilitation Science, The University of Manchester, UK; COULD FACILITATE APPLIED FORCE CONTROL WHILE
3 Warwick Emergency Care and Rehabilitation, UK; 4 Department MAINTAINING SENSITIVITY
of Physiotherapy, Technological Educational Institute (T.E.I.) of Diong J1 , Waddington G2 , Adams R3 ; 1 Liverpool Hospital, NSW,
Patras, Aigion, Patras, Greece; 5 National School of Public Health, Australia; 2 Physiotherapy School of Health Sciences, University
Athens, Greece of Canberra, ACT, Australia; 3 School of Physiotherapy, University
of Sydney, NSW, Australia
PURPOSE: The main purpose was to develop a list of clinical
features for the assessment of low back pain (LBP) patients among PURPOSE: During manual therapy, the hands are used to assess
Greek health professionals which are believed to be discriminatory and reassess stiffness in the spine, and mobilization forces are
in identifying different LBP subgroups. A secondary aim was to both applied and absorbed by the hands. Therefore, factors that
yield any cultural factors that appear important in diagnostic practice alter the force produced when force constancy is intended are
within Greece. RELEVANCE: Identifying homogenous subgroups of important, because unintentionally high force could injure the hands.
LBP patients is considered a priority in physiotherapy. In achieving Accordingly, a manual therapy/mobilization tool was designed, to
this, the specific features facilitating clinical discrimination across better spread these forces over the hands, and to show the amount
LBP patients need to be identified. PARTICIPANTS: A convenience of force being applied. RELEVANCE: Although therapist and patient
sample of 18 physiotherapists (PTs) and 5 doctors participated in positioning within the clinic is variable, effects of therapist posture
the focus groups, and a random sample of 150 physiotherapists on control of applied force are unknown. The tool was thus used to
stratified according to geographical area and work status participated determine whether (i) sensitivity to differences in stiffness when using
in the Delphi survey. METHODS: Three focus groups followed by the device is changed from the same stiffness assessment conducted
two Delphi rounds were conducted. Ethical approval was obtained with the hands alone, and (ii) force constancy can be maintained
from the Ethical Committee of the Technological Educational Institute with variations in posture. PARTICIPANTS: A convenience sample
of Lamia, Greece. The focus groups consisted of 11 PTs, 7 PTs of 30 subjects recruited from the third-year undergraduate and
specialized in LBP, and 5 doctors and focused in developing a postgraduate student body of the University of Sydney’s Faculty of
list of evaluating features utilized in their diagnostic practice for Health Sciences participated in the study. METHODS: Subjects were
patients with mechanical LBP, so as to distinguish different clinical tested to measure their discrimination, without feedback, between
subsets. The focus groups’ resulting items were transformed into different elastic stiffnesses. Stiffness assessment was conducted
the first round of a Delphi, to obtain consensus and hierarchy the when using the manual therapy tool and also with the hands alone.
most important of these classified factors. Altogether there were 80 In addition, subjects attempted to maintain force constancy during
clinical and 26 cultural items. In both rounds PTs were asked to vote a series of Grade II and IV mobilizing forces applied using the
whether to include or exclude each item from the examination list mobilizing tool on a plinth. The point of application of these forces
(whether it is an important ‘classification’ item). ANALYSIS: Content was at varying distances from the body, and no feedback was
given. ANALYSIS: A matched pairs t test was used to compare traction in the other directions (p < 0.01). There was no significant
sensitivity of stiffness discrimination with and without the use of difference between any directions with regard to the distal fibular
the mobilizing dynamometer. To examine the effect of posture displacements along the X and Y axes. CONCLUSIONS: In this
on force application, a repeated-measures analysis of variance experiment, the distal fibula moved toward similar directions during
was used. RESULTS: Stiffness discrimination was not significantly ankle dorsiflexion. While applying tractions that simulate mobilization
different whether the hands or the device was used (t 29 = −0.986, techniques, significant amount of fibular displacement was achieved
p = 0.332). Also, force constancy was maintained at Grade II when by applying tractions in posterolateral. Therefore, it was proved
the point of force application was moved away from the body, that posterolateral traction had certain beneficial effects on joint
but subjects were unable to replicate their Grade IV mobilization play restriction, thereby improving the range of ankle dorsiflexion.
forces in similar postures, despite an increase in perceived effort IMPLICATIONS: Our findings would be useful to treat limited range
(F1,29 = 18.622, p < 0.001). Both within and between subject variation of ankle dorsiflexion caused by the contracture of the distal tibiofibular
in force produced for both grades of mobilization was substantial, joint. KEYWORDS: Distal tibiofibular joint, Joint mobilization, Limited
although subjects were trying to produce the same force for each range of dorsiflexion. FUNDING ACKNOWLEDGEMENTS: No
grade. CONCLUSIONS: Subjects are equally good at discriminating grant or funding was received for this project. CONTACT: m-
between different stiffness levels whether the hands or the tool is [email protected]
used. Also, consistency of application of force cannot be maintained ETHICS COMMITTEE: Institutional Review Board of Sapporo
with changes in posture. IMPLICATIONS: Variations in applied force Medical University
observed with different therapist postures could be controlled if
force read-out was available on a mobilization tool, and use of
this tool in elastic stiffness discrimination did not inhibit sensitivity
compared to use of the hands alone. KEYWORDS: Manual therapy, 21-03 Monday 4 June 10:30
Mobilization, Tool use. FUNDING ACKNOWLEDGEMENTS: Not VCEC Exhibit Hall B & C
applicable. CONTACT: [email protected] PHYSICAL ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS
ETHICS COMMITTEE: University of Sydney Human Ethics Research ERYTHEMATOSUS
Committee Boström C1 , Karreskog H1 , Svenungsson E2 ; 1 Division of
physiotherapy, Department of Neurobiology, caring sciences and
Research Report Poster Display society, Karolinska Institutet; 2 Unit of rheumatology, Division for
19-11 Monday 4 June 10:30 medicine, Karolinska university hospital/Karolinska Institutet
VCEC Exhibit Hall B & C PURPOSE: The aim of this study was to 1) test aspects of reliability
QUANTITATIVE ANALYSIS OF DISTAL TIBIOFIBULAR JOINT and validity of designed questions about self-reported physical
MOBILIZATION: A CADAVER STUDY activity and to 2) describe the physical activity in a cohort of
patients with systemic lupus erythematosus (SLE). RELEVANCE:
Fujii M1 , Miyamoto S2 , Muraki T1 , Suzuki D3 , Teramoto A4 ,
Cardiovascular disease is the major cause of death in patients
Uchiyama E3 , Aoki M2 ; 1 Graduate School of Health Sciences,
with SLE. As physical activity reduces the risk for cardiovascular
Sapporo Medical University, Sapporo, Japan; 2 Department of
disease in the general population it is important to investigate the
physical therapy, Sapporo Medical University, Sapporo, Japan;
3 Department of anatomy, Sapporo Medical University, Sapporo, impact of SLE on physical activity. In order to do that, reliable
and valid measurement instrument are needed. PARTICIPANTS:
Japan; 4 Department of orthopedic, Sapporo Medical University,
Two hundred-three patients with SLE answered 11 questions about
Sapporo, Japan
physical activity and physical fitness and thirty-two of these were
PURPOSE: Although joint mobilization is an effective treatment consecutively selected for the test of the reliability and validity
procedure for limited range of ankle dorsiflexion, selection of an of the questions. METHODS: This is a cross-sectional study with
appropriate joint mobilization technique remains controversial. This preliminary results concerning physical activity. The 32 selected
research aims to evaluate the relationship between the directions patients answered the questions about physical activity twice, during
of application of the mobilization force on the distal fibula and a period of one to three weeks. At the second measurement
the amount of distal fibular motion. RELEVANCE: It is critical to the patients also answered four questions about their view of
assess the joint movement when mobilizing the distal tibiofibular the questions about physical activity. ANALYSIS: The analysis is
joint because selection of an appropriate mobilization technique mainly quantitative using descriptive statistics, sign test and weighted
may facilitate adequate distal tibiofibular joint play. PARTICIPANTS: kappa coefficients. RESULTS: 1) No systematic, statistical difference
Seven normal frozen-thawed cadaver legs (5 males, 2 females; between the first and the second measurement was observed. One
mean age of the specimens, 79.9 years, range 67-98) were used. of the questions had “moderate” agreement while the remaining
METHODS: Each foot was fixed on a jig at 10º plantar flexion. All had “substantial” or “almost perfect”. The majority of the patients
measurements are monitored by 3Space tracking system (Polhemus, reported that the questions were easy to understand and completely
USA). Prior to the experiment, the range of ankle motion and or partly reflected their physical activity and physical fitness. None
the fibular movements were measured. Subsequently, the distal wanted to exclude any question, eight wanted to add questions
fibula was mobilized in four directions (posterior, posterosuperior, and 16 gave further opinions. 2) One hundred-seventeen/188 (62%)
posterolateral, and superior). For simulating mobilization techniques, patients answered that they had reduced their physical activity since
a 19.6N traction force was applied to the distal fibula by inserting they have got SLE. One hundred-one/203 (50%) answered that
a bone anchor into the lateral malleolus. Displacements along the they had, never or once a week, been physically active on a high
coordinate axes of the fibula (X, anteroposterior; Y, mediolateral; and exertion level the latest six months. Ninety-six/195 (49%)patients
Z, superoinferior) were measured while the traction force was applied. answered that they had never or irregularly done physical exercises
ANALYSIS: Data analysis was performed using the two-way analysis the latest year and 31 (16%) once a week. Fifty-six/196 (29%)
of variance with repeated measures. Bonferroni’s correction was patients could run 2 km or more, with or without little rest periods,
used for conducting multiple comparisons. RESULTS: Application and the majority (125) of the patients believed that reduced physical
of the traction in the posterior, posterosuperior, posterolateral, and capacity was due to reduced physical fitness. CONCLUSIONS: The
superior directions caused displacements of 0.07±0.04, 0.05±0.05, majority of the designed questions were reliable enough, according
0.20±0.09 and 0.03±0.02mm, respectively, along the Z axis. The to interpretation of sign test and weighted kappa, to describe physical
displacement caused by applying traction in the posterolateral activity and physical fitness in patients with SLE. The questions were
direction was significantly larger than those caused by applying also valid according to the patients point of view, however further
studies are needed to describe more aspects of validity. The results clinical picture. KEYWORDS: Shoulder pain, exercise therapy,
from this study also show that patients with SLE are not physically randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
active enough to prevent cardiovascular diseases. IMPLICATIONS: none. CONTACT: [email protected]
Designing reliable and valid questions concerning physical activity ETHICS COMMITTEE: Human Review Committee (Trondheim,
and physical fitness is of great relevance for physical therapists. Norway)
The designed questions in this study may be useful in several
rheumatological diseases. Patients with SLE have to be informed
about the importance of being physically active in order to prevent
cardiovascular diseases and the physiotherapist could support the 22-11 Monday 4 June 10:30
patient in this behaviour. KEYWORDS: Exercise, physical activity, VCEC Exhibit Hall B & C
rheumatological diseases. FUNDING ACKNOWLEDGEMENTS: Un- THE JOINT CONTRIBUTION OF PARTICIPATION/ AUTONOMY
funded. CONTACT: [email protected] AND NEUROLOGICAL DISABILITY FOR QUALITY OF LIFE IN
ETHICS COMMITTEE: Karolinska university hospital Solna Stock- PEOPLE WITH MULTIPLE SCLEROSIS
holm Sweden Pedro L1 , Pais Ribeiro J2 ; 1 Centro Hospitalar Lisboa/Faculdade
psicologia Ciências Educação – U.Porto; 2 Faculdade Psicologia
Research Report Poster Display Ciencias da Educação- U.Porto
21-07 Monday 4 June 10:30 PURPOSE: New technologies allow medical staff to identify at
VCEC Exhibit Hall B & C early stages patients with multiple sclerosis. It is a chronic
DOSE-RESPONSE EFFECT OF MEDICAL EXERCISE THERAPY neurological disease, characterized by demyelisation, linked with a
IN PATIENTS WITH SUBACROMIAL PAIN. CONTROLLED TRIAL broad spectrum of physical, emotional and social impairment. The
WITH 6 MONTHS FOLLOW UP combination of a progressive and unpredictable disease process is
a strong stressor, which powerfully impacts upon the quality of life
Torstensen T1 , Østerås H2 , Østerås B2 , Haugerud L3 ,
of patients with multiple sclerosis. RELEVANCE: The purpose of the
Harms-Ringdahl K4 ; 1 Holten Institute AB, Stockholm, Sweden;
2 Sør-Trøndelag University College, Faculty of Health Education and present study is to explore the joint contribution of neurological, and
Social Work, Department of Physical Therapy, N-7004 Trondheim, autonomy and participation variables, and to identify the variables
NORWAY; 3 Moholt Fysioterapi, Trondheim, Norway; 4 Karolinska that contribute to the overall quality of life in patients with MS
Institutet, Stockholm, Sweden PARTICIPANTS: 280 patients with multiple sclerosis were recruited
via their physician at a neurology department of a central hospital
PURPOSE: To compare two different types of exercise programs in Lisbon. They were eligible for inclusion in the study if they met
in relation to dose response effects in patients with long lasting the following criteria: diagnosis according to relevant medical criteria,
subacromial shoulder pain. RELEVANCE: There is increasing between 18 and 65 years, being diagnosed at least 1 year ago,
evidence that exercise therapy is effective for this patient category, EDSS score under 7. The mean age was 40 years (range 18-
but no evidence regarding what type of exercises and dosage is most 65), 71.3% were women, 61.1% were married, 63% active workers,
effective. PARTICIPANTS: 61 patients with unilateral subacromial mean school level of 12 years, and the mean score of EDSS
pain. METHODS: Multi center, randomized controlled trial, where is 2.8. METHODS: the study was explorative and descritive the
patients were randomly assigned either to a high dosage (HD) patients diagnosed with definite MS in contact with Centro Hospitalar
medical exercise therapy group (n=30) or to a low dosage (LD) Lisboa Ward or a consultant in neurology, betwwen 16 April 2005
exercise therapy group (n=31). Patients in the (HD) group performed and 30 Marc 2006. ANALYSIS: Measures: two items for Overall
a total of 11 exercises consisting of 3 global exercises using a quality of life (OQOL), belonging to the Multiple Sclerosis Quality
stationary bike and 8 semiglobal and local exercises doing 3 sets of Life scale (MSQol-54), that taps global subjective assessment
of 30 repetitions of each exercise, a total of 80-90 minutes. The (LD) of overall quality of life. Expanded Disability Status Scale (EDSS)
group performed a global exercise once for 10 minutes and performed is a method of quantifying disability in multiple sclerosis. The
5 semiglobal and local exercises doing 2 sets of 10 repetitions of questionnaire IPA (Impact on Participation and Autonomy) measures
each exercise, a total of 20–30 minutes. Both groups received 3 several aspects of participation and autonomy. The IPA can make
treatments a week over 3 months. The difference between the groups a unique and fundamental contribution since it examines autonomy
were time performing aerobic global exercises, number of exercises, as opposed to dependency. The IPA addresses autonomy and
repetitions and number of sets. The patients were supervised and participation in 5 domains: autonomy indoors, family role, autonomy
the exercises were individually tailored and graded according to the outdoors, social relations, and work and educational opportunities.
clinical picture. Patients were assessed at inclusion, end of treatment RESULTS: The mean score for the variables are the following:
and at 6 months follow up where pain was measured using a visual OQOL (M=11.79; SD=2.98) EDSS (M=2.55; SD=1.75), 5 domains of
analogue scale (VAS), function was registered using the Shoulder IPA: Autonomy Indoors (M=11.60; SD=5.58) Family Role (M=18.05:
Rating Questionnaire (SRQ). ANALYSIS: Differences between the SD=7.67) Autonomy Outdoors (M=12.53; SD=5.68), Social Relations
groups were analyzed using a one-tailed Independent-Sample T- (M=10.86; SD=4.26), Work and Educational Opportunities (M=15.56;
Test. RESULTS: There were no statistical difference between the SD=6.74). Correlation between OQOL and domains of IPA are
two groups at inclusion. During treatment 5 patients (8%) dropped moderate (Autonomy Indoors r= −0.45, p < 0.0001), (Family Role
out. At end of treatment the (HD) medical exercise therapy group r= −0.52, p < 0.0001), (autonomy outdoors, r = −0.56, p < 0.0001),
came out significantly (p < 0.05) better compared to the (LD) group (social relations, r= −0.54, p < 0.0001), (Work and Educational
with less pain and improved function. The difference between Opportunities, r = −0.55, p < 0.0001). The correlation between OQOL
groups had increased at 6 months follow up. CONCLUSIONS: In and EDSS score r= −0.36, p < 0.0001: better OQOL better autonomy
patients with long lasting uncomplicated subacromial pain, (HD) and participation and better scores on EDSS. Linear regression
medical exercise therapy is an efficient treatment approach and analysis stepwise method, where OQOL is the dependent variable
significantly better compared to a (LD) program IMPLICATIONS: and the EDSS score more the five domains of the IPA the
Health professions should be aware that there is a dose response independent variables, shows a unique contribution of the “social
effect using exercise therapy treating patients with unilateral long relations” and the “Work and Educational Opportunities”, both,
lasting subacromial shoulder pain. To obtain good clinical results for dimensions of the IPA, to the explanation of the variance of
this patient category therapists using (LD) exercise programs need OQOL (adjusted R2=0.40). CONCLUSIONS: The present study
to increase the exercise dosage. The therapist must supervise the shows that autonomy and participation (“social relations” and
patient constantly progressing the exercises according to the patients “Work and Educational Opportunities”)are important variables for
patients with MS. IMPLICATIONS: This is important information for Neurologically Disabilities, Swedish Research Council. CONTACT:
physiotherapists because it helps to focus on better outcomes for [email protected]
rehabilitation. KEYWORDS: autonomy and participation, quality of ETHICS COMMITTEE: The study was approved by the ethical com-
life,multiple sclorosis. FUNDING ACKNOWLEDGEMENTS: None. mittee at the Karolinska University Hospital, Huddinge, Stockholm,
CONTACT: [email protected] Sweden, Nr 449/01.

22-15 Monday 4 June 10:30 SELF- EFFICACY OF PATIENTS WITH PARKINSON’S DISEASE:
VCEC Exhibit Hall B & C IMPLICATIONS FOR THE CLINICIAN
SENSE OF COHERENCE, LIVING WITH PARTNER AND WORK Lopez Rosado R, Bevins S, Bevins T; Department of Physical
STATUS PREDICT PERSISTENT OR INCREASED FATIGUE IN Therapy and Human Performance, Florida Gulf Coast University,
MULTIPLE SCLEROSIS, A LONGITUDINAL STUDY Fort Myers, FL USA
Johansson S1,2 , Ytterberg C1 , Widén Holmqvist L1,2 , von PURPOSE: The purpose of this study was to determine if self-
Koch L1 ; 1 Division of Neurology, Department of Clinical efficacy in patients with Parkinson’s disease differs based on
Neuroscience, Karolinska Institutet, Stockholm, Sweden; 2 Division sex or age. It was postulated that younger female patients with
of Physiotherapy, Department of Neurobiology, Care Sciences PD would score higher than males on the self-efficacy ques-
and Society, Karolinska Institutet, Stockholm, Sweden tionnaire. RELEVANCE: This study provides valuable information
when conducting a proper needs assessment of the patient with
PURPOSE: To a) describe the perceived level of energy in persons PD. It also provides a more clear expectation of the patient’s
with multiple sclerosis (PwMS) every six months and changes commitment to and cooperation with his/ her rehabilitation program.
over time during a two year period, and to b) explore the PARTICIPANTS: A total of 40 surveys were collected in a period of
predictive capacity of some personal (sex, age, sense of coherence 3 months. METHODS: The instrument used in this study was the
[SOC]) and environmental factors (living with a partner, living General Perceived Self-Efficacy Questionnaire (GPSEQ), developed
with children, work status, ongoing immune-modulating treatment), by Schwarzer and Jerusalem. The original GPSEQ consisted of
disease-related characteristics (disease severity, disease course, 10 questions. A modified version of the questionnaire was utilized,
time since diagnosis) and time, during the two years. RELEVANCE: including 5 additional statements related to motivation and adherence
Fatigue, a subjective lack of physical and/or mental energy interfering to a rehabilitation program. A convenience sampling method was
with usual and desired activities, is the most frequently reported used; patients with PD were identified in clinical settings located in
symptom in PwMS. Knowledge regarding how the perceived level Southwest Florida. Participants were classified by sex (male/female)
of energy varies over time, as well as factors contributing to and age: 1) 55-64, 2) 65-74, 3) 75-84, and 4) 85 and older.
One contact person in each of 3 clinical settings was identified to
fatigue are needed, in order to supply appropriate treatments
administer and collect the questionnaires. The research protocol
e.g., physical therapy. PARTICIPANTS: A cohort of 219 PwMS,
and modified questionnaire were approved by the FGCU Institutional
outpatients at a MS specialist clinic. METHODS: An observational
Review Board. ANALYSIS: Descriptive statistical analysis was
study was carried out during two years. Perceived level of energy
performed in order to determine significant differences among
was assessed every six months with the Fatigue Severity Scale
groups. RESULTS: The modified version of the GPSEQ was found
(FSS), categorized into non fatigue, border fatigue and fatigue. Data to have excellent internal reliability, based on the Cronbach’s alpha
regarding the independent variables were collected at baseline, obtained (R = 0.936). No significant difference among sex or age
except for the SOC which was collected at 6 or 12 months. groups in self-efficacy scores (p = 0.356 and 0.578, respectively)
ANALYSIS: Descriptive statistics was used to explore the perceived were found. CONCLUSIONS: There was a high correlation between
level of energy. Friedman ANOVA was used for analysis of changes in the motivation items added to the GPSEQ and the original 10
FSS scores during the study period. Predictive capacity was explored items. Data suggested that there was no significant variability in
with Generalized Estimating Equations employing proportional odds self-efficacy scores based on sex and age groups. Total GPSEQ
models. RESULTS: At inclusion 50% were fatigued and 33% non scores of all participants suggested a possible ceiling effect with
fatigued. Throughout the two year observation time 54% varied the majority of the total scores clustered in the high value range.
FSS category, 27% were persistent fatigued and 19% non fatigued. IMPLICATIONS: Although the younger female population is often
FSS scores varied significantly, p = 0.02. SOC was the strongest found to obtain higher scores in self-efficacy questionnaires among
independent predictor for an increase in or persistent fatigue, the general population, this study found no significant differences
followed by living with a partner and not working. PwMS with in either sex or age groups. Some limiting factors of this study
moderate disease severity, and relapsing remitting disease course include the sample size and its homogeneity. Future research
or >10 years since diagnosis, were at particular risk for increase in could focus on significant differences in ethnic backgrounds and
or persistent fatigue. CONCLUSIONS: Every second PwMS changed other adjacent geographical regions. KEYWORDS: Self-Efficacy,
FSS category and every fourth experienced persistent fatigue over Parkinson’s Disease. FUNDING ACKNOWLEDGEMENTS: Private
two years. SOC, living with a partner and work status were major funds. CONTACT: [email protected]
predictors for increase in or persistent fatigue. IMPLICATIONS: The ETHICS COMMITTEE: Institutional Review Board of Florida Gulf
variation in perceived level of energy over time in the majority of Coast University
PwMS as well as its persistence in every fourth should, together
with personal and environmental factors predicting increase in or
persistent fatigue, be considered by physical therapists and other
health-related services, when assessing, planning and providing
interventions for PwMS. KEYWORDS: Multiple sclerosis, fatigue.
FUNDING ACKNOWLEDGEMENTS: The study was funded by
grants from the Board of Research for Health and Caring Sciences,
from the Health Care Sciences Postgraduate School, Karolinska
Institutet and from the Swedish Association for Persons with
ENVIRONMENTAL FACTORS IMPACTING PARTICIPATION IN USE OF FUNCTIONAL INDEPENDENCE MEASURE™ WITH
COMMUNITY MOBILITY FOLLOWING STROKE PATIENTS WITH STROKES IN VIETNAM
Matsuda P, Robinson C, Ciol M, Beaverson J, Soine S, Flemming A, Binh N1 , Pechak C2 , Thompson M2 ; 1 Department of Rehabilitation
Shumway-Cook A; Department of Rehabilitation Medicine Medicine, Hospital C, Danang Vietnam; 2 Texas Woman’s University,
PURPOSE: Community mobility, defined as the ability to walk safely Dallas, USA
and independently in a community environment, is a critical factor in PURPOSE: The purpose of this study was to describe the
maintaining independence. Mobility limitations can restrict participa- characteristics and functional recovery of patients with strokes
tion, and lead to social isolation, anxiety and depression. There is that were treated between 2000 and 2004 in the Department of
limited evidence to suggest that participation in community mobility Rehabilitation Medicine of Hospital C in Danang, Vietnam using
may be restricted following stroke, however, the factors influencing Functional Independence Measure (FIM™) scores and compare to
participation remain unclear. Among older adults, limited participation available USA data. RELEVANCE: Despite the expectation that the
in community mobility results from an interaction between personal impact of stroke will increase as the economy develops and the
and environmental factors, and the specific environmental features population ages, few data are available in the English language
critical to disablement vary across individuals. This study examined literature regarding the scope of the problem in Vietnam. No study
the level of participation in community mobility following stroke, is available in the English language or Vietnamese literature that
and used a person-environmental interaction model to determine has documented the use of the FIM™ in Vietnam. In order to build
the relationship between the physical environment and level of evidence-based practice and promote rehabilitation research in Viet-
participation in community mobility following stroke. RELEVANCE: nam, problems must be defined and outcome measures employed.
Stroke is the leading cause of serious, long-term disability in the Dissemination of the data in the English language increases network-
United States. Despite the fact that 80% of individuals post stroke are ing and research opportunities between rehabilitation professionals
discharged home, most receive little to no community mobility training in Vietnam and their international colleagues. PARTICIPANTS: All
(Latham et al, 2005). PARTICIPANTS: Twenty-five adults diagnosed patients with strokes that were treated between 2000 and 2004 in
with stroke (mean age 68±9; mean time since stroke 40 mos) and the Department of Rehabilitation Medicine of Hospital C in Danang,
25 adults (mean age 68±11) without stroke participated. METHODS: Vietnam. METHODS: Data were collected retrospectively from
Level of community mobility participation was determined by self- medical records, and included: gender, age, body side affected by
reported number of trips and walking related activities performed in stroke, onset of stroke to start of rehabilitation interval, average length
the community over a 4 week period (12 days sampled), and level of of stay in rehabilitation in days, and FIM™ scores on admission and
satisfaction (1= not at all, 5=completely). The Environmental Aspects discharge. The internationally accepted FIM™ instrument is an 18-
of Mobility Questionnaire (EAMQ) was used to determine frequency item ordinal scale used for rating independence in self-care, sphincter
of encounter versus avoidance with 20 environmental features control, mobility, locomotion, communication, and social cognition.
impacting community ambulation. ANALYSIS: Comparisons between ANALYSIS: Descriptive analysis was performed; mean FIM™ scores
control and stroke groups were performed using Mann-Whitney upon admission and discharge, and mean FIM™ change scores
and Chi-square tests for continuous and categorical variables, were calculated. RESULTS: The majority of the patients (69%) were
respectively. Total number of trips and activities were analyzed using men with a mean age of 60. Most of the patients with stroke had
negative binomial regression. Total number of features encountered right hemiparesis (53.5%), and most of the patients (53%) initiated
versus avoided were analyzed using a negative binomial regression, rehabilitation between one week and four weeks post-stroke. The
and the effect of group (control or stroke), while adjusting for age and researchers report an average FIM™ gain of 21.0 from admission
sex was tested. RESULTS: Compared to controls, individuals with to discharge. CONCLUSIONS: This study highlights the potential
stroke reported significantly fewer trips (p = 0.001), fewer walking- of clinical researchers in Vietnam to utilize internationally accepted
related activities (p < 0.001), and had a lower level of satisfaction outcome measures and to contribute towards the currently very
with community mobility participation (p < 0.001). Compared to limited data on patients with stroke and their rehabilitation in Vietnam.
adults without stroke, those who had a stroke had a significantly IMPLICATIONS: Outcome measures can and should be incorporated
lower rate of encounters (p < 0.001) and higher rate of avoidance in physical therapy practice in developing countries. Sharing a
(p < 0.001) of physical features in the environment impacting gait. common language of outcome measures will promote evidence-
After adjusting for age and sex, level of participation (including based practice and research in rehabilitation at the international level.
total number of trips, total number of walking-related activities, and KEYWORDS: stroke, Vietnam, Functional Independence Measure
ratio of walking-related activities performed per trip) was significantly (FIM™). FUNDING ACKNOWLEDGEMENTS: none. CONTACT:
associated with rate of encounter (p = .03) and avoidance (p = .02). [email protected]
The model suggested that the total number of features avoided
may be a slightly better predictor of community participation than
features encountered. CONCLUSIONS: Results support the impact Research Report Poster Display
of environmental factors on level of participation in community 24-07 Monday 4 June 10:30
mobility following stroke. Reduced participation was associated with VCEC Exhibit Hall B & C
avoidance of some, but not all, physically challenging features EARLY DISCHARGE TO THERAPY-BASED REHABILITATION AT
within the environment, suggesting that some environmental features HOME IN PATIENTS WITH STROKE. A SYSTEMATIC REVIEW
may limit community mobility more than others following stroke.
Winkel A1 , Ekdahl C, Stig Jørgensen H, Gard G; 1 The unit for
IMPLICATIONS: An increased understanding of the environmental
neurology and rehabilitation, Hillerød, Denmark
factors limiting participation will enhance rehabilitation strategies
for recovery of community mobility following stroke. KEYWORDS: PURPOSE: Early discharge and home rehabilitation for stroke
stroke, mobility, participation. FUNDING ACKNOWLEDGEMENTS: patients is in many countries explored as an alternative to
This study was supported with funding from the Walter Stolov rehabilitation in stroke units. There is some evidence that this
Research Fund, Department of Rehabilitation Medicine, University rehabilitation scheme reduces length of stay, improves independence
of Washington. and quality of life and might reduce costs. The objective of this study
ETHICS COMMITTEE: Institutional Review Board, Human Subjects is to review the effects of early discharge on home rehabilitation in
Division, University of Washington, Seattle, WA stroke patients RELEVANCE: Stroke is the most frequent cause of
disability and the third most frequent cause of death in Denmark. statistics and Spearman Rho correlation coefficients were calculated
Prevalence is 13.000 inhabitants pr year entailing great expenses (sig p < 0.05). Subjects were categorized as having had more than
for treatment and rehabilitation. PARTICIPANTS: studies with stroke one fall or as having no or one fall in the prior six months. Receiver
patients over 18 years included METHODS: Randomized controlled operating characteristic (ROC) curves were generated to measure
trials published between 1980 and 2005 were identified in Medline, the ability of each variable to categorize subjects based on faller
Chinal, Embase, Cochrane Library and PEDro databases. After status. RESULTS: Subject demographics were: mean age = 58.1
exclusion 17 studies with stroke patients, which compared early years (+/−12.39; range 35-83); 53% male; 50% right and 50% left
discharge to home rehabilitation with rehabilitation at hospital were sided stroke; mean time since stroke. = 55.1 months (+/− 66.7, range
included. Methodological quality was rated using PEDro scale. 3-312); 44% had fallen in the prior 6 months and 28% reported
ANALYSIS: The results of the quality assessment were summarized multiple falls. 94% reported independent community ambulation; 50%
using a rating system consisting of the adapted criterion from used no assistive device. SR measures correlations were: FES(S)
Sackets rules of scientific evidence. Characteristics of the patients, and ABC (r = −0.81); FES(S) and ABC correlated with self reported
settings, interventions, physiotherapy and outcome measures used function SIS-16 (r = −0.77 and 0.78), FES(S) with FOF (r = 0.44), the
in the included studies were described. RESULTS: There was a ABC and FOF (r = −0.32). SR were correlated with PB measures:
compelling evidence, that early discharge to home rehabilitation can FES(S) and ABC correlated with BBS (r = −0.49 and 0.53), only the
reduce length of stay in hospital for patients with stroke. Three ABC correlated with the TUG (r = −0.49). The PB, TUG and BBS
intervention groups were identified: 1. Outgoing early supported were highly correlated (r =-.65). The SIS-16 best categorized falling
discharge services from hospital, 2. Outgoing early supported status of subjects with an area under the curve of 0.82, then the
disharge teams from hospital, who do not provide rehabilitation ABC (area = 0.81), the BBS (area = 0.76) and the FES(S) (area =
services and 3. Community based rehabilitation services after early 0.72.) The TUG was less effective (area = 0.65). CONCLUSIONS:
discharge. Isolated description of the physiotherapy intervention The single and multiple fall rates were high in this functionally
revieled, that home rehabilitation has advantage to rehabilitation in independent sample of persons with stroke. A strong relationship
hospital in respect of making use of patients coping capacities. If existed between confidence in performing a task without losing
patients’ coping capacities were taking into consideration a positive balance and in performing the task without falling. Subjects’ ratings
effect on basic activities was seen at six months and one year, and of balance and falls self-efficacy were more strongly related to other
on instrumental activites at one year in intervention group I. Some self report variables than to performance of balance and mobility.
positive effects of home rehabilitation on instrumental activities were Self-reports of function and balance self-efficacy identified multiple
found at 1, 3, 6 months, and at one and five years in intervention fallers better than performance-based measures. IMPLICATIONS:
group I og II, on health and quality of life of patient at 3 months The high rate of falls suggests that continued care in this population
in intervention group I and II, and at 6 months and 1 year in is needed. Self-report measures of function and balance self-
intervention group II. Less costs of the home rehabilitation was efficacy are good tools for identifying those who have a history of
found in intervention group I. CONCLUSIONS: Early discharge and multiple falls. It is recommended to add these measures to fall risk
home rehabilitation of stroke patients can reduce length of stay at screening as they may assess different aspects of overall status
hospital, might improve patients’ basic activities, but is more liable than performance-based measures. KEYWORDS: stroke, clinical
to improve the instrumental activities. The home intervention seem measures, faller status. FUNDING ACKNOWLEDGEMENTS: N/A.
to be cost effective but could be discussed. The physiotherapy CONTACT: [email protected]
intervention at home differs from the rehabilitation at hospital ETHICS COMMITTEE: Partners Health Care, Spaulding Hospital
making the context and patiens coping capacities the core issue. IRB
IMPLICATIONS: Physiotherapists, who rehabilitate patients at home
have to modify their behaviour away from the expert appearance.
KEYWORDS: Stroke, context, physiotherapy intervention. FUNDING
ACKNOWLEDGEMENTS: This study has been supported by the 25-15 Monday 4 June 10:30
Danish Physiotherapy Association and the County of Frederiksborg. VCEC Exhibit Hall B & C
CONTACT: [email protected] EXPOSURE TO PHYSICAL JOB RISK FACTORS FOR
MUSCULOSKELETAL DISORDERS IN PHYSICAL THERAPY
WORK: RESULTS OF WORK-SAMPLING OBSERVATIONS
Rockefeller K1,2 ; 1 University of South Florida, Tampa FL, USA;
25-11 Monday 4 June 10:30 2 University of Illinois at Chicago, Chicago IL, USA
THE RELATIONSHIP OF SELF-REPORT AND SELF-EFFICACY PURPOSE: The important work of healthcare providers has long
MEASURES TO AMBULATORY PERFORMANCE AND FALLS been associated with high rates of work-related musculoskeletal
HISTORY IN COMMUNITY-DWELLING PEOPLE WITH STROKE disorders (WRMSDs). Epidemiological and biomechanical research
suggests the tasks and activities inherent in manually caring for
Beninato M, Sullivan P, Belgen B, Narielwalla K; MGH Institute,
patients involve significant exposure to physical job risk factors of
Boston MA, USA
non-neutral postures and heavy loads. The goal of this study was
PURPOSE: To examine relationships among self-report measures of to observe the work of physical therapists in real-time settings
balance confidence, falls self efficacy, fear of falling and functional to obtain objective information about exposure to risk factors
performance, with performance-based measures of balance and for WRMSDs in physical therapy practice. RELEVANCE: There
mobility in community-dwelling stroke survivors and to examine if are a limited number of studies on WRMSDs among physical
these measures categorize faller status. RELEVANCE: Identifying therapists. The studies all collected self-reported measures of work
measures to determine those who fall may provide a basis for exposures and health outcomes among those reporting disorders.
determining those at risk. PARTICIPANTS: 32 subjects with stroke Overall, these studies suggest that physical therapy work is indeed
living in the community. METHODS: Subjects were examined during associated with WRMSDs and that some settings (neurological
a single session. Questionnaire assessed falls history. Self reported rehabilitation, pediatrics, geriatrics) and activities (patient handling
(SR) measures included the Falls Efficacy Scale [FES(S)], the such as transfers, performing manual therapy) are particularly related
Activities Balance Confidence (ABC) scale, fear of falling (FOF) a 1- to reports of these conditions. More objective information would
10 scale, and physical function subscale of the Stroke Impact Scale assist in interpreting such results. PARTICIPANTS: Subjects were
(SIS-16). Performance-based (PB) measures were the Berg Balance 13 physical therapists (11 female; 2 male) employed full-time at a
Scale (BBS) and Timed Up and Go (TUG). ANALYSIS: Descriptive University-associated major medical center in a large Midwestern
city. Five therapists were observed in the in-patient setting, five in out- Fritz and George (2006) found that significant amounts of variance
patient, and three in pediatrics. METHODS: An established method in change in disability could be explained by changes in fear-
of observational work sampling called PATH (Posture, Activity, Tools, avoidance beliefs, even after controlling for changes in pain intensity.
Handling) was used to collect data. Based in part on the Guide to Therefore, it is important for clinicians to determine and address fear-
Physical Therapist Practice, a taxonomy of physical therapy work avoidance beliefs in low back pain in order to minimize pain-related
was created and used to design the template for data collection. disability and improve chances of return to work. PARTICIPANTS:
Major task categories were evaluation, treatment, administration, Patients with subacute low back pain referred to an outpatient
and other. Categories for specific patient-related activities were rehabilitation program participated in this study. The average age
therapeutic exercise, manual therapy, gait training, patient handling, for the group was 39 years, and more than half (54.2%) were
education, and physical agents. Codes for shoulder, elbow, trunk, and women. Forty patients available to provide complete pre and post
leg postures were defined as were codes for loads handled, settings, data were included in the analyses. METHODS: A pretest-posttest
and equipment. Instances where forces were applied through the design was used within a randomized clinical trial of a cognitive-
thumb or finger were also noted. Each subject was observed for about behavioural disability management program. In addition to standard
4 hours doing their usual work; every 60 seconds observations were physiotherapy for low back pain, the intervention group participated
recorded on the template. ANALYSIS: Frequencies of observations in an individualized cognitive-behavioural type intervention. The fear-
were calculated for all categories. Cross-tabulations were done avoidance beliefs questionnaire was used to measure beliefs about
to compare exposure to individual risk factors of posture and physical activity (Crombez, 1999). The pain disability index was used
load with key tasks and activities. Summary scores were created to measure perceived disability (Tait et al., 1991), and the McGill Pain
for each observation to capture information about simultaneous Questionnaire current pain intensity subscale was used to measure
exposure to posture*load. Analysis of variance was used to compare pain (Melzack, 1987). ANALYSIS: t-tests (p < 0.05) used to determine
scores for tasks, activities, settings, and other categories of interest. if there were differences between the intervention and control group
RESULTS: Subjects were involved with direct patient care (evaluation showed that there were no significant differences. The groups were
or treatment) approximately 2/3 of the time observed. The greatest therefore combined for subsequent analyses. t-test were used to
frequency of non-neutral shoulder and trunk postures occurred while detect pretest-posttest differences and Pearson correlations were
treating patients. Activities of greatest risk were manual therapy, used to explore associations between the measures. RESULTS:
patient handling, and therapeutic exercise. The setting with greatest There were statistically significant improvements (t-tests; p < 0.05)
risk was pediatrics. Other results will be displayed. CONCLUSIONS: in all measures (FAB, pain and PDI scores) pre- to post-test.
Physical therapists are indeed exposed to physical job risk factors The poster will describe the associations found between the
for WRMSDs in the course of daily work tasks and activities. measures, and implications for clinical practice and future research.
IMPLICATIONS: This research provides an objective estimate of CONCLUSIONS: Fear-avoidance beliefs can be significantly reduced
exposure to ergonomic risk factors in the practice of physical therapy in rehabilitation programs tailored to address such fears. Fear-
and will assist efforts to design implement, and evaluate interventions avoidance beliefs are associated with pain reports and perceived
to improve the work environment and decrease risks for WRMSDs. disability. IMPLICATIONS: Fear-avoidance beliefs have to be ad-
This information may also have important implications for entry- dressed in order to prevent prolonged pain-related disability, including
level professional physical therapy education. KEYWORDS: Work- work absence. Physiotherapists are best positioned to provide
related musculoskeletal disorders; Physical job risk factors; Exposure reassurance to individuals with low back pain. KEYWORDS: fear-
assessment; Physical therapy. FUNDING ACKNOWLEDGEMENTS: avoidance beliefs, low back pain, pain-related disability. FUNDING
This resarch was supported by Grant # T42OH008672-01 from ACKNOWLEDGEMENTS: This Project was funded by a research
the National Institute for Occupational Safety and Health (NIOSH). grant provided by the Workplace Safety and Insurance Board
Its contents are solely the responsibility of the author and do (Ontario). The authors wish to acknowledge the support provided by
not necessarily represent the official views of NIOSH. CONTACT: Providence Continuing Care Centre, Kingston, Ontario. CONTACT:
[email protected] [email protected]
ETHICS COMMITTEE: Institutional Review Board at University of ETHICS COMMITTEE: Queen’s University and Affiliated Hospitals
Illinois at Chicago Research Ethics Board, Kingston, Ontario, Canada

FEAR-AVOIDANCE BELIEFS, PAIN AND PERCEIVED DISABILITY TRUNK POSITION SENSE AND FUNCTIONAL MOBILITY IN
IN PATIENTS WITH WORK-RELATED LOW BACK PAIN OLDER TAI CHI SWORD PRACTITIONERS
Mngoma N1,2 , Symes A2 , Stevenson J1 , Tripp D1 , Faris M1,2 , Tsang W, Fu S, Hui-Chan C; Department of Rehabilitation
Hopman W1,3 ; 1 Queen’s University, Kingston, Ontario, Canada; Sciences, The Hong Kong Polytechnic University, Hong Kong, China
2 Providence Continuing Care Centre, Kingston, Ontario, Canada;
3 Kingston General Hospital, Kingston, Ontario, Canada PURPOSE: The objectives of this study were to examine whether
older Tai Chi sword practitioners developed better trunk position
PURPOSE: The objectives of this study were to 1) determine fear- sense and faster timed up-&-go (TUG) score than healthy control
avoidance beliefs about physical activity in patients with low back subjects, and to determine the extent of correlation between these
before and after rehabilitation, and 2) explore associations between two measures. RELEVANCE: Joint position sense and mobility are
fear-avoidance beliefs, perceived disability, and pain. RELEVANCE: known to deteriorate in older adults. Tai Chi training has been found
There is growing evidence that fear-avoidance beliefs are associated to improve the knee joint proprioceptive acuity and static balance
with persistent low back pain and pain-related disability (Crombez control. The results of this cross-sectional study will delineate the
et al, 1999; Vlaeyen & Crombez, 1999). For example, Fritz and specific therapeutic value of an advanced form of Tai Chi using sword
George (2002) found that in a group of patients with acute work- on trunk position sense and functional mobility. PARTICIPANTS:
related low back pain, the psychosocial factor most predictive of Tai Chi sword practitioners and control subjects through convenient
return to work was fear-avoidance beliefs about work. Woby et sampling (all females; n = 16 aged 69.0±5.2 years, and n = 11
al. (2004) reported that reductions in fear-avoidance beliefs were aged 72.1±8.2 years, respectively) similar in age, gender, cognitive
associated with reductions in disability even when reductions in abilities, and physical activity level were examined. METHODS:
pain intensity, age and sex were controlled for. In a recent report, Active trunk repositioning was used to test trunk proprioceptive
acuity in three movement directions: forward flexion, rotation to the (RR) was related to age (p = 0.015). CV of the gain of eye tracking
right, and rotation to the left. The TUG was employed to assess toward left side in head neutral position (NL CV) was related to
functional mobility. ANALYSIS: Independent t-test was employed age (p = 0.044). CV of the gain of eye tracking toward left side
for comparing the TUG scores of the Tai Chi sword practitioners in head rotated position (RL CV) was related to the reposition
and control subjects. Multivariate analysis of variance was used error from left rotated position to neutral head position (p = 0.002).
to compare the absolute angle errors obtained in the active trunk CONCLUSIONS: The parameters of eye movement are associated
repositioning test during trunk forward flexion, rotation to the right with increased age and neck proprioception error. These changes
and rotation to the left. A Pearson product-moment coefficient of of eye movement control were demonstrated in both accuracy
correlation was used to correlate the absolute angle error obtained and stability of the control of eye movement. IMPLICATIONS: The
in the active trunk repositioning test and the TUG scores. RESULTS: finding of eye movement related with age and neck reposition error
Tai Chi sword practitioners made significantly smaller absolute angle suggested the decreased ability to integrate eye and neck control with
errors (2.2±0.9º) than control subjects (4.4±2.7º, P = 0.006) in trunk aging. KEYWORDS: cervical proprioception, eye-head coordination,
rotation to the left, and to the right (2.1±0.9º versus 4.2±2.9º of age. FUNDING ACKNOWLEDGEMENTS: NSC-92-2320-B-002-109,
control; P = 0.012), but negligible improvements in trunk forward Taiwan, ROC. CONTACT: [email protected]
flexion (respectively, 3.9±3.0º and 4.8±3.0º; P = 0.462). In addition, ETHICS COMMITTEE: Human Study and Ethic Review Board of
Tai Chi practitioners completed the TUG (9.2±1.0s) significantly National Taiwan University Hospital
faster than control subjects (10.9±1.9s; P = 0.021). However,
insignificant correlation was found between absolute angle errors and
time to complete the TUG (all P > 0.05). CONCLUSIONS: These
results demonstrate that long-term practice of Tai Chi sword had
developed better position sense in trunk rotation and in functional
mobility. IMPLICATIONS: The positive findings proved that Tai Chi 27-07 Monday 4 June 10:30
can be introduced to older adults as a low cost health promotion VCEC Exhibit Hall B & C
program. It also provides the basis for a prospective randomized CORRELATION AMONG BODY COMPOSITION, STRENGTH OF
control clinical trial. KEYWORDS: Aging, Trunk proprioception, LOWER EXTREMITY MUSCLES AND FUNCTIONAL CAPACITY
Health Promotion. FUNDING ACKNOWLEDGEMENTS: The authors IN WOMEN OLDER THAN 50 YEARS
thank The Hong Kong Polytechnic University for financial support Converso M, Freitas Jr I, Rosa C; São Paulo State University –
of this study through an Area of Strategic Development Grant Presidente Prudente – Brazil
to C.W.Y. Hui-Chan, W.W.N. Tsang, and S.N. FU. CONTACT:
[email protected] PURPOSE: The six-minutes walk test (SMWT) is generally used
ETHICS COMMITTEE: Ethics Committee of The Hong Kong to evaluate the functional capacity of aged people, who, usually,
Polytechnic University present some health problems such as arthritis and pulmonary,
cardiovascular, neuromuscular diseases, which limit the performance
Research Report Poster Display in SMWT and also in ergometric tests. The aim of the present
study was to verify the correlation among the results of SMWT, sit-
to-stand test (sit-to-stand) and body composition in women older
than 50 years. RELEVANCE: The knowledge of the association of
AGE AND NECK PROPRIOCEPTION RELATED CHANGES OF these results can support the physiotherapist in the treatment of
EYE MOVEMENT STABILITY patients. PARTICIPANTS: The sample was formed by 31 women,
Wang S1 , Lin Y1 , Wu J1 , Young Y2 ; 1 School and Graduate Institute aged 50-77 years. METHODS: Weight, height, sitting height, triceps,
of Physical Therapy, College of Medicine, National Taiwan University; suprailiac and thigh skinfold thickness, waist, hip, arm and thigh
2 Department of Otolaryngology, National Taiwan University Hospital circumferences, resistance and reactance were measured. Body
and National Taiwan University College of Medicine, Taipei, Taiwan composition was estimated by anthropometry and bioelectrical
impedance (BIA). The sit-to-stand test was applied to assess the
PURPOSE: Eye-head coordination involved the motor control of two
lower extremity muscles and SMWT was applied to assess the
subsystems of eye and head, and the integration of multiple afferents
functional capacity. The amount of steps during the SMWT was
from cervical, vestibular and vision. However, whether these systems
measured by pedometers (New Lifestyles, model NL-2000), which
were affected by aging and cervical afferents remained unknown.
were positioned on the waist of the subjects during the SMWT.
The aims of this study are to examine whether the changes of the
ANALYSIS: The association between the variables was evaluated
parameter of eye movement was associated with cervical range of
motion (ROM), body mass index (BMI), age, or neck proprioception. by Pearson correlation coefficient (p 0.05). RESULTS: The results
RELEVANCE: The significance of incoordination of eye-head system showed positive correlation between walked distance in the SMWT
has been showed to be related to the balance control and and sit-to-stand (r = 0.68, p = 0.001), number of steps in the SMWT
the fall incidence in previous study. PARTICIPANTS: Forty-five and sit-to-stand (r = 0.75, p = 0.001), walked distance and number of
asymptomatic women (age 46.1±13.8 year old) participated in this steps (r = 0.60, p = 0.001), and a negative correlation between number
study. METHODS: Cervical ROMs were recorded by an ultrasound- of steps in SMWT and triceps (r = −0.45, p 0.05) and midaxillary
based motion analysis system (Zebris system, Medizintecknik GmbH, skinfolds (r = −0.40, p 0.05), and between body mass (r = −0.44,
Tubingen Germany). The eye movements were recorded in various p 0.05) and fat mass estimated by BIA (R = −0.39, p 0,05) with
(neutral and rotated) head conditions when the subjects were asked the number of steps in SMWT. CONCLUSIONS: In this group of
to follow a horizontal moving target with a video-based eye movement women older than 50 years, those who presented the best results
recording system (VNG). The ratio (gain) of instantaneous speed of in the sit-to-stand, also presented best results in the SMWT, and for
eye and target during eye tracking; and within subject CV of the gain those who presented the highest amount of body fat, presented the
from different trials were measured. ANALYSIS: Linear regression lowest number of steps in the SMWT and the lowest performance
model was used to analyze the relationship of eye movements with in the sit-to-stand. IMPLICATIONS: if the physiotherapist to intensify
the possible factors, including age, BMI, previous history of neck exercises for strength of lower extremity muscles will be improving
pain, ROM and neck reposition error. RESULTS: The gain while the functional capacity of aged people and with this minimizing the
eye tracking toward right side in head neutral position (NR) was effect of the associates diseases. KEYWORDS: body composition,
related to target reposition error toward extension (p = 0.008). The women. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
gain during eye tracking toward right side in head rotated position [email protected]
FALLS AMONG COMMUNITY-DWELLING ELDERLY PEOPLE IN RELATIONSHIP BETWEEN LOWER-EXTREMITY MUSCLE
NORTHERN JAPAN STRENGTH AND FALLS AMONG COMMUNITY-DWELLING
Kojima S1 , Furuna T1 , Ikeda N2 , Nakamura M2 , Sawada Y2 ; ELDERLY PEOPLE
1 Department of Physical Therapy, School of Health Sciences, Ishii M1 , Hiroyuki S2,5 , Makizako H3 , Katoh H4 , Yoshida H5 ,
Sapporo Medical University, Sapporo, Japan; 2 Department of Suzuki T5 ; 1 Tsukui Corporation; 2 Research Fellow of the Japan
Occupational Therapy, School of Health Sciences, Sapporo Medical Society for the Promotion of Science; 3 Waseda University; 4 Gumma
University, Sapporo, Japan Paz College; 5 Tokyo Metropolitan Institute of Gerontology
PURPOSE: Hokkaido is the northernmost island of Japan. Due to PURPOSE: This study was intended to determine the cut-off value
heavy snowfall during winter, it is covered with snow or ice for of lower-extremity muscle strength for predicting falls. RELEVANCE:
one-third of the year. Therefore, many elderly people suffer from Fracture-inducing falls among elderly people have been recognized
falls or fall-induced injuries every year. However, little epidemiologic as a major reason for use of care insurance for disabled elderly
data exist on falls among community-dwelling elderly people in people in Japan. A cut-off value for population-based studies is
the northern regions of Japan, where the winters are long and, elusive. PARTICIPANTS: Subjects were 1429 (female 846, mean
consequently, the ground is slippery with ice and snow. The purpose age 75.7 years) community-dwelling elderly people who had attended
of this study is to investigate the circumstances and consequences a medical check in Tokyo, Japan. Exclusion criteria were 69 years
of falls among community-dwelling elderly people in northern Japan. old and under, MMSE < 24, with a history of stroke. METHODS:
RELEVANCE: Physical therapy plays an essential role in preventive We measured isometric muscle strength of the dominant leg (hip
intervention for falls. Epidemiological information on falls would aid and knee joint set at 90 degrees) using a masculator (Nihon
physical therapists in providing an effective therapeutic program Kohden Corp., Tokyo, Japan). History of a fall in the preceding
for fall prevention. PARTICIPANTS: The population of Hokkaido is year was obtained from individual subjects through interviews.
5.63 million, of which 20.9% constitutes people over 65 years of ANALYSIS: Multiple logistic regression analysis was used to assess
age. Residents of this description who were living at home were the relationship between falls and muscle strength. Tukey’s test
contacted by telephone and recruited in this study. In all, 1,000 was used to compare the occurrence of falls among quartiles of
subjects participated in this study. METHODS: A self-administered muscle strength values. RESULTS: The fall rate in the preceding
questionnaire was used to obtain information concerning health year was 18.5% for all subjects. Multiple logistic regression analysis
status, lifestyle, activity levels in daily life, and history of falls. revealed a significant relationship between falling and lower-extremity
Questions regarding the falls experienced included the number muscle strength (Odds ratios: 1.59, 95% CI: 1.09–2.32, p < 0.05).
of falls, the season and place of occurrence, the cause of the The quartile values of muscle strength were 0.82 (Nm/kg) and
falls, and the types of injuries sustained in the previous year. under, 0.83–1.06 (Nm/kg), 1.07–1.33 (Nm/kg), and 1.34 and over
This questionnaire was mailed to the 1,000 subjects. The study (Nm/kg), and the respective fall rates were 22.3%, 21.7%, 15.5%,
was approved by the Sapporo Medical University Research Ethics and 14.4%. The fall rates were significant different for the lower
Committee. ANALYSIS: Statistical analysis was performed using group of 0.82 (Nm/kg) and under and the group of 1.34 and
the chi-square test for categorical variables. RESULTS: Of the over (Nm/kg). CONCLUSIONS: A significant relationship was found
1,000 subjects, 860 (441 men and 419 women, mean age 73.0 between falls and lower-extremity muscle strength. We considered
years) completed the questionnaire. Two hundred and eighty-four that 0.82 Nm/kg of knee extension was the criterion value in risk
of them (33.0%) fell at least once during the year. Of those who of falling in community-dwelling elderly people. IMPLICATIONS:
fell, 158 subjects (55.7%) experienced two or more falls. The fall For physical therapy practice KEYWORDS: Falls, muscle strength,
rates increased with age and were higher for women than for men. predictor. FUNDING ACKNOWLEDGEMENTS: Work for this study
Falls occurred more frequently outdoors than indoors. In addition, was supported by a Grant-in-Aid from the Ministry of Health, Labour
60% of the falls occurred during winter. However, the proportion of and Welfare, Japan. CONTACT: [email protected]
falls occurring outdoors during winter decreased with age. Slipping ETHICS COMMITTEE: Tokyo Metropolitan Institute of Gerontology
(47.5%) was the most prevalent cause of falls. For 143 subjects
(50.4%), falls resulted in injury; 30 of them (10.6%) sustained
fractures. With advancing age, there was a significant increase in Research Report Poster Display
the rate of injurious falls. Compared to men, women had a higher 28-19 Monday 4 June 10:30
rate of injurious falls. CONCLUSIONS: The present study identified VCEC Exhibit Hall B & C
the characteristics of falls among the community-dwelling elderly in FALLS AND FUNCTIONAL PERFORMANCE IN ELDERLY
northern Japan. IMPLICATIONS: Based on the results of this study, WOMEN WITH OSTEOARTHRITIS OF THE KNEE
special attention should be directed to evolve strategies for avoiding
Dias R1 , Dias J1 , Mitre N2 ; 1 Physical Therapy Department, Federal
slip-related falls during winter in northern Japan. KEYWORDS:
University of Minas Gerais, Belo Horizonte, Brazil; 2 Physical
Fall, Elderly, community. FUNDING ACKNOWLEDGEMENTS: This
Therapy Department, Itauna University, Itauna, Brazil
study was supported by the Hokkaido Shimbun Press. CONTACT:
[email protected] PURPOSE: Knee osteoarthritis (OA) is a prevalent rheumatic
ETHICS COMMITTEE: Sapporo Medical University Research Ethics disease in the elderly individuals, mainly in females. There is
Committee a relationship between decreased functional performance and
self-report of pain and falls. This study aimed to assess the
functional capacity of elderly women with knee osteoarthritis (OA)
discriminating them in relation to the reports of falling. RELEVANCE:
Assessment of functional capacity and the impact of falls in
daily living activities might allow implementing effective Physical
Therapy intervention to prevent future falls and minimize dependency.
PARTICIPANTS: 46 women, 60 years-old and more, with knee
osteoarthritis took part. METHODS: This was an exploratory cross-
sectional study of non-fallers and fallers elderly women with knee
OA. A socio-demographic and clinical questionnaire was applied
and to assess their functional performance the Western Ontario Danish children, 16 in each age group, has been collected. The
McMaster Universities Osteoarthritis Index (WOMAC) and the sample consists of 13 first-born children and 19 second-born children
Physical Performance test Modified (PPTM) were used. ANALYSIS: and each age group consists of 7 girls and 9 boys. METHODS: In
Spearman correlation coefficient, multivariate binary logistic analyses this study the PEDI is administered as a questionnaire completed
(step-wise), qui-squared test, at the significance level at 5% and by the parents. General recommendations have been followed to
95% CI. RESULTS: 46 elderly women between 60 and 84 years increase the return rate. ANALYSIS: To conduct statistical analyses
(68.5±6.09 years) were assessed. Median age for the non-faller the software package SAS 6.0.0 is used. Student’s t-test is used
group (n=23) was 67.87±6.42 years and for the faller group (n=23) to compare the Danish mean values with the American reference
was 69.13±5.83 years. For the non-faller group there was a negative mean of 50. Independent samples t-tests are used to compare
correlation between the PPTM item “go up” and WOMAC pain, the results between the sexes and between first-born and second-
stiffness and physical function subscales, between “spinning” and born children. A p-value equal to or less than 0.05 is considered
pain and physical function subscales, and between “walking” and statistically significant. RESULTS: Significant differences are found
physical function subscale. In the faller group, there was a negative in the oldest age group on the caregiver assistance scale in the self-
correlation between “go up” and pain subscale, “book” and “go up/go care and social function domain (p = 0.03, p = 0.01). The girls score
down” and physical function subscale. The report of falling was significantly higher on the caregiver assistance scale in the self-care
correlated to “spinning” (p = 0.05) and pain subscale (p = 0.01). There domain (p = 0.0017). No significant differences are found between
was a statistical significant correlation between falls and WOMAC first-born and second-born children. CONCLUSIONS: In general, this
pain subscale (X2 = 7.72; p = 0.05). A multivariate binary logistic sample shows good correspondence between Danish values and
analysis (step-wise) was used to examine the correlation between the American normative reference values. It is argued that the few
falls and the PPTM items. The variables selected to enter the discrepancies, most likely, are due to cultural differences connected
model were “spinning”, “go up”, “Romberg” and “book”. Considering to specific items. It is recommended to carry out a Rasch analysis
the correlation coefficient and the p-value, “spinning” is inversely on a random national sample for all age groups in the PEDI. Studies
correlated with falls (p = 0.03). The odds ratio demonstrated that an of reliability and validity of Danish version of the PEDI are also
elderly woman who has one point less than other, had two times relevant. IMPLICATIONS: This study suggests that the American
more cumulative chance to be a faller (1/0.52 = 1.92 ≈ 2). There was normative data are most likely to be appropriate for reference
no statistically significant difference between groups when PPTM purposes in Denmark. However further studies must be carried out
items and falls were compared, neither for the PPTM total score before it is used as an functional assessment instrument in Denmark.
difference between groups. CONCLUSIONS: Even though there KEYWORDS: PEDI, functional assessment, disability. FUNDING
was no significant difference between groups in the functional items ACKNOWLEDGEMENTS: Copenhagen College of Physiotherapy.
investigated, the results pointed out that the significant correlations
found between falls and “spinning” and pain, between the subscales
of WOMAC and “spinning”, “go up” and “walk” in the faller group
stressed that this specific population have cumulative chances of 30-03 Monday 4 June 10:30
falling. IMPLICATIONS: Knee OA women with cumulative chances VCEC Exhibit Hall B & C
of falling need Physical Therapy management with pain control BEHAVIOR OF PRETERM NEWBORN DURING CHEST
modalities and functional exercise training to enable them to avoid PHYSIOTHERAPY
falls. Since this study has investigated only individuals with knee Lanza F1,2 , Gazzotti M1,2 , Luque A1,2 , Herrera G1,2 , Giovannetti A2 ;
OA, future studies should consider other important variables, such 1 Federal University of São Paulo/UNIFESP, Sao Paulo-Brazil; 2 São
as balance and proprioception and include a control group for better Camilo University Sao Paulo-Brazil
comparisons. KEYWORDS: elderly, osteoarthritis, falls. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT: PURPOSE: The purpose is to evaluate pain among NBPT during
[email protected] chest physiotherapy in neonatal intensive care unit (NICU). The
ETHICS COMMITTEE: Ethics Committee: UFMG ETIC 234/05 pain in preterm newborn(PTNB) has been studied since the
60’s and it is known that there are many short and long term
complications. Physiological and behavioral are the most common
Research Report Poster Display of them. RELEVANCE: Many clinical researches have already been
29-23 Monday 4 June 10:30 developed about pain in medical and nursing procedures, even
VCEC Exhibit Hall B & C though in physiotherapy there is not a consensus about pain during
APPLICABILITY OF THE PEDIATRIC EVALUATION OF non-invasive procedures among NBPT as desobstruction techniques.
DISABILITY INVENTORY (PEDI) IN DENMARK FOR NON- There are scales capable of diagnosing pain among preterm, one of
DISABLED CHILDREN AGED 1.5−2 YEARS AND 5−5.5 YEARS them is Premature Infant Pain Profile (PIPP), specific to PTNB. This
scale consists of the follow topics: gestational age (GA), cardiac rate,
Stahlhut M; Copenhagen College of Physiotherapy, Copenhagen,
face and eye aspects and oxigenation. Each variable has a score
Denmark
between 0 and 3, the highest sum is 21. Scores below 6 mean no
PURPOSE: The purpose of this study is to compare the values from pain, higher than 12 moderated and stronger pain. PARTICIPANTS:
non-disabled Danish children aged 1 21 -2 years and 5-5 12 years with It was observed PTNB with GA between 29 and 32 weeks. Weight
the American normative reference values of the Pediatric Evaluation born between 1500 and 2500gr. METHODS: The babies had not
of Disability Inventory. If discrepancies occur possible explanations used any vasoative drugs, invasive nor non invasive mechanical
must be discussed. Furthermore, any differences of the childrens’ ventilation, sedation or painkillers. The desobstruction technique
skills, as according to gender or first/second-born status, must be used was vibration and it was performed during 5 minutes on the
examined. RELEVANCE: The PEDI has been translated into Danish newborn’s chest. The PIPP scale was performed in 4 phases/stages:
as a questionnaire in 2005. PEDI evaluates functional status in before, during, immediately after and 15 minutes after the application
disabled children aged 6 months to 7 12 years. In Denmark only of the technique. ANALYSIS: Statistical analysis was performed
few translated and standardized outcome measures exist in the field by repeated ANOVA, statisticaly significance: p < 0.05. RESULTS:
of pediatric rehabilitation. To document outcomes after intervention 8 patients were studied, 5 females. There was an increase of
and to support an evidence-based practice it is very important PIPP score during the application of chest physiotherapy (7.61+0.88)
to use relevant outcome measures. PARTICIPANTS: Due to time meaning minimal pain. Before and after the technique the scores
constraints, only two age groups have been included. Convenience were 4.24 and 4.35 respectively. During the last phase, after 15
sampling is used to select the sample. Data from 32 non-disabled min, when the patient was positioning, the PIPP was the lowest,
2.36 p < 0. 05. CONCLUSIONS: We observed the lowest scores of postural adjustments to improve the ability to use the hands in
PIPP pain scale in PTNB when non invasive chest physiotherapy daily standing activities. KEYWORDS: Spastic diplegia, orthoses and
technique (vibration) was applied. IMPLICATIONS: The vibration postural adjustments. FUNDING ACKNOWLEDGEMENTS: Funding
technique, non invasive and conventional technique to mobilizate for this project was provided by the Norrbacka-Eugenia Foundation.
secretion in PTNB, does not cause pain. This may increase the CONTACT: [email protected]
application of chest therapy in NICU. KEYWORDS: preterm newborn, ETHICS COMMITTEE: The ethics committee at Umeå university,
chest physiotherapy, vibration. FUNDING ACKNOWLEDGEMENTS: Dnr-00-022.
None. CONTACT: Fernanda Lanza e-mail: [email protected]
ETHICS COMMITTEE: Ethical committee of General Hospital
Pedreira, Sao Paulo-Brazil
Research Report Poster Display LOWER EXTREMITY ISOMETRIC STRENGTH IN CHILDREN
30-07 Monday 4 June 10:30 WITH CEREBRAL PALSY OR JUVENILE IDIOPATHIC ARTHRITIS
Saarinen J1 , Lehtonen K1 , Lahdenne P1 , Autti-Rämö I2 , Mälkiä E3 ;
POSTURAL ADJUSTMENTS DURING REACHING IN CHILDREN 1 Helsinki University Central Hospital for Children and Adolescent;
WITH SEVERE SPASTIC DIPLEGIA WEARING DAFOS 2 Stakes National Research and Development for Welfare and
Näslund A1 , Sundelin G2 , Hirschfeld H3 ; 1 Department of Health; 3 University of Jyväskylä, Finland

Health Science, Luleå University of Technology, Luleå, Sweden;
2 Department of Community Medicine and Rehabilitation, Division PURPOSE: There are few reports published on muscle strength
in children with a chronical disease. It has been studied at least
of Physiotherapy, Umeå University, Umeå, Sweden; 3 Motor Control
in children with acute lymphoblastic leukemia, children with cystic
and Physical Therapy Research Laboratory, NVS Department,
fibrosis and in children and adolescents with Down Syndrome.
Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
Muscle weakness was found in these diagnostic groups when
PURPOSE: The aim of this study was to investigate the coordination compared to healthy controls. Muscle strength in children has been
between reaching kinematics, ground reaction forces and muscle studied more in children with juvenile idiopathic arthritis (JIA) and
activity in standing in children with severe spastic diplegia wearing cerebral palsy (CP). Muscle strength in JIA has been assessed in a
dynamic ankle-foot orthoses (DAFOs) and compare the results to few studies with different methods, e.g. an isokinetic dynamometry, a
age matched non-disabled children. RELEVANCE: Assessment and hand-held dynamometry and a computerized dynamo-meter. These
evaluation are essential because children with spastic diplegia, studies have suggested that children with JIA have reduced muscle
classified at level III-IV according to GMFCS (Gross Motor Function strength. On the other hand one study reported no difference in
Classification System), often recieve DAFOs as an adjunct to muscle strength between children with JIA and healthy controls. Also
physiotherapy in order to improve sitting, standing and walking. in children with CP different methods has been used and muscle
PARTICIPANTS: All children with spastic diplegia using DAFOs weakness has been reported in hip, knee and ankle in children
in a county in northern Sweden and had regular follow-ups of with diplegia. In hemiplegia group weakness has been found on
their ortohoses, were invited. Six participants at GMFCS level III-IV the involved side with some changes on the uninvolved side. The
formed the study group and six age- and sex-matched children with purpose of this study was to compare muscle strength in children
normal motor development served as a control group. METHODS: with various degrees of physical disorder. RELEVANCE: Muscle
Bilateral ground reaction forces and ankle muscle activity as well strengthening is often used in physiotherapy. It is important to spesify
as the reach hand kinematics were investigated by means of two the treatment plan for different kind of patients. PARTICIPANTS:
AMTI force plates, surface electromyography (EMG) and a two- The participants were patients with JIA (n=25) or CP (n=47) of
camera optoelectronic system (ELITE). Kinematic, EMG and force Hospital for Children and Adolescents, Helsinki University Central
plate signals were recorded simultaneously. The children reached Hospital (HUCH). All patients with JIA had lower extremity articular
for a cup filled with candy while standing on two force plates. involment with no active arthritis in lower extremities at the time of
Reflective markers were placed on the hand and cup. In this study, testing. All children were on anti-rheumatic medication. All children
standing support provided by the parent on the pelvis or by contact with CP could walk independently without a gait aid. The Gross Motor
of the non-reach hand on the table was necessary during the Classification System (GMFCS) was used to classify the severity of
standing task. ANALYSIS: Because of the small participant number the disability, Level I and II were identified. A control group (n=25)
and the heterogeneity of the group with pronounced difficulties of age-, height- and gender-matched healthy children, most of them
in locomotion, the results are presented on group as well as children of HUCH hospital staff. METHODS: A dynamometer chair
on subject level. RESULTS: Children with severe spastic diplegia, (Good Strength, Mtitur Ltd., Finland) was used and maximal isometric
wearing DAFOs, demonstrated that movement quality of upward strength in knee and ankle was measured from both sides in a sitting
and forward reach velocity differed regarding temporal phasing and position. ANALYSIS: All analysis were done with SPSS 11.5 for
amplitudes of velocity peaks compared to the controls. Furthermore, Windows. One-way ANOVA procedure and t-test were used in the
children with severe spastic diplegia, wearing DAFOs, lacked a group comparisons and post hoc analyses were performed using
coordinated muscle activity pattern and made use of postural Tukey test. Force values normalized by body weigth (N/kg) were
adjustments characterized by co-activation of agonist and antagonist used in all group comparisons. Zero values were not in analyzes.
muscles. However, the controls demonstrated coordinated muscle RESULTS: Significantly different values were found in knee extension
activity and interplay of the ground reaction forces on the reaching and knee flexion between GMFCS Level II and all other groups
and non-reaching side. CONCLUSIONS: In conclusion DAFOs and in ankle dorsiflexio/plantarflexion between both CP groups and
appear to provide some benefit for children with spastic diplegia other groups. In JIA knee extension was near tosignificantly different
GMFCS, level III-IV, by improving the use of postural adjustments (p = 0.52) compared to controls. CONCLUSIONS: The Level of
for balance control during a reaching movement in standing. An muscle strength is connected to the degree of the physical disorder.
intervention study would be of interest, to assess whether DAFOs In this study the muscle strength in JIA group was near to normal
could be valuable in the learning of processes regarding postural but in GMFCS Level II significantly lower compared to other groups.
adjustments, since postural control is a result of both maturation IMPLICATIONS: Adynamometer chair is well suited to measuring
and learning. IMPLICATIONS: Children with severe spastic diplegia pediatric patients and a good tool in assessment and planning of
wearing DAFOs can, despite different support conditions, practice treatment in physioterapy KEYWORDS: Children, mucsle strength,
reaching while standing and thereby promote motor learning of fixed dynamometer. FUNDING ACKNOWLEDGEMENTS: This study
was supported by Children’s castle Foundation and HUCH, Hospital grant from the Danish Foundation for Research in Physiotherapy.
for children and adolescent donation fund and McDonalds. CONTACT: [email protected]
ETHICS COMMITTEE: The Research Ethics Committee at the ETHICS COMMITTEE: De Videnskabsetiske Komitéer for Køben-
HUCH Hospital for Children and Adolescent approved this study havns og Frederiksberg Kommuner (ethical approval number KF 01-
383/97).

EFFECTS OF EXPERIMENTAL SHOULDER MUSCLE PAIN ON FUNCTIONAL OUTCOMES AND PHYSICAL THERAPY IN AN
SHOULDER-ABDUCTION FORCE STEADINESS INTERPROFESSIONAL CHRONIC PAIN TREATMENT PROGRAM
Bandholm T1,2 , Rasmussen L1,2 , Aagaard P1,3 , Diederichsen L1 , Hodgins I, Fast K, Wagenhoffer S, Tkachuk G, Olson P, Horlick A,
Jensen B2 ; 1 Institute of Sports Medicine – Copenhagen, Bispebjerg Woods M; Chronic Pain Centre, Saskatoon Health Region,
University Hospital, Copenhagen, Denmark; 2 Institute of Exercise Saskatoon, Canada
and Sport Sciences, Department of Human Physiology, University PURPOSE: This research highlights the contribution of physical
of Copenhagen, Denmark; 3 Institute of Sports Science and Clinical therapy in the interprofessional treatment of chronic pain and the
Biomechanics, University of Southern Denmark, Odense, Denmark use of functional outcome measures to evaluate clients’ physical
PURPOSE: We have previously demonstrated that shoulder sensory- progress. RELEVANCE: Research indicates that an interprofessional
motor control expressed as abduction force steadiness is mildly treatment program is the most effective treatment for chronic pain
impaired in patients with subacromial impingement syndrome (SIS) clients. The addition of physical outcome measures to self report
compared to a group of healthy matched persons, which might be questionnaires enhances the evaluation of chronic pain clients and
illustrates the role of physical therapists in an interprofessional
related to shoulder pain associated with SIS. The primary objective
team. PARTICIPANTS: 104 clients (females 62.5%) with a mean
of the present study therefore was to examine effects of experimental
age of 45.85 (10.09), and an average pain intensity of 6.59
shoulder muscle pain on shoulder sensory motor control in a group of
(1.66) on a 10 point scale completed treatment. 84.6% were
healthy persons previously matched to patients with chronic shoulder
publicly funded and 15.4% were privately funded. 65.4% were on
pain (SIS) and to evaluate to which extend the experimental shoulder
opioids. Area of pain: musculosketal (74%), neuropathic (16.3%),
pain model reflects key features of the SIS. RELEVANCE: In order to
headache (3.8%), abdominal (2.9%) and pelvic (2.9%). METHODS:
investigate interactions between shoulder pain and shoulder sensory-
The following 5 functional outcomes were administered before and
motor control in a clinically relevant model, the experimental pain
after treatment: 1 minute stair climb (n=101), 1 minute sit to
model needs to resemble key features of the pathology or syndrome
stand (n=101), 30 second single-leg standing balance (n=87), 20
that it is supposed to model. PARTICIPANTS: Nine healthy, non-
meter speed walk (n=104), sit and reach (n=87). In addition, the
medicated persons with ages ranging from 22 to 37 years (mean,
following 7 self-report questionnaires were administered: Canadian
27.7 years) volunteered to participate in the study. Informed consent
Occupational Performance Measure (COPM)(n=98), Chronic Pain
was obtained in accordance with the Declaration of Helsinki and the
Self-Efficacy Scale (CPSE) (n=104), Multidimensional Pain Inventory
study was approved by our Local Ethics Committee. METHODS: (MPI) (n=85), Chronic Pain Acceptance Questionnaire (CPAC)
Measurements were performed before, during and after experimental (n=84), Pain Catastrophizing Scale (PCS) (n=85), Tampa Scale
pain induction. Experimental muscle pain was induced by bolus of Kinesiophobia (TSK) (n=85) and Beck Depression Inventory-II
injections of hypertonic saline into the supraspinatus muscle to (BDI-II) (n=83). Physical therapy included education sessions on
mimic shoulder pain associated with SIS. The assessed parameters anatomy, posture, core stability and exercise. Treatment included
were isometric and isokinetic (concentric and eccentric) shoulder- daily stretching, ball and core stability exercise twice weekly, graded
abduction force steadiness at target forces (TF) corresponding to 20, conditioning, specific exercise prescription and pool class once
27.5, and 35% of the maximal shoulder-abduction torque expressed weekly. Clients attended multidisciplinary treatment (occupational
as the standard deviation and coefficient of variation in exerted therapist, pharmacist, physical therapist, psychologist, registered
force. Muscle activity during contractions was determined using nurse) half days, daily for 5 weeks of the 6 week program.
surface and intra-muscular electromyograms (EMG) obtained from ANALYSIS: Paired t tests compared pre and post treatment scores
eight shoulder muscles. ANALYSIS: Two-way, repeated measures on the 5 functional outcomes and 7 self report questionaires.
ANOVAs were used to examine main effects of condition (pre, during RESULTS: There were statistically significant improvements in stair
and post-pain) and load (TF) on the dependent force steadiness climb (t=-8.71, p < 0.001), sit to stand (t=-6.42, p < 0.001), standing
and EMG variables. RESULTS: Experimentally induced muscle pain balance (t=2.57, p = 0.012), speed walk (t=6.97, p < 0.001), flexibility
impaired shoulder-abduction force steadiness on average 21% during (t=-3.51, p = 0.001). In addition, there were statistically significant
isometric contractions (P < 0.05) and tended (P = 0.081) to do so improvements in COPM-Performance (t=-16.22, p < 0.001), COPM-
also during concentric contractions. Middle deltoid muscle activity Satisfaction (t=-18.19, p < 0.001), self efficacy (t=-7.91, p < 0.001),
during isometric contractions and infraspinatus and lower trapezius pain severity (t=4.65, p < 0.001), interference (t=5.99, p < 0.001),
muscle activity during concentric contractions increased during life control (t=-5.66, p < 0.001), affective distress (t=3.81, p < 0.001),
experimental pain. CONCLUSIONS: The present data indicate that acceptance (t=-7.48,p < 0.001), catastrophizing (t=9.00, p < 0.001),
experimental shoulder muscle pain impairs shoulder sensory-motor fear of movement/reinjury (t=6.13, p < 0.001) and depressive symp-
control, expressed as shoulder-abduction force steadiness, during toms (t=7.34, p < 0.001). CONCLUSIONS: The functional outcomes
isometric contractions in healthy persons. Few minor increases in indicated improvement in the clients’ physical abilites. These results
muscle activity were observed as a result of experimental pain support the integral role of physical therapy and the use of both
induction and these were not consistent across contraction types. functional and psychosocial outcomes when assessing the effec-
The experimental shoulder pain model seems to reflect some but tiveness of a chronic pain treatment program. Future research can
not all key features of the subacromial impingement syndrome. include cross-validation studies among the physical and psychosocial
IMPLICATIONS: Results obtained in experimental pain models measures and the further development of clinically useful functional
should be interpreted with caution when extrapolated to chronic measures for the interprofessional treatment of chronic pain.
pain conditions. KEYWORDS: Pain, shoulder, steadiness. FUNDING IMPLICATIONS: As there are not widely accepted tools to assess the
ACKNOWLEDGEMENTS: The study was supported in part by a physical functioning of chronic pain clients, this research highlights
the usefulness of functional outcomes in a treatment program and positive attitudes and lower knowledge than final year students.
the need for their continued development. KEYWORDS: function, Knowledge scores of clinical educators and final year students
pain, interprofessional. FUNDING ACKNOWLEDGEMENTS: none. suggest that health professional education had little impact on
CONTACT: [email protected] their knowledge of aging. As self-report questionnaires were used
ETHICS COMMITTEE: University of Saskatchewan Behavioral these findings need to be interpreted cautiously. IMPLICATIONS:
research Ethics Board When designing academic curricula more attention needs to be
given to increasing students’ knowledge of aging. Furthermore
students’ attitudes and knowledge could be positively influenced by
innovative strategies such as greater interaction with healthy older
32-23 Monday 4 June 10:30 adults before clinical experiences. KEYWORDS: Ageism education
VCEC Exhibit Hall B & C health. FUNDING ACKNOWLEDGEMENTS: Auckland University
KNOWLEDGE AND ATTITUDES TOWARDS OLDER PEOPLE of Technology Contestable Research Fund (Grant no. 01/146).
HELD BY HEALTH PROFESSIONAL STUDENTS AND CONTACT: [email protected]
PRACTITIONERS ETHICS COMMITTEE: Ethics approval was given by the Auckland
Stewart J1 , Giles L2,3 , Paterson J4 , Butler S4 ; 1 Physiotherapy University of Technology Ethics Committee
School, Faculty of Health and Environmental Sciences, Auckland
University of Technology, Auckland New Zealand; 2 Department of Research Report Poster Display
Rehabilitation and Aged Care, Flinders University, South Australia; 35-23 Monday 4 June 10:30
3 Research Office, Faculty of Health and Environmental Sciences,
Auckland University of Technology, Auckland New Zealand;
4 National Institute of Public Health and Mental Health Research, NORMATIVE VALUES FOR THE HARRIS HIP SCORE: A
Faculty of Health and Environmental Sciences, Auckland University CROSS-SECTIONAL STUDY
of Technology, Auckland New Zealand Muscat I2 ; 1 School of Health Science and Social Work, University
of Portsmouth, Portsmouth. UK; 2 Portsmouth City Primary Care
PURPOSE: Two studies investigated undergraduate health profes-
Trust, Portsmouth. UK
sional students’ knowledge and attitudes towards older people. Study
1 compared knowledge and attitudes held by final year occupational PURPOSE: The purpose of the study was to provide normative
therapy (OT) and physiotherapy (PT) students and their clinical values for the Harris Hip Score (HHS) for a population aged 30-
educators. Study 2 compared knowledge and attitudes held by 100 years and explore the associations between age and HHS.
new entry nursing, OT and PT students. RELEVANCE: The rapidly This study is responding to the need to provide normative values
aging population in industrialized countries is leading to increasing for the HHS, as identified by Keener et al (2003), and in so doing
numbers of older adults requiring health care. Studies examining provides a more representative population for comparison with the
knowledge and attitudes of health professionals towards older adults population who have undergone hip arthroplasty. RELEVANCE: Hip
suggest differences exist across professional groups of students outcome measures are essential in the field of orthopaedics and
and practitioners. An understanding of students’ knowledge and physiotherapy to monitor performance and long term function in
attitudes towards older adults is important in developing education people who have undergone hip arthroplasty. It is therefore important
that adequately prepares future practitioners to deliver quality care that hip outcome measures are measuring what they are supposed
to this population. PARTICIPANTS: Study 1: Final-year PT (n=92) to be measuring i.e., demonstrating validity. A problem with the
and OT (n=59) students, and PT (n=136) and OT (n=163) clinical HHS appears to be a decline in score with increasing age, despite
educators participated. Study 2: First-year PT (n=140), OT (n=82) an adequately functioning total hip arthroplasty. PARTICIPANTS:
and nursing students (n=153) were recruited during the first month Three hundred and eighty one participants (aged between 30 and
of their education. METHODS: A postal questionnaire was used 100 years) were recruited between June and November 2006 from
in these descriptive studies. Participants completed questionnaires various community groups in the Portsmouth and Chichester areas
about their sociodemographic factors, experience and interaction of England, UK. A call for volunteers was made by displaying posters
with older people. Kogan’s Attitudes Towards Older People Scale and/or giving presentations to the relevant groups. Volunteers were
(KAOP) and Palmore’s Facts on Aging Quiz (FAQ1) were used to recruited from a variety of community groups such as churches, over
measure attitudes and knowledge about older adults. ANALYSIS: 50’s exercise groups, social groups, work places, rest homes and
KAOP negative scores were reversed then responses were summed. relatives/friends accompanying those attending hospital outpatient
Positive, negative and net bias percentages were derived from departments. Potential participants were excluded if they had hip
incorrect FAQ1 responses. ANCOVAs were used with demographic pain, previous treatment for hip pain or pathology, were currently
variables as covariates, to compare the KAOP and FAQ1 scores under investigation for hip problem or had prior injury or known
of student groups and clinical educators. Alpha level was set pathology concerning the hip. METHODS: The study was of cross-
at 0.05. RESULTS: Study 1: Final-year PT and OT students sectional, observational, analytic design. The data was gathered by
showed no difference in their overall knowledge and attitudes face-to face interview(n=46, 12%) and self-complete questionnaire
towards aging (all p values >0.05). While Clinical Educators in both (n=335, 88%). ANALYSIS: Multiple regression was used to explore
professions showed more positive attitudes than students (p = 0.004) the effect of the clinically relevant factors (predictor variables)
they had no better knowledge about aging (p > 0.05). Further such as age, gender, ethnicity, socioeconomic status, alcohol
analysis of knowledge showed that a greater percentage of students’ consumption, smoking history, number of musculoskeletal and
incorrect answers were negatively biased towards older adults in medical comorbid conditions on normal scores (HHS). RESULTS:
comparison to clinical educators in both professions (p = 0.026). The results presented a demographic description of the study
Study 2: New entry nursing, PT and OT students did not differ on population and normative values of the HHS for each decile of age
KAOP or FAQ1 scores (all p values >0.05). When combining the group between 30 and 100 years. A significant negative correlation
total sample, those with higher social contact showed significantly was found between age and the HHS [r = −0.41, p 0.0005]. Multiple
less negative bias on incorrectly answered knowledge questions regression identified age, number of musculoskeletal and medical
(p = 0.004) while younger students had more negative attitudes comorbidities were significant predictors of HHS [adjusted R square =
towards older adults (p = 0.001). Across both studies participants’ 0.414, p < 0.0005]. The relationship between age and HHS was
correct knowledge scores ranged from 42 to 52%. CONCLUSIONS: non-linear and the quadratic model provided the best estimation of
Within each study students’ knowledge and attitudes towards aging the curvi-linear effect. CONCLUSIONS: The results show that age,
did not differ across disciplines. New entry students showed less number of musculoskeletal and medical comorbidities are significant
predictors of the HHS. These results are supported by contemporary Research Report Poster Display
research by Brinker et al (1996) and Ritter et al (2004). This study 36-07 Monday 4 June 10:30
provides substantial normative values for the HHS, which can be used VCEC Exhibit Hall B & C
for future research comparing outcomes with a population who have VALIDITY OF THREE PHYSICAL PERFORMANCE MEASURES
undergone hip arhroplasty. This is an area of much needed research. IN INPATIENT GERIATRIC REHABILITATION
IMPLICATIONS: This study provides new knowledge, which will
Brooks D1−3,5 , Aileen D1,3 , Gary N1,3 ; 1 Graduate Department of
be used for providing fair comparison with the joint replacement
Rehabilitation Science, University of Toronto, Toronto, Canada;
population and improve and produce more meaningful outcome 2 Department of Physical Therapy, University of Toronto, Ontario;
evaluations in this area. KEYWORDS: Hip outcome measure, hip 3 Toronto Rehabilitation Institute, Toronto, Canada; 4 Baycrest Centre,
arthroplasty. FUNDING ACKNOWLEDGEMENTS: The study has
Toronto, Ontario; 5 West Park Healthcare Centre, Toronto, Ontario
received a funding contribution from the Wessex Primary Care
Research Network (WReN). PURPOSE: To evaluate the construct validity and the responsiveness
ETHICS COMMITTEE: Isle of Wight, Portsmouth and South East of three measures of physical performance measures as outcome
Hants Local Research Ethics Committee, England, UK. LREC no: measures for frail older persons. RELEVANCE: Clinicians are often
05/Q1701/37 faced with the dilemma of which physical performance measure
to use in different settings such as inpatient programs, outpatient
Research Report Poster Display clinics or in people’s homes. Physical performance measures can
have different measurement properties in different patient populations
and the literature on the use of these measures in frail elderly is
conflicted. PARTICIPANTS: Fifty-two subjects (35 women, 17 men;
OUTCOME MEASURES IN RANDOMISED CONTROLLED TRIALS age, 80 + 8 years). METHODS: Pre-post design was used with
OF CONSERVATIVE INTERVENTIONS FOR ROTATOR CUFF measures at admission and discharge from three inpatient geriatric
DISORDERS: A 15-YEAR AUDIT AND SYSTEMATIC REVIEW rehabilitation programs. Physical performance measures were timed
McCreesh K; Dept. of Physiotherapy, University of Limerick, up and go (TUG), two-minute walk test and functional reach.
Limerick, Ireland Functional status was measured with the Functional Independence
Measure (FIM) and the modified Barthel Index. ANALYSIS: To
PURPOSE: To establish current and recent practice in rotator cuff
determine if performance measures define known groups of patients
research with regard to the use of outcome measures and to
according to their ambulatory status at discharge, a one-way ANOVA
determine if any recommendations can be made with regard to
was performed. To determine the relationship between performance
optimal outcome measures for use in conservatively managed rotator
and functional status measures, correlation analysis was performed
cuff disorders RELEVANCE: Clinicians and researchers involved
using Pearson’s correlations, correlation analysis was performed
in managing rotator cuff disorders require outcome measures that
using Pearson’s correlations. The standardized response mean
accurately reflect patient outcome PARTICIPANTS: N/A METHODS:
was calculated by dividing the mean change by the standard
15 year audit (July 1990-2005) of randomised controlled trials of
deviation of the change score. RESULTS: The TUG and two-minute
conservative management of rotator cuff disorders to assess trends
walk test scores were significantly different in groups of patients
in outcome measure use, followed by systematic review of properties
using different ambulatory aids (p = 0.006), while no such difference
of outcome measures identified during the audit ANALYSIS: Out-
was observed for the functional reach (p = 0.4). The correlations
come measures were assessed against pre-defined quality criteria.
between the TUG/two-minute walk test and the FIM were −0.59 and
RESULTS: Eight different questionnaire based measures were
0.59 (p < 0.0001), respectively, at admission, and −0.42 and 0.47
identified; with the Constant score the most commonly used. There
(p < 0.04), respectively, at admission and discharge. The correlations
was limited patient involvement in development of the measures,
between functional reach and the FIM were not significant (p > 0.09).
reducing content validity. The UCLA score, SDQ and Constant score
Standardized response means were 1.1 for the TUG, 0.7 for the two-
had limited evidence of reliability. Floor and ceiling effects were
minute walk test and 0.5 for functional reach. CONCLUSIONS: The
poorly studied. The SRQ had limited evidence of validity. The ASES
TUG and two-minute walk test are valid and responsive outcome
form received the best ratings overall for its psychometric properties.
measures in older persons participating in geriatric rehabilitation.
The widespread use of the Constant score was not substantiated
Functional reach was a moderately responsive outcome measure,
by review of its properties. CONCLUSIONS: Based on the criteria
but did not consistently reflect ambulatory or functional status.
used, the ASES form was the measure most strongly recommended
IMPLICATIONS: Physical performance measures appear to provide
for use in populations with rotator cuff disorders. Further research
somewhat different information than functional status measures. The
is required to examine the properties of commonly used shoulder
strong correlation between the TUG and two-minute walk test suggest
outcome measures. IMPLICATIONS: This work may assist clinicians
a considerable overlap between these two measures. The TUG may
and researchers in their choice of outcome measures for use in
offer some advantages over the two-minute walk as an outcome
persons with rotator cuff disorders. The criteria list used may form
measure for this population. KEYWORDS: Geriatrics, physical
a basis from which outcome measures may be assessed in future
performance, walk test, exercise, function, walking, ambulation.
studies or by clinicians. KEYWORDS: outcome measure, rotator
FUNDING ACKNOWLEDGEMENTS: Supported by grants from the
cuff. FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
Toronto Rehabilitation Institute and Collaborative Research Program,
Rehabilitation and Long-Term Care. Drs. D. Brooks and A. Davis
hold New Investigator Awards from the Canadian Institute for Health
Research. Dr. G. Naglie is supported by the Mary Trimmer Chair
in Geriatric Medicine Research, University of Toronto. CONTACT:
[email protected]
ETHICS COMMITTEE: Toronto Rehabilitation Institute, Baycrest and
West Park Research Ethics Committees
WALKING ENDURANCE AND PROXIMAL COMPENSATION FOR FUNCTIONAL PERFORMANCE AND EXPERIENCED
DISTAL WEAKNESS IN CHARCOT-MARIE-TOOTH DISEASE LIMITATIONS OF DAILY LIFE IN PEOPLE WITH CHARCOT-
Ramdharry G1 , Marsden J1 , Day B1 , Reilly M2 ; 1 Sobell Department MARIE-TOOTH’S DISEASE
of Movement Neuroscience, Institute of Neurology, London, UK; Eklund E, Svensson E, Häger-Ross C; Department of Community
2 National Hospital for Neurology and Neurosurgery, London, UK Medicine and Rehabilitation Section of Physiotherapy, Umeå
university, Umeå, Sweden
PURPOSE: This investigation aims to investigate factors limiting
walking distance in Charcot-Marie-Tooth disease (CMT). It has PURPOSE: To evaluate possible correlations between hand function
been suggested that in the presence of distal weakness, the hip in persons with Charcot-Marie-Tooth’s disease (CMT) and functional
flexor muscles are more active to compensate for reduced ankle performance in the lower extremities. Further, we aimed to investigate
power at preswing and foot clearance during swing phase. The how people with CMT experience their limitations of daily life,
hypothesis is that fatigue of the hip flexor muscles limits walking and if this relates to functional performance of upper and lower
endurance. RELEVANCE: People with CMT present with sensory extremities. RELEVANCE: Charcot-Marie-Tooth is a peripheral
loss, weakness and musculoskeletal changes. The presence of neuropathy causing progressive sensory loss, muscle atrophy and
these characteristics lead to compensatory strategies to maintain weakness. The lower extremities are first affected and most studied
function. Understanding how impairments limit walking, and how but to which extent this correlates to reduction in hand function is
compensations maintain function will in turn allow the development poorly understood. CMT is the most common inherited neuropathy,
and investigation of specifically targeted rehabilitation approaches. but research on physiotherapy is limited. It is essential to establish
PARTICIPANTS: 14 people with CMT and 7 age, height and weight good outcome measures that reflect function in daily life, i.e, in
matched healthy controls were recruited. METHODS: Study1: People relation to impairment as well as activity dimensions according to the
with CMT walked on a treadmill until they reached level 17 on the International Classification of Function (ICF), and that are reliable
Borg perceived exertion scale. Gait was analysed using 3D motion and easy-to-use in clinic in the rehabilitation of these patients.
analysis. The maximum voluntary contraction (MVC) of the hip flexors PARTICIPANTS: Twenty out of 24 persons with CMT registered
was recorded before and after the walking task. Matched controls at the neurological clinics in three counties of northern Sweden
walked at an identical speed, cadence and total time. Study 2: (~630,000 inhabitants, comparative to world reported incidence);
People with CMT undertook a sub-maximal fatigue task to reduce 9 men, 11 women aged 24-73 years and all right handed.
hip flexor MVC by 20%. Walking was assessed prior to and after the METHODS: We examined functional performance using tests of
fatigue task and the time taken to reach Borg level 17 determined. dexterity (Box and Block Test, BBT; Nine-Hole Peg test, NHP), grip
ANALYSIS: The primary outcome measures of hip flexor MVC, hip and pinch strength (Grippit® dynamometer), tactile sensation (Shape
joint amplitude and velocity at pre-swing to swing were compared Texture Identification test, STI) and function of the lower extremity
using a general linear model ANOVA. Secondary outcome measures (Short Physical Performance Battery, SPPB). Disabilities of the
were compared using the same test with a Bonferroni correction. Arm Shoulder and Hand outcome questionnaire (DASH) was used
RESULTS: Study 1: People with CMT walked on the treadmill for to estimate self-rated daily life function. ANALYSIS: Correlations
a mean time of 42 minutes before stopping. Controls reached a between performance in the lower extremities and hand function,
median Borg level of 8 compared to 17 in the CMT group for as well as between DASH and functional performance in both upper
the same walking duration. After walking, all subjects significantly and lower extremities, were evaluated using Pearson’s correlation
reduced hip flexor MVC (P < 0.001) but the drop was greater in and Spearmans rank correlation. RESULTS: More reduced hand
people with CMT. The hip velocity decreased in people with CMT function was observed in persons with poor functional performance
and increased in controls (P < 0.006) and there was no significant in the lower extremities, i.e. there was a correlation between all of
difference in hip amplitude. An increase in trunk coronal motion was the hand function tests and SPPB, respectively. Likewise, persons
observed (P = 0.017). Study 2: Following isolated fatigue of the hip who experienced more limitations in daily life as measured by DASH
flexors the walking time in the CMT group was reduced to 16 minutes also had worse hand function. Preliminary analyses show that the
(P = 0.032). There was no difference in hip velocity and amplitude, reduced functional performance in both upper and lower extremities
however there was a marked increase in trunk motion in the coronal causes limitations in daily life for people with CMT. CONCLUSIONS:
(P < 0.000) and horizontal planes (P = 0.007). CONCLUSIONS: Hip A correlation existed between functional performance in the lower
flexor strength and velocity of hip motion decreases with prolonged extremities and hand function, and also between self rated limitations
walking and specifically fatiguing the hip flexors markedly reduces of daily life and functional performance in both upper and lower
the time a person with CMT is able to walk. The observation of extremities. SPPB as well as DASH seem to be suitable as outcome
increased trunk motion in both studies may indicate a secondary measures for evaluation of function in persons with CMT, but needs to
compensation to maintain the forward progression of the limb in be evaluated in a larger population. IMPLICATIONS: Implementation
swing phase when hip flexors are fatigued. IMPLICATIONS: If as of outcome measures that can give insight into problems experienced
indicated the hip flexors do limit prolonged walking in people with by people with CMT, especially due to reduced hand function. This is
CMT, a specific hip flexor strengthening regime may help increase important in order to develop evidence based physiotherapy manage-
walking endurance thus impacting on their functional mobility. The ment of people diagnosed with CMT. KEYWORDS: Charcot-Marie-
nature of this regime requires further study. KEYWORDS: Charcot- Tooth’s disease, correlations, functional performance. FUNDING
Marie-Tooth disease, walking endurance, compensation. FUNDING ACKNOWLEDGEMENTS: Swedish Association of Persons with
ACKNOWLEDGEMENTS: Medical Research Council. CONTACT: Neurological Disabilities (NHR), Swedish Association of Registered
[email protected] Physiotherapists’ minnesfond, Stiftelsen JC Kempes Stipendiefond
ETHICS COMMITTEE: The National Hospital for Neurology and and Västerbotten County Council, Sweden.
Neurosurgery and the Institute of Neurology Joint Research Ethics ETHICS COMMITTEE: The Regional Ethical Review Board, Umeå,
Committee Sweden.
Research Report Poster Display levels of soccer. ANALYSIS: Demographic data, injury information,
37-19 Monday 4 June 10:30 and soccer exposure were described as a percentage of the total
VCEC Exhibit Hall B & C responses. RESULTS: Fifty three percent of the respondents were
DEPRESSION AS EXPERIENCED BY FEMALE PATIENTS WITH males and 47% were females. The average age of respondents was
FIBROMYALGIA 16 years; 73% played at the elite level (Metro), and 86% kicked
with their right leg. Seventy percent played soccer between 7–14
Sallinen M; Satakunta University of Applied Sciences, Pori, Finland
hours/week, and 71.7% played other sports up to 6 hours/week.
PURPOSE: The purpose of this study was to describe and The most common playing surfaces were outdoor turf and grass.
analyze the experiences of depression among female patients with Fifteen of the respondents indicated they had experienced a severe
fibromyalgia. RELEVANCE: Depression is one of the most common injury (all of which were lower extremity) during the soccer season
symptoms associatede with chronic pain in fibromyalgia. Every third (14.5%). Of those, 11 completed additional injury information. The
patient with FM could also be diagnosed with clinical depression. respondents also indicated that 15.3% played soccer with pain.
However, for the physiotherapist recognizing depressive symptoms CONCLUSIONS: The incidence of severe injury in this survey is
can be difficult. PARTICIPANTS: 5 middle aged female patients higher than other epidemiological studies in the literature. Further
with long history of FM were included in the study. Participants investigation with a greater number of respondents is warranted to
were recruited from a aquatic exercise group for musculoskeletal see if this higher incidence exists in British Columbia and, if so,
pain patients. Participation was based on voluntariness. METHODS: what the contributing factors may be that are unique to this area.
A qualitative theme interview was used to collect the data. Each IMPLICATIONS: Sports injuries are a concern for the short and long
patient was interviewed in a session of 1.5-2 hours. Interviews were term health of our youth. Because each geographic and demographic
tape recorded and transcribed verbatim for the analysis. ANALYSIS: area brings with it a unique set of risk factors for injury, these
The interviews were analysed using both phenomenographic and must be identified prior to the design of intervention programs. A
narrative analysis. The narratives were analysed in perspective to prospective survey and injury surveillance in British Columbia are
the storyline, highlights, the beginning and the end of the story, directions for future research. KEYWORDS: soccer; injury; incidence.
as well as the roles that the patients gave to themselves, the FUNDING ACKNOWLEDGEMENTS: Physiotherapy Foundation of
physiotherapists/doctors and to the pain. The phrases used by Canada. CONTACT: [email protected]
the patients were categorised and analysed in-depth. RESULTS: ETHICS COMMITTEE: Behavioural Research Ethics Committee,
Although the experiences of disability varied from person to person University of British Columbia, Vancouver, Canada
some common features connected to mental wellbeing could be
categorised: 1) solitude and loneliness 2) mood variations 3) changes
of self-perception 4) body image issues and 5) overwhelming fatique.
Experience of not being heard or believed lead to uncertainity 39-03 Monday 4 June 10:30
and experienced helplessness. The narratives could be labelled VCEC Exhibit Hall B & C
as “princess-stories” or “hero-stories” depending on the roles THE CORRELATION OF LOWER EXTREMITY FLEXIBILITY
the patients took.The role of professional helpers was seen as AND STRENGTH WITH BALANCE IN AN INTERNATIONAL
essential support in the recovery. CONCLUSIONS: Experience of POPULATION OF SPECIAL OLYMPIANS
depression varies a lot, but in physiotherapy recognition of the Adewunmi R, James T, Reicherter E, Kasior-Szerszen I; Howard
symptoms can be done through narratives. Understanding the University, Washington DC, USA
role of the patient is necessary in order to provide sufficient
and accurate mental support in physiotherapy. IMPLICATIONS: PURPOSE: The purpose of this study was to assess the correlation
More research is needed on the recovery process and the role between lower extremity flexibility and strength measurements with
of physiotherapy in fibromyalgia. In pt-education the importance balance scores in Special Olympian men, women, and children
of developing social skills and active listening should not be participating in the 2005 Nagano Japan Winter World Games.
underestimated. KEYWORDS: narrative research; chronic pain; RELEVANCE: Research has shown that individuals with intellectual
fibromyalgia. FUNDING ACKNOWLEDGEMENTS: unfunded. disabilities have low levels of physical fitness and high incidence
of obesity which puts them at risk for many health problems.
Due to their expertise, physical therapists are uniquely situated
Research Report Poster Display to address these health disparities. However, compared with other
38-23 Monday 4 June 10:30 populations, little is known about the relationship of strength and
VCEC Exhibit Hall B & C flexibility as related to the balance of youth and adults with mental
SURVEY OF SEVERE INJURY IN ADOLESCENT SOCCER retardation to guide clinicians in their efforts with this population.
PLAYERS: A PILOT STUDY PARTICIPANTS: A database including lower extremity strength and
flexibility and balance measures of 482 international participants
Celebrini R1,2 , MacIntyre D1,2 ; 1 School of Rehabilitation Sciences,
from the 2005 Winter World Special Olympics Games in Nagano,
University of British Columbia, Vancouver, Canada; 2 Rehabilitation
Japan was utilized. Participants were of both genders; ages ranging
Research Lab, GF Strong Rehab Centre, Vancouver, Canada
from 10–55 years. METHODS: The participants provided informed
PURPOSE: The purpose of this pilot survey was to determine consent before participating and institutional review board approval
the rate of severe injury (defined as greater than 8 weeks of was attained for the study. Utilizing the FUNfitness protocol, lower
lost playing time in a season) among adolescent soccer players. quarter strength (sit to stand, abdominal crunch) and flexibility (hip
RELEVANCE: An understanding of severe injury rates and the nature and knee extension, ankle dorsiflexion) and balance (functional
of these injuries is critical in the design of effective injury prevention, reach, single leg stance) were measured and recorded onto score
rehabilitation, and training programs. The results of this survey will sheets by physical therapists. ANALYSIS: The data for each of
add to our understanding of soccer related injuries and provide the the strength and flexibility measures were compared to each of
first insight into these injuries in British Columbia. PARTICIPANTS: the balance measures to identify the correlation between them. A
One hundred and three surveys were returned from community Pearson correlation was performed utilizing SPSS 13.0 statistical
soccer players in the lower mainland of British Columbia from Oct software. RESULTS: The results from the data analysis found
2005 – April 2006. METHODS: Surveys that covered questions on statistically significant correlations amongst the strength, flexibility,
demographics, the nature of recent injuries, environmental factors and balance measures. Increased time (seconds) to perform single
and exposure to soccer were distributed through the BC Soccer leg stance was inversely correlated to quickly perform sit-to-stand
Association and coaches to teams of players 14-18 years old at all (repetitions/minute); ranging from r = −0.26 to −0.52 (p 0.01) across
age groups. Increased time to perform single-leg-stance was also given once a week and additional home exercises performed daily.
negatively correlated with ability to perform the Functional Reach ANALYSIS: The results were analysed by relevant methods in SPSS
Test; ranging from r = −0.25 to −0.40 (p 0.01) across age groups. and visual inspection. RESULTS: Results show that mean score on
To a lesser significance level (p 0.05), decreased ankle dorsiflexion the DRI and VAS pain intensity was significantly reduced from before
range-of-motion was negatively correlated with increased single leg to after the intervention period for everyone. Significant correlation
stance time in the older groups. CONCLUSIONS: The findings from was found between change in function and pain (r = 0.8). The analysis
this study showed a highly significant correlation between decreased of ultrasound data is in progress. CONCLUSIONS: In the present
lower extremity flexibility and poor balance in an international study women with PLPP improved their function and obtained pain-
Special Olympian population. To a lesser degree, lack of lower relief during the intervention period. IMPLICATIONS: This pragmatic
extremity flexibility was correlated with poor balance, particularly intervention seem to benefit women with persistent pelvic pain post
in the older athlete groups. IMPLICATIONS: The results of this partum. Closer analysis may show which of the treatment elements
study found that even in an elite athletic population, lack of lower are most important for each of the patients. KEYWORDS: pelvic
extremity strength and flexibility can impair balance for persons pain, pregnancy, treatment. FUNDING ACKNOWLEDGEMENTS:
with intellectual disabilities. This implies that for these athletes The Norwegian Fund for Postgraduate Training in Physiotherapy.
and for other persons with this disability, the increased risk of ETHICS COMMITTEE: Norwegian regional ethics committee;
falls and other injuries is significant. Physical therapists can play Norwegian statistical database
a vital role in addressing this health concern to improve the
physical health and quality of life of these individuals. KEYWORDS:
Mental Retardation; Musculoskeletal Equilibrium; Physical therapy.
FUNDING ACKNOWLEDGEMENTS: Presentation of the results of 01-13 Monday 4 June 14:00
this study was supported by a Howard University Fund for Academic VCEC Exhibit Hall B & C
Excellence Grant and Center for Advancement of Service Learning EFFECTS OF POSITIONING OF NEONATES WITH UNILATERAL
Grant. CONTACT: [email protected] LUNG DISEASE ON CARDIOPULMONARY PARAMETERS
ETHICS COMMITTEE: Howard University Institutional Review Board Almazeedi S, Aytoughlo D; Farwania Hospital, Farwania, Kuwait
PURPOSE: To determine the effects of positioning of neonates
Research Report Poster Display with unilateral lung disease on cardiopulmonary parameters.
39-07 Monday 4 June 10:30 RELEVANCE: Physical therapists have a great role in treating
VCEC Exhibit Hall B & C neonates with unilateral lung disease in the NICU. Thus for safe and
CHANGES IN DAILY FUNCTIONING AND PAIN INTENSITY proper treatments of neonates, the pyhisical therapist has to be aware
AFTER SPECIFIC EXERCISE FOR WOMEN WITH PERSISTENT of the effects of different positions on ventilation, oxygenation and
PELVIC PAIN POST PARTUM other cardiopulmonary parameters such as heart rate and respiratory
Unsgaard-Toendel M, Vasseljen O, Fladmark A, Woodhouse A, rate. PARTICIPANTS: Nine neonates with left lung disease at
Mørkved S; Norwegian University of Science and Technology, Farwania hospital’s NICU in Kuwait were included in the this study.
Faculty of Medicine, Department of Community Medicine and METHODS: Each neonate was turned from supine position to one
General Practice of the lateral positions (chosen at random), then turned to the supine
position and finally turned back to the supine position. Each position
PURPOSE: The aim of this study was to assess the effect of an was maintained for 10 minutes. For analysis, we recorded the values
intervention program, including the use of ultrasound as biofeedback, for heart rate, respiratory rate, transcutaneous arterial oxygen and
to improve daily life functioning and reduce pain intensity in women carbon dioxide pressures and arterial oxygen saturation at one-
with persistent low back- and pelvic pain after pregnancy (PLPP). minute intervals during 10 minute period and then averaged the
RELEVANCE: PLPP is a considerable problem for many women. An results. ANALYSIS: Conventional statistical methods were employed
individually designed treatment program including specific stabilizing to determine means, standard deviation and standard error. Paired
exercises are recommended in European guidelines for treatment t-tests were used to compare differences between the positions
of PLPP. The recommended intervention addresses training of both for the dependent variables. RESULTS: Mean gestational age was
global and local muscles. However, which of the treatment elements 29 plusminus 5 weeks, mean birth weight was 1.86 plusminus
are the most effective remains unknown. In the present study we 1 Kg. There were no statistical significant differences between
wanted to investigate possible correlations between changes in the positions regarding heart rate, respiratory rate, transcutaneous
Disability Rating Index (DRI) and VAS pain intensity scores and the arterial oxygen and carbon dioxide pressures and arterial oxygen
ability to perform an isolated muscle contraction. Ultrasound imaging saturation. Heart rate during supine, right and left side lying positions
was used both as biofeedback when teaching isolated muscle activity, was 150 plusminus 12, 150 plusminus 14 and 152 plusminus 11
and as an evaluating tool to study quality of muscle contractions and respectively (p. greatequal 0.05). Respiratory rate during supine,
thickness / lateral contraction of deep muscles. Women reporting right and left side lying was 50 plusminus 12, 54 plusminus 8 and
PLPP constitutes a heterogeneous group and there is a lack of 49 plusminus 14 respectively (p greatequal 0.05). Arterial oxygen
knowledge related to the effect of interventions on subgroups. Single saturation during supine, right and left side lying was 94 plusminus 4,
subject experimental design allows close study of single participants 95 plusminus 3 and 93 plusminus 3 respectively (p greatequal 0.05).
in order to identify good responders. PARTICIPANTS: 13 women Transcutaneous arterial oxygen pressure during supine, right and left
mean age 31 (range 24-40), parity 1.7 (range 1-4) with persistent side lying was 10 plusminus 7, 10 plusminus 6 and 11 plusminus
low back- and pelvic pain after pregnancy at least 3 (range 3-81) 7 respectively (p greatequal 0.05). Finally arterial transcutaneous
months after the last delivery was included. METHODS: A single carbon dioxide during supine, right and left side lying was 4 plusminus
subject experimental ABA-design was used. Effect parameters were 3, 4 plusminus 4 and 4 plusminus 3 respectively (p greatequal 0.05).
DRI, VAS for pain intensity and ultrasound imaging of displacement CONCLUSIONS: The results of this study suggest that neonates with
and cross-section in deep abdominal muscles. Tests were performed unilateral lung disease can be turned safely on any position: Affected,
once a week during 4 weeks for initial baseline, 16 weeks of treatment unaffected side or supine. However, even though the results were not
and 4 weeks post treatment. The intervention consisted of relearning statistically significant, respiratory rate was lower and transcutaneous
strategies through ultrasound feedback to isolate muscle contraction arterial oxygen pressure was higher when the affected lung was
in transversus abdominis, stimulation of muscle-tendon-fascia-slings dependent and the good lung was uppermost. Replication of this
that stabilises the low back-pelvic area, stretching and, when study is essential with inclusion of a larger sample size in order
considered necessary, manual therapy. Individual treatment was to obtain statistical significance. IMPLICATIONS: The information in
this study will encourage physical therapist working in the NICU to Operator performance (use of a three second TI ) is also important.
monitor cardiopulmonary parameters closely with positional changes IMPLICATIONS: The use of a three second TI during manual
of neonates. KEYWORDS: Heart rate, Respiratory rate, unilateral hyperinflation is recommended for clinical practice. More complete
lung disease, transcutaneous arterial oxygen and carbon dioxide documentation of pattern of ventilation in future research is required.
pressures. FUNDING ACKNOWLEDGEMENTS: This research study KEYWORDS: Manual hyperinflation, Respiratory therapy. FUNDING
was unfunded. However, We would like to thank Dr. Reema Alsawan ACKNOWLEDGEMENTS: No funding was received for this work.
the head of the NICU for giving us the permission to conduct the study ETHICS COMMITTEE: University of Sydney; Concord Repatriation
on the neonates in her unit. Also we would like to thank the NICU and General Hospital
nursing staff for their great help and support with data collection.
ETHICS COMMITTEE: Farwania Hospital
01-17 Monday 4 June 14:00 THORACOABDOMINAL MOTION AT REST AND DURING
VCEC Exhibit Hall B & C CYCLING EXERCISE IN PATIENTS WITH CHRONIC
EFFECT OF A THREE SECOND INSPIRATORY TIME ON OBSTRUCTIVE PULMONARY DISEASE
PATTERN OF VENTILATION AND SPUTUM CLEARED DURING
Britto R1 , Alves G, Campos F, Vilaça A, Moraes K, Parreira V;
MANUAL HYPERINFLATION 1 Federal University of Minas Gerais
Maxwell L, Ellis E; School of Physiotherapy, Faculty of Health
Sciences, University of Sydney PURPOSE: The aim of this study was to compare breathing patterns
and the thoracoabdominal motion of patients with chronic obstructive
PURPOSE: The primary aim of this study was to compare the use pulmonary disease (COPD) during rest and exercise RELEVANCE:
of a three second inspiratory time (TI ) during manual hyperinflation The knowledgement about the breathing patterns and the thora-
on pattern of ventilation (volume delivered, peak inspiratory (PIFR) coabdominal motion during physical activity is important to plan the
and expiratory (PEFR) flow rates, inspiratory to expiratory (I:E) exercises protocols in pulmonary rehabilitation PARTICIPANTS: We
flow rate ratio) and secretion clearance in intubated adult patients evaluated 25 men with COPD, 68.2±7.4 (SD)years, VEF1 42±12.8%
in intensive care. RELEVANCE: Manual hyperinflation is used by (SD) predicted and with body mass index of 22.9±3.4 (SD).
physiotherapists in many countries to prevent volume loss, reinflate METHODS: Changes in respiratory frequency (FR ), tidal volume
areas of atelectasis or collapse, and assist secretion removal. The (VT ), inspiratory time (TI ), expiratory time (TE ), total respiratory time
original two papers describing the technique have been interpreted (TTOT ), percentage of abdomen and rib cage contribution to tidal
as recommending a slow inspiration over three seconds. The volume (%RC/VT , %AB/VT ) and phase angle (F, synchronism) were
effect of a three second TI on pattern of ventilation and secretion analyzed by inductive respiratory plethysmography at rest and during
clearance in the clinical setting has not been reported. In addition, three moments of incremental cycling test(30, 70 and 100% of total
the research to date has used a set peak inspiratory pressure time of exercise) ANALYSIS: Repeated measures ANOVA followed
(PIP) to standardise performance. The validity of using PIP to by pre-planned contrasts and Bonferroni corrections were used for
for this purpose has not been evaluated. The findings of this analyses with a significance level of 0.008 RESULTS: As expected,
study have relevance for both clinical practice and future research there were observed progressive increases in VT and FR (p = 0.001).
investigating the effects of manual hyperinflation. PARTICIPANTS: The progressive decline in TTOT was proportional to the TI and
intubated patients and 11 rotating physiotherapists from one principle TE reductions during the two last moments of exercise compared
referral (A1) Australian hospital ICU were recruited. METHODS: A with rest (p < 0.008). The %AB/VT increased compared to rest
double blinded, prospective, randomized, cross over, with-in subject (rest: 50.2±11.4% vs exercise: 63.6±10, 62.8±10.9, 64.69±11.1%;
repeated measures design was used. Subjects were treated by p = 0.001). Compared with rest F increased (rest: 12±7.6 vs exer-
a physiotherapist trained to perform manual hyperinflation over cise: 23.3±13.9, 20.5±8.6, 21.8±8.4; p = 0.001) without differences
three seconds with an even rate of bag compression and an between the moments of exercise CONCLUSIONS: These data
“untrained” physiotherapist. The therapists performed six sets of suggest that in patients with COPD there is an increase participation
six manual hyperinflation breaths to a peak inspiratory pressure of abdominal compartment during cycling exercise. IMPLICATIONS:
of 40 cm H2 O, with a Mapleson-F circuit on the same patient on Aerobic exercises can contribute to improve diaphagmatic movement
two consecutive days. Pattern of ventilation [TI , volume delivered, in patients with COPD KEYWORDS: plethysmography, abdomen,
PIFR, PEFR] were recorded using a heated pneumotachometer, exercise, COPD. FUNDING ACKNOWLEDGEMENTS: National
pressure transducer and custom designed data acquisition and Counsel of Technological and Scientific Development-CNPq/Brazil.
analysis systems. The I:E flow rate ratio was manually calculated. CONTACT: [email protected]
Sputum was collected in a trap and weighed. ANALYSIS: A 2x2 ETHICS COMMITTEE: Ethic Committee of Federal University of
repeated measures ANOVA (variables – therapist and time of day) Minas Gerais
was used for pair-wise comparisons. Relationships between pattern
of ventilation measures were examined using Pearson’s r correlation.
SPSS version 14.0 was used for the statistical analysis. RESULTS: Research Report Poster Display
The trained therapist delivered a larger volume breath (p < 0.001), 03-01 Monday 4 June 14:00
generated a slower PIFR (p = 0.004) and faster PEFR (p < 0.001). VCEC Exhibit Hall B & C
Although the trained therapist produced a lower I:E flow rate ratio INFLUENCE OF THE RETURN-TO-WORK ON MOTOR FUNCTION
(p = 0.004), most therapists (59 of 70 treatments) produced an I:E AND HEALTH-RELATED QUALITY OF LIFE IN MIDDLE-AGED
flow rate ratio which met the requirements for two-phase gas-liquid PATIENTS UNDERGOING CORONARY ARTERY BYPASS
flow. The trained physiotherapist used a longer TI (p < 0.001), but GRAFTING
there was a moderate correlation (r = 0.68, p < 0.001) between TI
Yonezawa R, Matsunaga A, Saitoh M, Ishii A, Kutsuna T,
for the trained and untrained therapists. There was no significant
Matsumoto T, Yamamoto K, Sato T, Sawairi T, Nanri Y, Masuda T;
difference in wet weight sputum cleared between the trained and
Graduate School of Medical Sciences, Kitasato University,
untrained therapists however there was a trend for the trained
Kanagawa, Japan
therapist to clear more sputum (p = 0.09). CONCLUSIONS: Use of
a set peak inspiratory pressure alone does not standardise pattern PURPOSE: The return-to-work is one of the most important goals in
of ventilation during manual hyperinflation in the same patient. middle-aged patients with acute myocardial infarction (AMI), and has
beneficial effects on their health-related quality of life (HRQOL). It Transplant recipients have reduced peak cardiorespiratory fitness,
was reported that the aged patients who underwent coronary artery however, the effect that transplantation has on aerobic endurance
bypass grafting (CABG) were showed poor level of activities of daily (i.e., 6MWT) has not been well studied. Moreover, the car-
living after the hospital discharge, and that middle-aged patients with diopulmonary responses during a 6MWT have not been studied
AMI returned to work later in CABG than in percutaneous coronary in transplant recipients. PARTICIPANTS: Fifty-four (48±12 years)
intervention (PCI). However, there were few studies reporting the individuals who received a heart (n = 12), heart double-lung (n =
changes of motor function and HRQOL after return-to-work in middle- 2), double-lung (n = 8), kidney (n = 14), kidney-pancreas (n = 2),
aged patients undergoing CABG. The present study investigated liver (n = 14), or bone marrow transplant (n = 2) participated in
the influence of return-to-work on the motor function and HRQOL this investigation. METHODS: The participants completed a 6MWT
in them. RELEVANCE: This study helps to practice the cardiac with a portable telemetry gas analyzer and heart rate (HR) monitor
rehabilitation (CR) for middle-aged patients who return to work to quantify oxygen consumption (VO2 ), HR, and O2 -pulse (product
after AMI. PARTICIPANTS: Twenty-eight middle-aged outpatients, of stroke volume and arteriovenous O2 difference). ANALYSIS:
54±7 yrs, were divided into following two groups, after completing Participants were grouped according to their VO2 during the 6MWT
a phase I CR because of AMI: 20 patients who received PCI (PCI as: 1) Very low fit (VLF: 25th percentile, n = 17); 2) Low
group) and 8 who did CABG (CABG group). METHODS: The left fit (LF:26-50th percentile, n = 12); 3) Moderately fit (MF:51-75th
ventricular ejection fraction (LVEF), brain natrium peptide (BNP) and percentile, n = 12); 4) High fit (HF:76-90th percentile, n = 7),
exercise capacity were evaluated during hospitalization. The motor and 5) Very high fit (VHF;>90th percentile, n = 6). Comparison
function including the lower limb muscular strength, grip strength between groups was made using ANOVA and significance set at
and functional reach was evaluated at the hospital discharge and p < 0.05. RESULTS: VO2 was significantly different between the VLF
6 months after AMI. The HRQOL was measured by using the MOS (13±2; mL/kg/min), LF (17±1 mL/kg/min), MF (20±1 mL/kg/min),
short-form 36-items health survey (SF-36) that consisted of physical HF (24±2 mL/kg/min) and the VHF group (30±3 mL/kg/min). HR
functioning (PF), role-physical (RP), bodily pain (BP), general health was significantly higher in VHF (147±16 beats/min) compared to
perceptions (GH), vitality (VT), social functioning (SF), role-emotional VLF (105±13 beats/min), LF (125±12 beats/min), MF (116±15
(RE) and mental health (MH) at the hospital discharge and 6 months beats/min), and HF (128±14 beats/min). HR was also significantly
after AMI. ANALYSIS: Unpaired t-test and ANOVA were used to higher in HF and LF compared to the VLF group. O2 -pulse was
compare clinical variables, motor function and HRQOL between PCI significantly greater (p < 0.05) in VHF (15±3 mL/beat) versus VLF
and CABG groups. RESULTS: All patients returned to work within (10±3 mL/beat) and LF (10±2 mL/beat), but not MF (13±3 mL/beat)
3 months after the hospital discharge. The LVEF, BNP and exercise or HF (12±3 mL/beat). 6MWT distance was greatest (p < 0.05) in VHF
capacity showed no significant differences between PCI and CABG (730±37 m) compared with VLF (501±82 m), LF (537±59 m), MF
groups. The lower limb muscular strength and grip strength were (601±41 m), and HF (599±40 m). 6MWT distance was also greater
significantly lower at the hospital discharge in CABG group than those between HF and MF compared with VLF (p < 0.05). CONCLUSIONS:
in PCI group (P < 0.01). Both lower limb muscular strength and grip The increased VO2 in VHF compared to low fit transplant recipients
strength measured at 6 months after AMI improved significantly as during the 6MWT is secondary to a greater exercise stroke volume
compared those at the hospital discharge in CABG group (P < 0.01 and/or arteriovenous O2 difference. Further, ~50% of our transplant
and P < 0.01, respectively). Although the lower limb muscular strength recipients have a VO2 during the 6MWT that is below the threshold
at 6 months after AMI showed no significant difference between level required to function independently in their environment (i.e.,
PCI and CABG groups, the grip strength was significantly lower <18 mL/kg/min). IMPLICATIONS: A substantial number of our
in CBAG group than that in PCI group (P < 0.01). The functional transplant recipients have an impaired cardiopulmonary response
reach showed no significant difference between the 2 groups. The during the 6MWT and would benefit from participating in an
PF score was lower at the hospital discharge in CABG group than exercise rehabilitation program. KEYWORDS: 6-Minute Walk Test,
that in PCI group (P < 0.05). Although the scores of RP and RE VO2 , Transplant Recipients. FUNDING ACKNOWLEDGEMENTS:
were significantly ameliorated 6 months after AMI in PCI group Drs. Haykowsky and Warburton are supported by the Canadian
(P < 0.01 and P < 0.01, respectively), the scores of all subscales Institute of Health Research (CIHR). C. Tomczak and B. Esch
showed no significant changes in CABG group. CONCLUSIONS: are supported by the Natural Sciences and Engineering Research
The middle-aged patients undergoing CABG showed poor HRQOL Council of Canada and C. Tomczak is a CIHR Strategic Training
and less improvement of their motor function after return-to-work, as Fellow in TORCH (Tomorrow’s Research Cardiovascular Health
compared with those who treated with PCI. IMPLICATIONS: The Professionals). CONTACT: [email protected]
evaluation of motor function and HRQOL after return-to-work are ETHICS COMMITTEE: University of Alberta Health Research Ethics
very meaningful for middle-aged patients who underwent CABG, to Board
advise them on better psychosocial situation. KEYWORDS: quality
of life, return-to-work, coronary artery bypass grafting. FUNDING
ACKNOWLEDGEMENTS: This study was not funded. CONTACT: Research Report Poster Display
[email protected] 07-13 Monday 4 June 14:00
ETHICS COMMITTEE: The study protocol was approved by the VCEC Exhibit Hall B & C
Ethics Committee of Kitasato University on human research. A SURVEY OF FACTORS THAT INFLUENCE PHYSICAL
THERAPIST STUDENTS’ INTENTIONS TO WORK WITH THE
Research Report Poster Display ELDERLY POPULATION
Coleman A, Waring P, Bird N, Ladd H, Morris J, Wheeler B;
University of Tennessee, Memphis, TN USA
CARDIOPULMONARY RESPONSES DURING THE 6-MINUTE
WALK TEST IN TRANSPLANT RECIPIENTS: ROLE OF PURPOSE: The purpose of this study was to investigate the
PHYSICAL FITNESS relationship between various factors and physical therapist students’
intentions to work with the elderly population after graduation.
Tomczak C1 , Warburton D2 , Bhambhani Y1 , Jendzjowsky N1 , RELEVANCE: There is concern in the healthcare community that
Riess K1 , Haennel R1 , Esch B2 , Pechter D1 , Haykowsky M1 ; there will not be sufficient numbers of physical therapists interested
1 Faculty of Rehabilitation Medicine, University of Alberta; 2 School
in working with the elderly to meet the expected demand. It is
of Human Kinetics, University of British Columbia important to identify factors that might influence a physical therapist
PURPOSE: To examine the cardiopulmonary responses during the student’s desire to work with this population. PARTICIPANTS: Senior
6-minute walk test (6MWT) in transplant recipients. RELEVANCE: physical therapist students graduating from four accredited physical
therapy programs in Tennessee in 2005 were invited to participate. length and 4 cm in width was raised in all animals and a plastic
Seventy nine completed questionnaires were returned. Our subject barrier was interposed between the flap and donor site. The flap
population consisted of 16 males (20%) and 63 females (80%), with was then sutured back in place with 4-0 interrupted nylon sutures.
74 of the respondents being Caucasian, 4 African American and 1 After the operative procedure, animals of all groups were maintained
Hispanic. The mean age was 25.4 years old. METHODS: We used anesthetized one more hour with electrodes positioned in the base
a modified version of a survey developed by Coren et al (1987). of the flap and submitted to treatment according to their respective
It consisted of demographic questions and 18 yes-no questions group. This procedure was repeated on the two subsequent days.
concerning biographical, experiential, socioeconomic and attitudinal G1: sham TENS, G2: TENS (f = 80 Hz and I = 5 mA), G3:
factors. A final yes-no question asked the subjects if they intended TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I
to work primarily with elderly patients after graduation. Subjects = 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). ANALYSIS:
were also asked to list the most positive and negative aspects of For statistical analyses, one way Analysis of Variance (ANOVA)
working with elderly persons. Survey packets were distributed to was used followed by post hoc Dunnett’s test. RESULTS: The
the students by the Academic Coordinator of Clinical Education mean percentage necrotic area was 43.11±9.30 (mean ± standard
of each institution and were returned in a self-addressed envelop. deviation) in G1 (sham TENS), 34.65±12.29 in G2 (80 Hz 5 mA),
ANALYSIS: Survey results were divided into two groups based on 49.44±15.58 in G3 (80 Hz 10 mA), 23.52±10.83 in G4 (80 Hz 15 mA)
the subjects’ stated intention (I) or no intention (NI) to work primarily and 45.10±16.14 in G5 (80 Hz 20 mA). Statistical analyses showed
with elderly patients after graduation. Using StatView (1996), a significant differences between G4 (80 Hz 15 mA) and G1 (sham
Fisher’s Exact Test was performed to see if there was a relationship TENS) (P < 0.001). There were no statistical differences between G2,
between the I and NI group and each of the answers to the 18 G3, G5 and sham TENS (P > 0.05). CONCLUSIONS: The amplitude
yes-no questions. A two-tailed t-test compared the mean ages of of 15 mA presented a lower necrotic area than sham TENS group
the two groups. A chi-square test was performed to determine the and Transcutaneous Electrical Nerve Stimulation was efficient in
influence of gender and race on the intention to work with the improving the random skin flap viability in rats. IMPLICATIONS:
elderly population. RESULTS: No significant differences were found The results of this animal investigation confirm previous reports
between the I and NI groups regarding age (P=0.9), gender (P=.74) about TENS effects on skin flaps viability. The amplitude must be
or race (P=.05). Analysis of the responses to the 18 yes-no questions increased to a high sensorial level or at the beginning of motor
indicated the answer to one question was statistically significant threshold. New studies must be performed in human subjects now.
(df=1, P=.005). This question asked if the subject believed working KEYWORDS: Transcutaneous Electric Nerve Stimulation, surgical
with elderly patients often entailed working in an environment that is flaps, tissue survival, rats. FUNDING ACKNOWLEDGEMENTS: This
considered depressing. The most commonly cited positive aspects work was financial supported by the Centro de Apoio à Pesquisa e
of working with the elderly were the depth of life experiences in ao Ensino Superior (CAPES). CONTACT: [email protected]
this population and the perception that the patients were grateful ETHICS COMMITTEE: This research was approved by the
for their help. The most commonly cited negative aspects were Committee of Ethics in Research of UNIFESP/Hospital São Paulo,
the concerns about incontinence and other hygiene factors and the CEP Nº. 0380/03.
impending morbidity of their patients. CONCLUSIONS: The belief
that working with the elderly can be depressing was identified in
this study as a factor that might influence one’s decision to work with
this population. IMPLICATIONS: Educators should identify strategies 07-21 Monday 4 June 14:00
in the didactic and clinical portion of the curriculum to address VCEC Exhibit Hall B & C
this concern. Further investigation may identify additional factors A POST-MORTEM INVESTIGATION OF THE HEATING PATTERN
that can be addressed by educational and healthcare institutions OF SHORTWAVE DIATHERMY IN PIG TISSUES USING
in an effort to encourage more practitioners to consider a career THERMOGRAPHY
with the geriatric population. KEYWORDS: elderly, physical therapist Aoki M1 , Goh A2 ; 1 Department of Physical Medicine and
students. FUNDING ACKNOWLEDGEMENTS: None. Rehabilitation, Shinshu University Hospital, Matsumoto, JAPAN;
ETHICS COMMITTEE: University of Tennessee IRB 2 School of Health Sciences, Shinshu University, Matsumoto, JAPAN
PURPOSE: Short wave diathermy (SWD) is a common modality

Research Report Poster Display that is used for thermotherapy. SWD can be applied either via the
07-17 Monday 4 June 14:00 condenser or the induction method. In a previous study, we had
VCEC Exhibit Hall B & C investigated the heating pattern of SWD using the induction method.
THE EFFECT OF HIGH FREQUENCY TRANSCUTANEOUS The aim of this study is to investigate the heating pattern of SWD
ELECTRICAL NERVE STIMULATION (TENS) ON VIABILITY OF using the condenser method. RELEVANCE: In order to learn how
RANDOM SKIN FLAP IN RATS to apply and control the heat energy from SWD, it is necessary
to understand its heating pattern. This will assist the clinician in
Liebano R1,2 , Abla L1 , Ferreira L1 ; 1 Plastic Surgery Division,
making the right decisions regarding dosimetry. PARTICIPANTS: A
Surgery Department, Universidade Federal de São Paulo, Escola
total of three thigh specimens from post-mortem pig tissues were
Paulista de Medicina, São Paulo, Brazil; 2 Universidade Cidade
used for this study. The specimens were left to stabilize at room
de São Paulo, São Paulo, Brazil
temperature prior to commencement of the study. METHODS: The
PURPOSE: Skin flaps are largely used in all fields of plastic surgery SWD equipment used was the SW-180 model (Ito Co. Ltd, Tokyo,
especially in reconstructives. The main and more feared complication JAPAN). Two rigid electrodes were used to apply the SWD energy
by plastic surgeons in the use of the flap is the ischemia that to either side of the thigh sections of pig tissues at intensities of
develops to tissue necrosis in a large number of cases taking a 20W, 40W, 60W and 30W (pulsed at 25Hz) for 15 minutes. The
failure in the proposed treatment. The aim of this study was to cross sectional tissue temperature at 1, 2, 3, 4 and 5 cm below
determine the effect of high frequency Transcutaneous Electrical the skin were recorded at 1 minute intervals for 15 minutes exposure
Nerve Stimulation (TENS) on viability of random skin flap in rats. followed by another 15 minutes post-exposure using a thermographic
RELEVANCE: Although there are publications about TENS effects unit, InfraEye 2000 (Nihon Koden, Tokyo, JAPAN). The surface skin
on skin flaps survival in the literature, there is no consensus about temperature was also recorded at 1 minute intervals using a hand-
the optimal parameters for this effect. PARTICIPANTS: Seventy- held infrared spot thermometer, the HT-11 (Minolta Co. Ltd., Japan).
five adult male Wistar rats, weighing 230 to 358 g were used ANALYSIS: A total of three specimens were used, and the average
in this study. METHODS: The dorsal skin flap, measuring 10 in increases in temperature were analyzed for the skin surface (0 cm)
and at 1, 2, 3, 4 and 5 cm below the skin. RESULTS: The results a significantly smaller reduction in percentage edema. Thus, EV2
show that increase in temperatures were greatest at the skin surface exceeded EV’2 for arms (571+/− 381 vs. 502+/−414 ml, p = 0.002)
(0 cm), and decreased as the tissue depth increased from 1 cm and for legs (1388+/−1814 vs. 1206+/−1778 ml, p = 0.002) with
to 5 cm. CONCLUSIONS: Compared to the previous results for corresponding calculated percentage reductions in edema volume
the induction method, the increase in temperatures were similar for arms of 39.2+/−26.4 vs. 49.5+/−30.7%, p = 0.003 and for legs
for both induction and condenser methods. IMPLICATIONS: The 47.0+/−35.6 vs. 60.0+/−37.3%, p = 0.002. CONCLUSIONS: Using
results obtained from this study can be used to guide the clinician in only pre-treatment control limb volumes as refererence to determine
selecting the treatment dosages for SWD. Since both the induction therapy-related edema and percent edema reductions leads to
and condenser methods provided similar heating patterns, it may be significant overestimations. IMPLICATIONS: Avoid this by using
more convenient to use the induction method for SWD treatment both pre- and post-treatment control limb volumes as reference.
applications. KEYWORDS: Shortwave Diathermy, Electrophysical KEYWORDS: lymphedema assesssment, complete decongestive
Agents, Heating pattern. FUNDING ACKNOWLEDGEMENTS: Nil. therapy, limb volumes. FUNDING ACKNOWLEDGEMENTS: None.
CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: Ethics committee of Shinshu University ETHICS COMMITTEE: University
Hospital
VCEC Exhibit Hall B & C THE EFFECTS OF ULTRASOUND IRRADIATION ON THE
IMPORTANCE OF INCLUDING MEASUREMENTS OF BOTH INHIBITION OF DISUSE MUSCLE ATROPHY IN THE RAT
AFFECTED AND CONTROL LIMB VOLUMES IN ASSESSING Araki K1 , Nakamura M2 , Okita M3 , Nakano J4 , Kataoka H5 ,
OUTCOMES OF LYMPHEDEMA THERAPY Sakamoto J5 , Yoshimura T4 , Ohkida H1 , Tsujihata M6 ; 1 Department
Mayrovitz H1 , Davey S2 ; 1 College of Medical Sciences, Nova of Rehabilitation, Nagasaki KITA Hospital, Nagasaki, JAPAN;
Southeastern University, Ft. Lauderdale Florida, USA; 2 Healing 2 Graduate School of Medicine, Saga University, Saga, JAPAN;
Hands of Lymphatics Plus, Ft. Lauderdale Florida, USA 3 Faculty of Care and Rehabilitation, Seijoh University, Nagoya,
JAPAN; 4 Nagasaki University School of Health Sciences, Nagasaki,

PURPOSE: To determine the difference in estimated therapy-related
JAPAN; 5 Department of Rehabilitation, Nagasaki Memorial Hospital,
edema reductions when outcomes are based only on pre-treatment
Nagasaki, JAPAN; 6 Section of Neurology, Nagasaki KITA Hospital,
volumes of non-affected control limbs versus using both pre- and
Nagasaki, JAPAN
post treatment control limb values as reference. RELEVANCE:
Progress and outcomes of limb lymphedema therapy are usually PURPOSE: Ultrasound (US) irradiation has been reported to
tracked and documented by changes in volumes derived from limb stimulate the expression of growth factors such as FGF (Fibroblast
circumferences. With unilateral limb involvement, paired affected limb growth factor) and IGF-I (Insulin linked growth factor-I) in various
volume (VA) and control limb volume (VC) may be used to assess cells. The expression of these growth factors is known to be
pre-treatment edema volume (EV) and to track changes using VC as associated with the mechanism of muscle fiber hypertrophy. This
a reference. Some clinics measure VC every time that they measure suggests that US irradiation may be effective in the treatment and
VA but others only measure VC at the patient’s initial evaluation and prevention of disuse muscle atrophy. We herein investigated the
use the pre-treatment volume (VC1 ) as a reference for determining effect of US irradiation on the inhibition of disuse muscle atrophy.
edema volume changes throughout therapy. Not measuring VC at RELEVANCE: Up to now very little information has been reported
each VA assessment is clearly a time saving feature, which in a regarding the effect of US irradiation on disuse muscle atrophy. In
busy clinic, is an important consideration. However, since changes this study, we identified a new effect of US irradiation on muscle
in VC may occur with time and conditions, the effect of using a fibers. PARTICIPANTS: Twenty male Wistar-derived rats (220±10g)
single VC value on outcome assessments is unclear. Despite its were divided into four groups: a control group (n=5), a continuous-
clinical relevance, there has been no systematic investigation of US irradiation group (CONTI-US, n=5), a pulsed-US irradiation group
this issue. PARTICIPANTS: Subjects included in this study were (PULS-US, n=5), and a placebo group (No-US, n=5). METHODS:
persons who had unilateral arm lymphedema secondary to breast Both ankles of rats in the CONTI-US, PULS-US, and No-US groups
cancer-related treatment (N=75) and persons with unilateral leg were immobilized by the placement of a cast in the maximum
lymphedema (N=45) all of whom were referred for lymphedema plantar flexion angle for two weeks. The casts were removed
therapy. To be included in the analyses that form the basis of this under anesthesia and thereafter US irradiation on the gastrocnemius
study they had to have an initial edema volume of at least 10% muscles through skin for 15 minutes was performed five times a week
and have had 10 complete decongestive physiotherapy treatments. for two weeks. Ultrasound irradiation was applied using an ultrasound
METHODS: Leg and arm circumferences were measured at four machine (ITO, JAPAN), which provided continuous US (1MHz, 1
cm intervals starting at the ankle or wrist and ending at the groin Watt/cm2) in the CONTI-US group and the pulsed US (1MHz, 1
or axilla. From two adjacent limb circumference values, C1 and Watt/cm2, duty cycle=1:4) in the PULS-US group. After the two-week
C2 separated by a distance of L cm, limb segmental volume experimental period, frozen sections of left gastrocnemius muscles
(VSEG) was calculated from the equation for a truncated cone model were stained with myofibrillar adenosine triphosphatase (myosin
as VSEG=L(C12 +C1C2+C22 )/12p. ANALYSIS: Limb volumes were ATPase, pH 4.2, 4.5) and then the diameters of the muscle fibers for
calculated as the sum of all measured segments. Pre-treatment each muscle fiber type were measured. In addition, the FGF and IGF-
edema volume was calculated as EV1 = VA1 − VC1 . End treatment I contents of the left gastrocnemius muscles were determined using
edema volumes were calculated using the end-therapy control the ELISA method. The experimental protocol was approved by the
volume as EV2 = VA2 – VC2 and also using the pre-treatment control Ethics Review Committee for Animal Experimentation of Nagasaki
volume as EV’2 = VA2 – VC1 . Thus the only source of potential University (Nagasaki, Japan). ANALYSIS: For multiple comparisons,
difference between EV2 and EV’2 is attributable to a change in VC one-way ANOVA with Fisher PLSD post hoc tests were performed.
from start to end of therapy. EV2 and EV’2 and their percentage A value of P < 0.05 was accepted as the statistical significance
change were compared by paired T-tests. RESULTS: Pre-treatment level. RESULTS: The mean diameter of the muscle fibers for all
edema volumes (mean+/−sd) for arms and legs were 939+/−567 ml fiber types of gastrocnemius muscle significantly increased in the
and 2272+/−2302 ml respectively. The main analytical result showed CONTI-US group in comparison to the PULS-US and the No-US
that EV2 as compared to EV’2 was significantly greater and yielded groups. In addition, the FGF content also significantly increased
in the CONTI-US group in comparison to the other three groups. after each exercise. 4) Significant differences were found between
The IGF-I content significantly increased in the CONTI-US group in the groups, time, and interaction between the groups and time for
comparison to the PULS-US and No-US groups. CONCLUSIONS: the H-wave. Post hoc analyses determined that the SCPD caused
The result of this study suggests that the continuous irradiation a change in the H-reflex of the FCR, while there was no change
of US inhibits the progression of disuse muscle atrophy of the in the H-reflex from resistive grasping. The mean H-wave amplitude
gastrocnemius muscles due to cast immobilization of the ankle joints. during the SCPD was significantly reduced as compared with the
This mechanism may be associated with the expression of FGF and 100-120 s post-SCPD potentiation. CONCLUSIONS: The depression
IGF-I by US irradiation. IMPLICATIONS: US irradiation may therefore of the H-reflex was most profound during the SCPD, and the post-
be a potentially useful method for performing muscle-strengthening exercise potentiation after the SCPD supported the evidence of the
exercise. KEYWORDS: ultrasound, disuse muscle atrophy, growth remote ascending effects of SCPD. IMPLICATIONS: The remote
factor. FUNDING ACKNOWLEDGEMENTS: The funding source of facilitating effects of the upper extremities by the SCPD may be an
this study was the General Research Fund of Nagasaki University effective indirect approach for therapy. KEYWORDS: PNF, SCPD,
(Nagasaki, Japan). CONTACT: [email protected] resistive exercise. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: The experimental protocol was approved CONTACT: [email protected]
by the Ethics Review Committee for Animal Experimentation of ETHICS COMMITTEE: The study was approved by the Ethical
Nagasaki University (Nagasaki, Japan). Committee of the Hiroshima Teishin Hospital.

EFFECTS OF SUSTAINED CONTRACTION OF LOWER TRUNK SHORT-TERM EFFECTS OF DORSIFLEXION LUNGE
MUSCLES ON THE H-REFLEX OF THE FLEXOR CARPI RADIUS STRETCHING ON GASTROCNEMIUS FLEXIBILITY
MUSCLE O’Connor A1 , Seynnes O2 ; 1 Department of Physiotherapy,
Arai M1 , Shimizu H2 , Shimizu M3 , Shiratani T4 , Yanagisawa K5 , University of Limerick, Limerick, Ireland; 2 Manchester Metropolitan
Tanaka Y1 ; 1 PNF Society of Japan; 2 Division of Occupational University, Alsager, UK
Therapy, Institute of Health Sciences, Faculty of Medicine,
PURPOSE: This study investigated whether the validated dorsiflexion
Hiroshima University; 3 Department of Physical Therapy, Faculty
lunge stretch, as prescribed by chartered physiotherapists, has an
of Health Sciences, Hiroshima Prefectural College of Health
acute effect on the flexibility of the gastrocnemius muscle-tendon
Sciences; 4 Graduate student, Institute of Health Sciences, Faculty
unit. RELEVANCE: As well as the importance of the reliability
of Medicine, Hiroshima University; 5 Department of Physical
and validity of this stretching technique, scientific evidence of its
Therapy, Tokyo Metropolitan University of Health Sciences
clinical effectiveness is imperative to support its continued use.
PURPOSE: Compared with prolonged stretching procedures, the Therefore, research is needed to determine the effectiveness of the
active and passive range of motion of severely restricted joints dorsiflexion lunge stretch using durations and frequencies commonly
of the upper extremities in patients with orthopedic diseases prescribed by chartered physiotherapists in the clinical/ sports
was significantly improved with a sustained contraction of the rehabilitation setting. An answer to this question is imperative, in a
Proprioceptive Neuromuscular Facilitation pelvic-depression pattern time where chartered physiotherapists strive to achieve standards of
(SCPD), The purpose of this study was to determine the effect excellence by means of evidence based practice. PARTICIPANTS:
of an SCPD on the ipsilateral upper extremity without any other Ten healthy males were randomly assigned to two groups. Group
concomitant activation than the direct effect of SCPD resistive 1 (n=5) completed three dorsiflexion lunge stretches of 30 s
exercise. RELEVANCE: Application of this approach (SCPD) may duration, once daily, for four days. Group 2 (n=5) completed the
be effective in indirectly treating extremities that cannot be exercised same programme twice daily. Participant’s non-dominant leg acted
directly. If the remote SCPD exercise actually facilitates the upper as control. METHODS: Elongation of the stretched gastrocnemius
extremities, it will be valid evidence of the indirect facilitative approach muscle-tendon unit was recorded using real time ultrasound before
of resistive exercise. PARTICIPANTS: Seven female and five male stretching, immediately after one set of stretches, and 24 hours after
subjects, aged 22 to 45 years, with no known neurological diagnoses, the last set of stretches. Range of motion (ROM) was recorded and
volunteered for this study. METHODS: The study was approved by torque, expressed relative to elongation of the muscle-tendon unit,
the Ethical Committee of the Hiroshima Teishin Hospital, and all was calculated as an index of stiffness. ANALYSIS: Data for length,
subjects were given written, informed consents. The subjects were ROM and stiffness were not normally distributed, consequently a
randomly divided into two groups. Group 1 (n=6) served as a control Wilcoxon Signed Ranks test was used to determine any significant
group. These subjects performed submaximal resistive grasping with differences within groups for each of the variables over the three test
the contralateral upper extremity while the H-wave of the Flexor Carpi sessions. A Mann-Whitney test was used to detect any significant
Radialis (FCR) was measured and while no movement of the upper differences between groups. RESULTS: There were no significant
extremities occurred. Group 2 (n=6) received the pelvic resistive changes in length after stretching in any group and no significant
exercise (SCPD) while the FCR H-wave was measured and while no changes in ankle ROM or stiffness, although a trend showing
movement of the upper extremities occurred. Each subject received decreasing ankle stiffness developed after four days. There were
a total of 2 sessions of the SCPD or resistive grasping exercise, with no significant differences between groups. CONCLUSIONS: For this
each resistive exercise lasting 20 seconds. ANALYSIS: 1) Intraclass sample group, dorsiflexion lunge stretching, as prescribed clinically,
correlation coefficients (ICC) were determined by the value of the has no short-term effect on flexibility. Further research is needed to
force of resistance by a pinch meter at random points for 20 seconds. ascertain its effectiveness over a longer time, or in individuals with de-
2) The data of the M-wave and H-wave at rest were analyzed using creased ROM. IMPLICATIONS: These results suggest that chartered
the ICC. 3) An analysis of variance (ANOVA) with repeated measures physiotherapists may be currently prescribing stretching programmes
over time was calculated for the amplitude of the M-wave and H- for the gastrocnemius muscle using parameters that are not clinically
wave respectively. We used the post hoc analysis with Bonferroni effective. This study supports other literature which suggests that
multiple comparison tests to evaluate significant differences between the duration of the stretch hold may be more important than the
means. RESULTS: 1) The ICC determined by the pinch meter was number of stretches completed. The results of this study are difficult
0.93. 2) The ICC of the M-wave and H-wave were both 0.99. 3) to extrapolate to a wider population because of the small sample size
Significant differences were not found for the M-wave during and used. A follow-up study addressing these limitations would provide
more information about clinically effective parameters for stretching Research Report Poster Display
the gastrocnemius muscle. KEYWORDS: gastrocnemius, stretching, 12-05 Monday 4 June 14:00
ultrasound, dorsiflexion. FUNDING ACKNOWLEDGEMENTS: none. VCEC Exhibit Hall B & C
CONTACT: [email protected] SYSTEM ORIENTED PATHWAYS IN PHYSICAL THERAPY IN THE
ETHICS COMMITTEE: Manchester Metropolitan University Ethics ACUTE HOSPITAL BASED ON THE ICF: MUSCULOSKELETAL
Committee SYSTEM
Huber E1,4 , Grill E3 , Gloor-Juzi T1,2 , Stucki G3,5 ; 1 Department of
Research Report Poster Display Rheumatology and Institute of Physical Medicine, University Hospital
10-21 Monday 4 June 14:00 Zurich, Switzerland; 2 Physiotherapy Science Studies, Department
VCEC Exhibit Hall B & C of Rheumatology and Institute of Physical Medicine, University
EXERCISE THERAPY FOR SEVERELY ISCHEMIC LIMBS Hospital Zurich, Switzerland and Faculty of Health Sciences,
Maastricht University, the Netherlands; 3 ICF Research Branch of the
Yamamoto S1 , Shiraishi H1,2 , Sawada N1 , Saito M1 , Mani H3 , WHO FIC Collaborating Centre (DIMDI), IHRS, Ludwig-Maximilian
Tatsumi T2 , Hase H1,4 , Matsubara H2 ; 1 Rehabilitation Unit, University, Munich, Germany; 4 Swiss Association of Physiotherapy,
University Hospital, Kyoto Prefectural University of Medicine; Sursee, Switzerland; 5 Department of Physical Medicine and
2 Department of Cardiovascular Medicine,Graduate School of
Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
Medical Science Kyoto Prefectural University of Medicine; 3 Faculty
of Laboratory Medicine, University Hospital, Kyoto Prefectural PURPOSE: To Improve processes, results and the quality of physical
University of Medicin; 4 Department of Orthopaedics, Graduate therapy, and provide information on costs by developing system-
School of Medical Science, Kyoto Prefectural University of Medicine oriented therapeutical pathways based on the ICF. RELEVANCE: In
the acute hospital, physical therapists plan, treat and evaluate based
PURPOSE: Exercise therapy for obstructive arteriosclerosis obliter- on assessment of functioning and their identification of the patients’
ans and Buerger’s disease is mainly applied to Fontain classification resources. Hospitals have started to adopt a process-oriented view,
I and II, and its efficacy for III and IV has not been established which leads automatically to patient orientation. By introducing
because of aggravation of resting-state pain and skin ulcer. the idea of pathways, we are able to describe how a patient
RELEVANCE: In this study, we investigated exercise therapy in proceeds from admission to discharge. A patient pathway, also called
persons with severely ischemic limbs admitted for regenerative clinical pathway, is very often determined by medical and nursing
medical treatment. PARTICIPANTS: The subjects were 11 persons interventions, but rarely by therapeutical interventions. Nonetheless,
with Fontain classification III-IV admitted to our hospital between therapeutical pathways (T-pathways) are a documentation of ther-
April 2004 and Februar2005. Group A consisted of 4 people who apeutical activities and output. The International Classification of
received regenerative medical treatment (FontainIV: 4, male/female: Functioning, Disability and Health is a worldwide agreed upon system
2/2, mean age: 60±2 years, mean number of days with exercise for classification of all aspects of human health. Arguably, it can
therapy: 15±17 days), and Group B consisted of 7 people who also be used to classify therapeutical interventions and contribute
received internal medical treatment (not indicated for regenerative to the development of therapeutical pathways. Multidisciplinary work
medical treatment) (FontainIII/FontainIV:3/4,male/female: 5/2, mean could be facilitated by use of the ICF as a common framework.
age: 63±12 years, number of days with exercise therapy: 12±7 PARTICIPANTS: Patients with musculoskeletal conditions from a
days). METHODS: They underwent the execise therapy such as representative sample of 23 acute care hospitals in the three different
lower muscle strengthening, dynamic joint control, and gait trainings language regions of Switzerland. METHODS: Data were collected
for 40minutes per day. ANALYSIS: the evaluations of Fontain prospectively at admission to hospital. ICF categories relevant for
classification, findings of the ulcerative region, resting-state pain therapeutical interventions had previously been identified by an
(Visual analogue scale: VAS) and the maximal gait distance at international consensus process. Out of this set of ICF intervention
the time of initiation and completion of exercise therapy were categories, a physical therapist specified the categories which
compared. RESULTS: In all people, no worsening of Fontain were treated or modified by therapeutical interventions. ANALYSIS:
clasification and ulcer was noted. VAS (initiation/completion) was We reported absolute and relative frequencies of ICF intervention
5.8±1.0/2.5±2.0 in Group A and 4.1±2.0/3.0±1.0 in Group B. categories of the components Body Functions, Body Structures
The maximal gait distance (initiation/completion) was 0/98±92 in and Activities and Participation. RESULTS: 234 patients (mean age
Group A and 215±145/539±377 in Group B. CONCLUSIONS: 56.1 years, 50.0% female) were included. Of a total of 59 ICF
In all people, resting-state pain and the maximal gait distance intervention categories, 18 (31%) were treated in at least 30% of the
were improved without aggravation of the severely ischemic limb, patients, 9 (39%) of the component Body Functions, one (8%) of the
suggesting that combination with regenerative or internal med- component Body Structures and 8 (35%) of the component Activities
ical treatment allows introduction of exercise therapy even for and Participation. Pain, mobility of joints, muscle power, gait pattern,
severely ischemic limbs. IMPLICATIONS: physical therapy practice walking, and climbing stairs were the categories treated in at least
KEYWORDS: Severely Ischemic Limbs,Exercise Therapy. FUNDING 70% of the patients. CONCLUSIONS: ICF categories can be used to
ACKNOWLEDGEMENTS: None. classify therapeutical interventions and hence to frame therapeutical
ETHICS COMMITTEE: yes. pathways in a generally understood and accepted language.
IMPLICATIONS: System-oriented therapeutical pathways based on
the ICF could be established as a management and benchmarking
tool. They are intended to improve the professional status of
physical therapists. A better understanding of decision-making and
consequently the amount of interventions given would provide us
with an important basis for a more rational decision-making, the
allocation of resources in services provision and the reimbursement
of physiotherapeutic interventions. KEYWORDS: ICF, International
Classification of Functioning, Therapeutical pathways, Pathways.
FUNDING ACKNOWLEDGEMENTS: We gratefully acknowledge the
Swiss Physiotherapy Association for its financial support and the
cooperation of all participants in this study.
ETHICS COMMITTEE: The study was approved by the ethic
committee of Zurich, Switzerland
SEARCHING A MOVEMENT VOCABULARY TO DESCRIBE THE RELATIONSHIP BETWEEN PERONEUS LONGUS AND
HEALTHY ASPECTS OF MOVEMENT QUALITY TIBIALIS POSTERIOR MUSCLE ACTIVITIES INVOLVED IN
Skjærven L1 , Kristoffersen K2 , Gard G3 ; 1 Bergen University RAISING THE HEEL DURING CALF-RAISE AND IN GAIT
College, Bergen, Norway; 2 University of Bergen, Bergen, Norway; Tokuoumaru K1 , Inamizu T1 , Sekikawa K1 , Tabusadani M2 , Sota K2 ,
3 Lund University, Lund, Sweden Kawaguchi K2 ; 1 Graduate School of Health Science,Hiroshima
University; 2 Department of Rehabilitation,The Hospital of Hyogo
PURPOSE: The aim of the study was to search for healthy movement
College of Medcine
aspects and to explore the vocabulary used to describe movement
quality by a group of expert physiotherapists. RELEVANCE: In PURPOSE: This study aimed to clarify the relationship between
watching human movement focusing movement quality, we often the activities of the peroneus longus and tibialis posterior muscles
observe movement patterns that are bound of flow, unbalanced, in raising the heel from the ground during gait and calf-raise.
uncoordinated, stiff, staccato, un-rhythmic and in disharmony. Earlier RELEVANCE: Movements involved in raising the heel from the
studies claim that a vocabulary for describing movement quality ground during gait and calf-raise are ankle plantar flexion. In
for use in a clinical setting is lacking. Physiotherapists requires both movements, the trajectory of the maximum point of planter
awareness and means to describe movement quality from a health pressure is especially affected by a balance of the activities of
perspective. The relevance of the study is to broaden the movement the peroneus longus and tibialis posterior muscles, which control
vocabulary for use in physiotherapy. PARTICIPANTS: 15 peer- inversion and eversion of the calcaneal bone. PARTICIPANTS:
designated expert physiotherapists, 5 from each field of neurology, Healthy subjects (5 male, 18 female, aged 22.1±1.4years), were
psychiatric physiotherapy and primary health care participated in selected for this study. METHODS: Subjects were examined using
the study to ensure information from each professional area. surface electromyography during gait and calf-raise, which showed
They were nominated by physiotherapist leaders in the region. peroneus longus, tibialis posterior muscle activities and their ratio
Each physiotherapist was contacted and informed to ensure their (peroneus longus muscle activity/ tibialis posterior muscle activity).
willingness to participate by signing a written informed consent. ANALYSIS: We calculated the root mean square around the time that
METHODS: A qualitative study with phenomenological in-depth the heel was raised from the ground during gait and calf-raise, and
interviews was chosen as source for the research. In addition a the rate of the root mean square during gait and calf-raise to during
selection of 10 copis of Fine Art of sculptures and paintings were standing. And, Spearmans rho and Pearson correlation coefficient
used to stimulate the description of the phenomenon at the end of was used to statistical analysis. RESULTS: The results showed that
the interview. The interviews were taped, transcribed and sent to peroneus longus muscle activity and the ratio between this and tibialis
the informants for confirmation. ANALYSIS: Giorgis‘recommendation posterior muscle activity that take place from the time the calcaneal
concerning analysis of qualitative interviews was followed. The data bone leaves the ground to when there is maximum planter pressure
of the lived experienced descriptions, told by the physiotherapists, at the head of metatarsal bones during gait, correlate with the muscle
depicted a movement vocabulary used in their professional context. activity and the ratio during calf-raise. CONCLUSIONS: The greater
In the analysis it was searched for themes around which the the peroneus longus muscle activity, the greater the ratio between it
phenomenological synthesis was woven. RESULTS: The results and tibialis the posterior in plantar flexion during gait, and the greater
showed a vocabulary that was categorized in four interacting themes, these activities and the ratio in plantar flexion during calf-raising. It
describing movement quality from a health perspective: (1) form and can be considered that the location of the maximum point of planter
function, relating to a biomechanical aspect, (2) flow, elasticity, vitality pressure during gait is related to that during calf-raising. Further
and rhythm, relating to a physiological aspect, (3) attentive, intentional research is needed to clarify the relationship between the distribution
(cognitive), and emotional expressions in movement, relating to of planter pressure during the gait, and that during calf-raising.
a psychological aspect and (4) unity, clarity, freedom, ease and IMPLICATIONS: As a results, calf-raise can be used as a indicator
naturalness in movement, including a personal expression, relating of the balance of the peroneus longus muscle activity and tibialis
to a purely human aspect. CONCLUSIONS: The results indicates posrterior muscle activity. KEYWORDS: peroneus longus, tibialis
a vocabulary based on a model of four main themes. However, to posterior, calf-raise. FUNDING ACKNOWLEDGEMENTS: This study
develop a clinical tool, continued analysis and development of the was unfunded. CONTACT: [email protected]
movement vocabulary is needed. IMPLICATIONS: It is necessary for
the physiotherapist to have a rich movement vocabulary for clinical
use, for research and for communication with patients and coworkers. Research Report Poster Display
The results indicate that it is neccessary for physiotherapists not only 13-17 Monday 4 June 14:00
to focus pathological and biomechanical movement aspects, but to VCEC Exhibit Hall B & C
include a focus and descriptions of healthy aspects as well. Hopefully, RESEARCH OF FREEDOM LEVEL INFLUENCE ON PARTICULAR
the study will contribute to strengthen the physioterapists‘ awareness JOINT DURING THE SENSORY MOTOR TRAINING
of movement, views and thinking, to develop the uniqueness of the
Palma P1 , Strojnik V2 ; 1 University of Ljubljana, University College
profession. KEYWORDS: Movement quality, movement vocabulary,
for Health Studies, Ljubljana, Slovenia; 2 University of Ljubljana,
movement analysis, Basic Body Awareness Therapy. FUNDING
Faculty of Sport, Ljubljana, Slovenia
ACKNOWLEDGEMENTS: Thanks to the Faculty of Health and Social
Sciences, Bergen University College, Norway, for supporting the PURPOSE: The purpose of the current study was to determine the
study. CONTACT: [email protected] influence of sensory motor training with fixed or free knee joint on
ankle joint function. RELEVANCE: Methods for performing sensory
motor training are not particularly determined. By reducing the
number of freedom levels, determined by joints with their number and
plains of movement, the role of still active joints can be changed. That
would mean, that we can influence on extent of functional adaptation
in active joint by reduced the number of freedom levels movement
control during the sensory motor training. PARTICIPANTS: 22 non-
trained healthy subjects (10 male, 12 female),leg injury and vestibular
deficits free, aged 25.5 years (SD 4) were recruited. Subjects were
randomly divided into two groups of 11 participants. Both groups bending position by EMG quantification. The subjects held their right
performed 6 weeks sensory motor training on two different balance hip joint 10 degrees (abducted position) while lying on their left
boards (in sagittal and lateral direction). In the first group subjects side with hip joints 10º extended and 0º, 10º, 20º, 40º, 60º flexed.
kept balance during the stance on dominant leg without fixation, Electromyographic activity was recorded using surface electrodes on
while the second group kept balance during the stance on dominant the gluteus medius and tensor fasciae latae muscles, and normalized
leg with external knee fixation support. METHODS: Measurements to values derived from maximal isometric trials. ANALYSIS: The
were undertaken before and after training period. The evaluation of percent maximal voluntary isometric contraction (%MVIC) of the
proprioceptive acuity was performed through position sense using a gluteus medius and tensor fasciae latae muscles was evaluated
bubble inclinometer. H and M waves were recorded with EMG. Twitch in the each hip position. RESULTS: The %MVIC of the gluteus
and maximal voluntary isometric contraction were measured with a medius muscle when the hip joint was flexed 60º was significantly
special brace that enabled fixation at 90º knee and ankle angles. reduced from 10º extension and 0º flexion. The %MVIC of the
Balance during the stand on dominant leg was measured by force tensor fasciae latae muscle did not vary with hip joint flexion angle
plate. ANALYSIS: Student’s t-test was used to establish differences changes. At 60º hip joint flexion, the %MVIC for the gluteus medius
before and after training period within single group. Analyses of and the tensor fasciae latae muscles showed significant differences.
covariance were used to compare the group without fixation (WFG) CONCLUSIONS: Our study reveals two things. First, as the hip
with the group with fixed knee (FG). RESULTS: Balance and postural joint flexion angle moves to 60º, muscle activities of the gluteus
sway with eyes open were improved in both groups. Improvement medius muscle decrease significantly compared with those of hip
on postural sway with lower frequency during measurements with joint flexion angle 0º. Second, muscle activities of the tensor fasciae
eyes closed was determined only in the WFG (A-P p = 0.013; M-L latae muscle are not affected by the hip joint flexion angle. It is
p = 0.034). Furthermore tend to significant decrease of absolute error determined from these two observations that muscle strength of
on dorsal flexion passive movement was determined only in the WFG the gluteus medius plays an important role because gluteus medius
(p = 0.052). Maximum torque of plantar and dorsal flexors of dominant activities are restricted when using abductor strengths in hip joint
leg during maximum voluntary isometric contraction was statistically flexion for going up and down stairs. IMPLICATIONS: We tend to
increased only in the WFG (p = 0.025; p = 0.004). Excitability of a be satisfied that evaluation of the hip joint abductor muscle can
motoneuron pool was decreased in the WFG, whereas an increasing be made by evaluations at 0º hip joint flexion and motion analysis
trend was determined in the FG. An increased twitch torque was at the time of walking, but this study suggests the importance of
significant for improved contractile properties of plantar flexors in both evaluating the hip joint abductor muscle in hip joint flexion and the
groups (WFG p = 0.004; FG p = 0.007), while at the same time an role of the tensor fasciae latae muscle in the hip joint flexion posi-
improved M wave on soleus muscle after training period was found tion. KEYWORDS: hip abductor muscle, electromyogram, muscle-
only in the FG (p = 0.055). CONCLUSIONS: Sensory motor training strengthening exercise. FUNDING ACKNOWLEDGEMENTS: None.
with and without external knee fixation causes different functional CONTACT: [email protected]
adaptation. Training without knee fixation is more efficient on central ETHICS COMMITTEE: Kibi International University
level, while training with knee fixation or training with decreased
freedom level of movement control is important for the improved
performance of peripheral mechanisms. IMPLICATIONS: Specially
designed program of training could be used also on other joints 15-01 Monday 4 June 14:00
with intention to improve function of mechanisms on reflex level in VCEC Exhibit Hall B & C
joint we want to rehabilitate. KEYWORDS: proprioception, sensory EFFECT OF PELVIC STABILIZATION AND HIP POSITION ON
motor training, freedom level of movement control. FUNDING TRUNK EXTENSORS ACTIVITY DURING BACK EXTENSION
ACKNOWLEDGEMENTS: The work was supported by the research EXERCISES ON A ROMAN CHAIR
grant L5-5330 from the Research Agency of the Republic of Slovenia. Da Silva R1 , Larivière C2 , Arsenault B1 , Nadeau S1 , Plamondon A2 ;
CONTACT: [email protected] 1 University of Montreal and CRIR – Montreal Rehabilitation
ETHICS COMMITTEE: National Ethics Committee of the Republic of Institute, Montreal (Qc), Canada; 2 Occupational Health and Safety
Slovenia and was carried out in accordance with the Declaration of Research Institute Robert-Sauvé (IRSST), Montreal (Qc), Canada
Helsinki.
PURPOSE: To assess the effect of pelvis stabilization and of
hip position on the electromyographic (EMG) activity of back and
Research Report Poster Display hip extensor muscles during a dynamic back extension exercise
13-21 Monday 4 June 14:00 on a Roman chair. RELEVANCE: For a more specific training
VCEC Exhibit Hall B & C of back muscles, it is important to maximize the activity of back
EFFECT OF HIP JOINT FLEXION ON ACTIVITIES OF THE muscles while minimizing the activity of hip extensors (specificity
HIP ABDUCTOR MUSCLES IN STRAIGHT LEG RAISING (HIP principle). PARTICIPANTS: Twenty-two healthy volunteers (11 males
ABDUCTION) EXERCISES and 11 females), aged between 20 and 55 years, participated in
this study. METHODS: The subjects performed five trunk flexion-
Sugahara Y, Kimoto H, Hakashita H, Furue Y, Nakajima M; Kibi
extension cycles on a Roman chair in the following 3 conditions:
International University, School of Health Science Department
(1) pelvis unrestrained (PUR; control condition), (2) pelvis restrained
of Physical Therapy
(PR), using a strap pressing the pelvis against the support pad
PURPOSE: A “straight leg raising exercise in side-lying position for and (3) hip at an angle of 40º relative to the horizontal (H40º)
hip joint abductor muscle strengthening” is a hip adductor isometric with the pelvis unrestrained. EMG signals were recorded with 12
muscle-strengthening exercise which can be widely used in early pairs of surface electrodes placed bilaterally on four back muscles
hip rehabilitation. The objective of this study is to explain how the (at L4, L3, L1 and T10 levels), as well as on two hip extensor
hip joint position affects muscular activities of the hip joint abductor muscles (Gluteus and Biceps femoris). The EMG amplitude was
muscles, the gluteus medius and tensor fasciae latae muscles, in computed in the concentric portion (extension) of each cycle and
straight leg raising exercises performed while lying on one side. the Muscular Utilization Ratio (MUR), defined as the percentage
RELEVANCE: In a clinical setting, we often see patients perform the of EMG amplitude relative to the maximal EMG obtained from
straight leg raising exercise in a hip flexed position. PARTICIPANTS: maximal contractions, was used to assess the level of muscular
The subjects were healthy adults with normal physical constitutions activation of each muscle group across exercises. ANALYSIS: EMG
consisting of 6 males and 6 females (average age 21.1±1.1). activity (MUR%) within each muscle group were compared, using
METHODS: In this study, we analyzed the effect of this hip joint analysis of variance, among Roman chair conditions. RESULTS:
The activity of back muscles ranged between 38 to 54% across difference of the lateral flexion angle between the convex and the
conditions, while hip extensor muscles ranged between 14 to 25%. concave side was related to the size of the Cobb’s angle (p < 0.05).
The Roman chair conditions did not affect the EMG activity of In double curve cases, the lateral flexion angle of each convex side
back muscles. However, the H40º condition significantly (P < 0.05) was larger at the top and bottom of the curve. For single curve
reduced the activity of Biceps femoris, by an average of 10 to cases, the lateral flexion angle of the concave side of the higher
14%, relative to the other two conditions. CONCLUSIONS: This thoracic spine or lumbar vertebrae was increased. There were no
study demonstrated that pelvic stabilization does not increase the relationships between the laterality of lateral flexion or the rotation
activation of back muscles nor reduces significantly the activation of angle in the sagittal plane and the Cobb’s angle. CONCLUSIONS:
hip extensors during dynamic exercises on a Roman chair. On the Lateral flexion range of the spine in AIS was limited by the structural
other hand, elongating hip extensors (40º hip flexion) was efficient to curve, and there was laterality through the lateral flexion range of the
decrease the level of activity of the Biceps femoris. IMPLICATIONS: whole spine. As for the active lateral flexion of the spine in a natural
Using the H40º exercise would be more likely to avoid task failure standing position, the range of motion toward the concave side rather
due to possible exhaustion of biceps femoris. This would allow than the convex side was decreased in AIS. The rotation range of
the exercise to train more specifically the targeted back muscles motion to the concave side of AIS was limited. IMPLICATIONS: One
by overloading them on a longer duration to induce physiological must be careful to compensate for the top and bottom regions of the
changes. This has implications for the training of low back muscle curve to properly correct scoliosis. KEYWORDS: AIS, spine, motion
endurance in low back pain patients. KEYWORDS: Trunk extensor analysis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
muscles, Electromyographic Activity, Back extension exercises, [email protected]
Stabilization effect. FUNDING ACKNOWLEDGEMENTS: Funded by ETHICS COMMITTEE: Our experiments were performed based on
the Occupational Health and Safety Research Institute Robert-Sauvé the Institutional Guidelines for Experimental Investigations on human
(IRSST). CONTACT: [email protected] subjects.
ETHICS COMMITTEE: ethics committee of the CRIR-site Montreal
Rehabilitation Institute.
15-05 Monday 4 June 14:00 RELATIONSHIP BETWEEN UPPER CERVICAL MOTION AND
VCEC Exhibit Hall B & C MASTICATORY MUSCLE IMBALANCE
SPINAL MOTION ANALYSIS OF ADOLESCENT IDIOPATHIC
Oshiro S1 , Miyamoto S2 , Aoki M2 , Iwamoto K1 , Takata Y3 ,
SCOLIOSIS
Muraki T1 , Izumi T1 , Takasaki H4 ; 1 Graduate School of
Minehisa K1 , Shinkoda K2 , Nara I3 , Matsunaga Y4 , Endoh T5 , Health Sciences, Sapporo Medical University, Sapporo, Japan;
Togashi S1 ; 1 Osaka Kawasaki Rehabilitation University, Osaka, 2 Department of physical therapy, Sapproro Medical University,
Japan; 2 Hiroshima University Graduate School of Health Sapporo, Japan; 3 Yamahana Orthopeadic Clinic, Sapporo, Japan;
Sciences, Hiroshima, Japan; 3 Faculty of Rehabilitation Kobe 4 Shinoro Orthopeadic Clinic, Sapporo, Japan
Gakuin University, Kobe, Japan; 4 Anabuki Rehabilitation College,

PURPOSE: Previous anatomical, biomechanical, and neurophysio-
Takamatsu, Japan; 5 Department of Orthopedic Surgery, Mitoyo
logical investigations have indicated that the stomatognathic system
General Hospital, Kagawa. Japan
and cranio-cervical motions are functionally linked. Although there
PURPOSE: Adolescent idiopathic scoliosis (AIS) is a three- have been reports on the relationship between cranio-cervical
dimensional deformity characterized by lateral vertebral deviation motions and masticatory muscle functions, these relationships have
and axial rotation. The specific spinal movement in each case not been well understood. The purpose of this study is to elucidate
of AIS is influenced by the pattern, region, and flexibility of the the relationship between upper cervical motion and masticatory
spinal curves. It is known that the combined motion of thoracic muscle imbalance by using EMG analysis. RELEVANCE: This
rotation occurring with lateral flexion in scoliosis is different from study contributes to the physical examination and treatment of the
that of a normal human. However, this mechanism has not yet been stomatognathic and cervical dysfunction. PARTICIPANTS: Healthy
thoroughly examined. Therefore in this study, we examined the spinal subjects (n = 31) with no abnormal history involving the stom-
movement of patients with AIS using a three-dimensional motion atognathic system, cervical spine, and shoulder were used as
analysis system. RELEVANCE: Evaluating the active movement of participants. Bilateral upper cervical rotation of the subjects were
the spine in AIS, including structural deformities, by an objective measured, and the ratio of rotational laterality ([range of rotation
procedure provides useful information for devising a physiotherapy towards greater side – range of rotation towards smaller side/range of
program for the management of AIS. PARTICIPANTS: Data were rotation towards greater side] × 100), was calculated. Subsequently,
collected from 6 women (mean age 16±1.9 years). All subjects had the flexion-rotation test was performed using a device to measure
AIS with right major curves. All scoliotic curves (9 curves) including the cervical range (Performance Attainment Associates, St Paul,
compensatory curves were analyzed, and the frontal plane Cobb’s MN), and the subjects were divided into two groups of 12 and 19
angle in the standing position was 25.6±18.7 degrees. METHODS: members each. Group-1 (8 males and 4 females; mean age, 26±5.8
Skin markers were attached using double-sided adhesive tapes on years) and group-2 (10 males and 9 females; mean age, 24±4.9
the spinous processes of C7, T2, T5, T8, T10, L1, L4, and S1. The years) had rotational lateralities that were equal to or more than
subjects were instructed to perform lateral bending to the right and 14%, and less than 14%, respectively. METHODS: Surface EMG
left, and rotation of the trunk to the right and left. The study employed activity was recorded using six channels (TeleMyo2400, Noraxon,
a camera motion analysis system and purpose-built software for data USA) that were attached to the bilateral masseter, temporalis,
collection and analysis (UM-CAT; Unimec Co. Japan). The angles and sternocleidomastoid muscles. The EMG amplitude (mV) was
between the three points at the top and bottom of each marker assessed by the root mean square (r.m.s.). The sampling frequency
(joints 1-6) and the higher thoracic spine, thoracic spine, and angle of was 1500 Hz and band-pass filtering 10–350 Hz. During the tests,
the lumbar region were calculated in the frontal and sagittal planes. the subjects sat with their heads unsupported and were instructed
ANALYSIS: Statistical analysis was performed using Stat View J to maintain a natural erect position. EMG recordings were obtained
5.0 for Macintosh (SAS Institute Inc.). A p-value less than 0.05 was while the subject performed a 3-s maximum voluntary clench on
considered statistically significant. RESULTS: In the region including cotton rolls that were positioned on his/her posterior teeth (test 1)
the apex for all curves, the lateral flexion angle towards the concave and a 3-s maximum voluntary clench without the cotton rolls (test
side was decreased compared to the convex side (p < 0.05). The 2). EMG potentials of test 2 were standardized as a percentage
of the maximum potential obtained in test 1. The symmetry rate importance of having an all-inclusive information package available
of the EMG output of paired muscles was expressed by the at all stages of the continuum of care. IMPLICATIONS: In an effort
percentage overlapping coefficient (100% = perfect symmetry, by to promote successful outcomes and improved quality of life for
Ferrario, 2000). ANALYSIS: Student t-tests were used to compare those with TJA, it is recommended that health care professionals,
the paired muscle activity of each muscle between the groups including physiotherapists, provide an educational package that has
(P < 0.05). RESULTS: There were significant differences (P < 0.05) content that is all-encompassing covering a broad range of topics.
between the mean symmetry rates of masseter muscle contraction in KEYWORDS: total joint arthroplasty, educational needs, health care
group-2 (94.49% ±4.44%) and group-1 (87.25% ±11.92%). However, professional. FUNDING ACKNOWLEDGEMENTS: This research
there were no significant differences in symmetry rates of the was generously funded by a grant to the GTA Rehab Network from
temporal and sternocleidomastoid muscles. CONCLUSIONS: Our The Change Foundation and the Government of Ontario. Views
findings showed that the group with greater rotational laterality of expressed in this presentation are not the views of The Change
the upper cervical spine demonstrated asymmetric masseter muscle Foundation or the Government of Ontario.
activity. This suggests a relationship between muscular asymmetry ETHICS COMMITTEE: St. Joseph’s Health Centre Research Ethics
of the masseter and upper cervical dysfunction. IMPLICATIONS: Board; University Health Network Research Ethics Board; Toronto
Our findings will be useful for the physical examinations and Rehabilitation Institute Research Ethics Board
treatment of masticatory imbalance and upper cervical dysfunction.
KEYWORDS: Upper cervical spine, Masticatory muscles, EMG Research Report Poster Display
activity. FUNDING ACKNOWLEDGEMENTS: No grants or outside
funding were received in support of this research study. CONTACT:
[email protected]
ETHICS COMMITTEE: Institutional Review Board of Sapporo SELF-REPORTED SYMPTOMS, FUNCTION AND ANXIETY IN
Medical University THE POST-DISCHARGE PERIOD PREDICT SATISFACTION
AND QOL FOLLOWING REHABILITATION AFTER TOTAL KNEE
ARHTROPLASTY
16-13 Monday 4 June 14:00 Walton D, Padfield B; The University of Western Ontario
VCEC Exhibit Hall B & C PURPOSE: To examine the ability of a variety of patient demographic
EDUCATIONAL NEEDS OF ADULTS UNDERGOING TOTAL HIP variables and self-report measures captured in the early post-
AND TOTAL KNEE ARTHROPLASTY: A QUALITATIVE STUDY operative period to predict satisfaction and knee-related quality of life
(KRQOL) at discharge from outpatient physiotherapy following TKA,
Soever L1−3 , MacKay C1,2,4 , Brien H1 , Davis A1,2,4 , Flannery J1,2,5 ,
and to estimate the feasibility of a larger multi-centre study based
Jaglal S1,2,5 , Levy C1 , Mahomed N1,2,4 , Tina S1,2 ; 1 GTA Rehab
on attrition rates and data collection procedures. RELEVANCE:
Network, Toronto, Canada; 2 University of Toronto, Toronto, Canada;
3 St. Joseph’s Health Centre, Toronto, Canada; 4 University Health In an era of decreased wait times and increased volume of total
joint arthroplasty, outpatient Physiotherapists require a mechanism
Network, Toronto, Canada; 5 Toronto Rehabilitation Institute, Toronto,
of triage for identifying those patients who are likely to do well
Canada
with their total knee from those who are at risk of poor self-
PURPOSE: To determine the educational needs of adults undergoing reported outcome. A logical extension of this work would be to
total hip and total knee arthroplasty (TJA) surgery. RELEVANCE: identify targetted interventions aimed at preventing poor self-rated
Total joint arthroplasty of the hip and knee is a widely accepted, outcomes. PARTICIPANTS: A cohort of 55 patients presenting
efficacious treatment for patients with advanced arthritis of the hip for physiotherapy following primary TKA were recruited from one
and knee, who have unacceptable levels of pain and/or physical of two rural hospital-based outpatient physiotherapy clinics in
function. There is evidence in the literature that patients with Ontario, Canada. METHODS: Demographic and self-report data
TJA have better outcomes with timely information and education. were captured at initial outpatient physiotherapy visit. Two measures
Physiotherapists play an important role in the management of of outcome were used: A KRQOL scale and an overall satisfaction
patients with TJA at all stages of the continuum of care including score. These outcomes were captured during the final physiotherapy
pre-admission, acute, and rehabilitative. As part of ther role, visit. ANALYSIS: Mean group difference in KRQOL and satisfaction
physiotherapists are involved in the education of patients with TJA. were investigated for significance between the two levels of any
PARTICIPANTS: Participants were eligible if they were scheduled dichotomous demographic variable. Continuous variables were
to undergo TJA or had undergone TJA in the previous three to evaluated for their association with the dependent variables using
six months. Of twenty-two potential participants, fifteen participated. univariate correlational procedures. Stepwise linear regression was
Five were booked for upcoming TJA and ten had undergone at used to generate the final model for predicting each of KRQOL and
least one TJA in the previous three to six months. METHODS: satisfaction. RESULTS: We had a 24.7% refusal rate, and a low 3.5%
A qualitative research design using semi-structured interviews was attrition rate. The baseline ‘other symptoms’ and ADL subscales of
utilized. Interviews were conducted in a Canadian community at the Knee Injury and Osteoarthritis Outcome Score (KOOS), along
a location chosen by the participants, and followed an interview with self-reported anxiety intensity were the strongest predictors of
guide. The interviews were taped and transcribed verbatim. Data KRQOL at discharge, explaining 49% of the variance in this measure.
collection continued until saturation was reached. The research Satisfaction was best predicted by body mass index and the baseline
protocol was approved by the Research Ethics Boards of the KOOS ADL subscale. This model explained 28.9% of the variance
participating hospitals. ANALYSIS: A comparative contrast method in general satisfaction. Anxiety intensity showed a similarly strong
of analysis was used. Transcripts were analyzed line by line correlation with both measures (r = −0.51). CONCLUSIONS: The
using a coding process whereby words or groups of words were results of this pilot study suggest that a larger multi-centre trial is
identified that addresssed the research question. These words feasible. The KOOS subscales of ‘other symptoms’ and ADLs, along
and groups of words were organized into themes. RESULTS: with self-reported intensity of anxiety and BMI show value in their
Participants reported educational needs that were encompassed ability to predict outcome at discharge from outpatient physiotherapy
under three main categories: Educational Needs; Factors Affecting in patients who receive TKA. IMPLICATIONS: Further research is
Educational Needs; and Method of Delivery. Common to each needed. The development of a tool based on self-report measures
category was the premise that being informed would overall lead to to be used during triage of patients following discharge from hospital
a better quality of life. CONCLUSIONS: Adults who undergo TJA after TKA appears plausible. Physiotherapists should be aware of
identified a broad range of educational needs which validate the the impact of psychosocial factors on self-report outcome measures.
KEYWORDS: Total knee arthroplasty, prediction, quality of life, Research Report Poster Display
satisfaction, observation. FUNDING ACKNOWLEDGEMENTS: The 18-01 Monday 4 June 14:00
authors wish to thank the London region subgroup of the Ontario VCEC Exhibit Hall B & C
Physiotherapy Association for their financial support of this project. PHYSICAL EXAMINATION FOR DIAGNOSING DISC HERNIATION
CONTACT: [email protected] IN PATIENTS WITH LOW BACK PAIN: COCHRANE PILOT
ETHICS COMMITTEE: Health Sciences Research Ethics Board at REVIEW OF DIAGNOSTIC ACCURACY STUDIES
The University of Western Ontario van der Windt D1,2 , Simons E3 , Riphagen I2 , Ammendolia C4 ,
Verhagen A5 , Laslett M6 , Devillé W7 , Aertgeers B8 , Deyo R9 ,
Bouter L2 , De vet R2 ; 1 Primary Care Musculoskeletal Research
Centre, Keele University, UK; 2 EMGO Institute, VU university
Research Report Poster Display medical centre, Netherlands; 3 Department of Experimental
16-21 Monday 4 June 14:00 Anatomy, Vrije Universiteit, Brussels, Belgium; 4 Institute for Work
VCEC Exhibit Hall B & C and Health, Toronto, Canada; 5 Department of General Practice,
EFFECTS OF INTERMITTENT STRETCHING AND/OR CLEN- Erasmus University medical center, Rotterdam, The Netherlands;
6 PhysioSouth, Christchurch, New Zealand; 7 Netherlands Institute
BUTEROL ON DISUSE ATROPHY OF RAT SOLEUS MUSCLE
for Health Services Research, Utrecht, The Netherlands; 8 Center
Yamazaki T, Yokogawa M, Tachino K; Division of Health Science, for Evidence Based Medicine, Belgian Branch of the Cochrane
Graduate School of Medical Science, Kanazawa University, Collaboration, Brussels, Belgium; 9 Division of General Internal
Ishikawa, Japan Medicine, University of Washington, Seattle, USA
PURPOSE: The present study was undertaken to evaluate the effects PURPOSE: In 2003 the Cochrane Collaboration decided to accept
of intermittent stretching (IST) or treatment with clenbuterol (Cb, systematic reviews of diagnostic accuracy in their database.
a drug with anabolic effects) or a combination of IST and Cb on Publication of the first reviews is not expected until 2007 or 2008.
rat soleus muscle in the presence of progressive disuse atrophy. In the meantime, however, review groups in various medical fields
RELEVANCE: Prevention or suppression of disuse muscle atrophy have been working on pilot protocols and reviews. We would like
is an important task of physical therapy. For patients lying on bed report on one of these pilot reviews. The objective of this review
for prolonged periods of time, it is difficult to accommodate the was to assess the diagnostic performance of tests carried out
excessive loads borne on their body. Intermittent weight bearing during physical examination in the identification of disc herniation
(IWB) is found to be a safe means of intervention to maintain the in patients with low back pain. RELEVANCE: Disc herniation is
leg muscles of such patients. However, since complete prevention the cause of symptoms in a small proportion of patients with low
of atrophy is difficult to achieve with IWB alone, the authors have back pain. Physical therapists and physicians often use physical
previously reported on treatment using a combination of IWB and Cb examination to decide which patients should be referred for diagnostic
(WCPT-AWP&ACPT 2005 Congress, in Seoul). The present study imaging, or to decide if a patient is a suitable candidate for
was aimed at evaluating the effects of a combination of IST (keeping surgical intervention. An accurate clinical diagnosis of lumbar disc
the soleus muscle stretched for one hour each day) and Cb treatment herniation is desirable to avoid unnecessary surgical intervention.
in experimental animals, with an assumption that a similar technique PARTICIPANTS: Several bibliographic databases including Medline
could be used to patients unable to bear weight. PARTICIPANTS: and Embase were searched to identify eligible studies. We included
The subjects were thirty-five male Wistar rats (7 weeks old, mean diagnostic studies evaluating the accuracy of physical examination
body weight 215±6 g). METHODS: The rats were divided into five (any test) in the diagnosis of disc herniation among patients with
groups: control (CON), hindlimb unweighting (HU), Cb treatment low back pain. Studies were eligible if they compared the results
during hindlimb unweighting (Cb), IST during hindlimb unweighting of physical examination to those of diagnostic imaging or surgical
(IST), and combined Cb+IST during hindlimb unweighting (Cb+IST) findings (reference standard). METHODS: The quality of selected
studies was assessed using the Quality Assessment of Diagnostic
group. This protocol was approved by the committee on animal
Accuracy Studies checklist (QUADAS). Final selection of papers,
experimentation of Kanazawa University (No.050301). ANALYSIS:
quality assessment, and data extraction was carried out by two
The soleus muscle was removed 14 days after the start of treatment
reviewers independently. ANALYSIS: We extracted diagnostic two-
to measure its wet weight, cross-sectional area (CSA) of muscle
by-two tables (true positive, false positive, true negative, and false
fibers, percentage of each fiber type, and contractile properties.
negative rates) from each publication. For each test estimates of
ANOVA was used for statistical analysis. RESULTS: The mean CSA
sensitivity and specificity are used to display the results in Receiver
of type 1 fiber, relative to CON group (= 100%), was 81.0% in Cb
Operating Characteristic (ROC) space, and superimpose a summary
group, 58.3% in IST group and 74.2% in Cb+IST group. Twitch ROC curve (SROC). RESULTS: At the time of preparing this
tension, relative to CON group, was 33.9% in Cb group, 50.3% abstract 18 studies were included in the review. We encountered
in IST group and 45.9% in Cb+IST group. CONCLUSIONS: No several problems during searching and selection of studies, quality
particular benefit was observed after applying IST in combination assessment and data extraction. Problems were often associated
with Cb treatment. IMPLICATIONS: IWB involves exercising the with poor quality of reporting. The methods used for patient selection
patient by means of stretching the soleus muscle and inducing were poorly described, it was sometimes unclear what reference
the appropriate muscle work needed to bear the body weight. IST standard the participants received, or in what order tests were
involves only muscular stretching and isometric resistant exercise, executed. Most studies have evaluated the diagnostic performance
which do not provide adequate stimulus to reinforce the efficacy of of the straight leg raising test. Preliminary results show that this test
Cb treatment. However, since IST is a technique of physical therapy has adequate sensitivity, but lower and widely varying specificity.
useful for inducing muscular tension, it may be possible to elevate CONCLUSIONS: Final results on the sensitivity, specificity, predictive
the effectiveness of combined Cb+IST by modifying the method of values and likelihood ratios of physical tests used in the diagnosis
applying this combined therapy. KEYWORDS: intermittent stretching, of lumbar disc herniation are presented during the conference. We
clenbuterol, soleus muscle. FUNDING ACKNOWLEDGEMENTS: will address some of the problems encountered when preparing
This study was supported in part by Grant-in-Aid for Scientic this review and present our solutions. Methods for summarizing
Research (No.17500351), Japan Society for the Promotion of and presenting diagnostic evidence that are useful and accessible
Science. CONTACT: [email protected] for physical therapists and other health care professionals will
ETHICS COMMITTEE: This protocol was approved by the committee be explained. IMPLICATIONS: Systematic reviews of diagnostic
on animal experimentation of Kanazawa University (No.050301). research are not easy to perform but provide valuable information on
the diagnostic performance of history taking, physical examination, Human Services, and UC Davis Medical Center Physical Therapy
and other tests that are commonly used by physical therapists. Department. CONTACT: [email protected]
These reviews will soon become available through the Cochrane ETHICS COMMITTEE: California State University, Sacramento
database, further supporting evidence-based practice in physical Committee for the Protection of Human Subjects
therapy. KEYWORDS: Systematic Review; Diagnostic accuracy,
Lumbar disc herniation. FUNDING ACKNOWLEDGEMENTS: This
project is carried out without additional external funding. CONTACT:
[email protected] Research Report Poster Display
MOTORISED LUMBAR TRACTION IN THE MANAGEMENT
18-05 Monday 4 June 14:00 OF LOW BACK PAIN WITH NERVE ROOT INVOLVEMENT: A
VCEC Exhibit Hall B & C FEASIBILITY STUDY OF EFFECTIVENESS
AN EXPLORATION OF MAITLAND’S CONSTRUCT OF LOW
Harte A1 , Baxter G2 , Gracey J1 ; 1 University of Ulster, Northern
BACK PAIN IRRITABILITY
Ireland; 2 University of Otago, New Zealand
Barakatt E1 , Riddle D2 , Romano P3 , Beckett L3 , Retke J3 ,
Bechtold K4 ; 1 California State University, Sacramento; 2 Virginia PURPOSE: Nerve root involvement accompanies between 3-10% of
Commonwealth University; 3 University of California, Davis Medical Low Back Pain (LBP) and despite current guidelines, lumbar traction
Center; 4 Sutter Davis Hospital is a treatment still used by 40% of physiotherapists treating such
patients. However its benefits remain to be established. The aim of
PURPOSE: To examine the inter-rater reliability and construct validity this study was to establish the feasibility of a pragmatic Randomized
of Maitland’s construct of low back pain (LBP) irritability, and Controlled Trial (RCT) to compare two treatment protocols reflecting
to identify LBP characteristics for consideration in an operational current clinical practice (manual therapy, exercise and advice, with
definition of LBP irritability. RELEVANCE: Low back pain irritability is or without traction) in the management of acute/sub acute low
a clinical characteristic developed by Maitland and used by physical back pain with ‘nerve root’ involvement. RELEVANCE: Evidence
therapists to influence the vigor of examination and treatment
for the effectiveness of lumbar traction remains inconclusive due
techniques. Though widely used by physical therapists treating
to the poor methodological quality, inadequate treatment doses,
patients with musculoskeletal disorders, Maitland’s concept of LBP
and heterogeneous populations used in past studies. This study
irritability has not been defined to the extent that its measurement
addressed these issues by investigating a homogeneous group
properties can clearly be tested. PARTICIPANTS: Data for this
(‘nerve root’) and used treatment parameters for traction established
investigation were gathered from 183 subjects being treated for
from a UK wide survey of current practice. This represents the first
low back pain consecutively recruited from three physical therapy
high quality trial reflecting current traction use. PARTICIPANTS: 30
clinics: two in Sacramento and one in Davis, CA, USA. Thirty
patients with nerve root pain, with or without neurological signs,
physical therapists with experience in treating patients with low back
were recruited between March 2004 and February 2005 within Down
pain participated in this investigation. METHODS: Prior to inital
Lisburn Health and Social Care Trust, Northern Ireland. METHODS:
evaluation subjects were surveyed detailing their LBP characteristics
A pragmatic RCT design was employed with patients randomly
of time to aggravate symptoms with specific activities, time specific
assigned to one of two treatment groups: Manual therapy (manual
activities were tolerated, and pain persistence following specific
therapy, exercises and the ‘Back Book’) or Lumbar traction (lumbar
activities. Physical therapists evaluated and treated all 183 subjects
with LBP. Eighty subjects received 2 examinations at their initial traction, manual therapy, exercises and the ‘Back Book’). Outcome
visit. Therapists judged subjects’ LBP as irritable or non-irritable, measures used were the: McGill pain questionnaire, Roland Morris
and recorded treatments provided at the initial visit. ANALYSIS: disability questionnaire, Short form 36, and the Acute LBP Screening
An unweighted kappa statistic evaluated the reliability of therapists’ Questionnaire; these were recorded at baseline, discharge, 3
LBP irritability judgments. A Fisher’s Exact Test evaluated the and 6 months post-discharge. In addition, visual analogue scale
association between therapists’ irritability judgments and treatment (VAS) scores for back and leg pain, the percentage of overall
decisions. A principal components analysis was performed on improvement (patient’s perception), and changes in neurological
patient-reported LBP characteristics to identify potential components and neurodynamic tests were recorded. ANALYSIS: Data recorded
of an operational definition of LBP irritability. Logistic regression was from the primary outcome measures, VAS scores and percentage
used to assess the relationship between LBP characteristics and overall improvement were considered interval level and analysed
therapists’ irritability judgments. RESULTS: The kappa statistic for with parametric statistics: repeated measures ANOVA (within group
inter-rater agreement of physical therapist irritability judgments was changes) and the independent t-test (between group changes).
0.39 (95% CI = 0.19 to 0.60). Associations were found between RESULTS: 27 patients completed treatment with a loss of four
subject irritability status and various treatment categories. Five patients at the 3 and 6 month follow up: data for 23 patients were
dimensions of LBP irritability were identified related to subjects’ pain analysed. ANOVA showed a significant improvement in pain and
persistence and activity limitations. Four of these five dimensions disability from baseline to all follow up points for both groups; however
were associated with therapists’ LBP irritability judgments. Other there was no significant difference between groups. Feasibility issues
LBP characteristics were found to be as strongly associated with highlighted that recruitment, selection, and outcome measures were
therapists’ irritability judgments. CONCLUSIONS: Low reliability of appropriate however a sample size calculation suggested that a large
therapists’ LBP irritability judgments suggests the need for the study would be unfeasible (n=1,975). CONCLUSIONS: The results
development of an operational definition of LBP irritability. Multiple demonstrated that both groups improved with treatment but that no
LBP characteristics were identified for consideration in an operational additional benefit was achieved with the addition of lumbar traction
definition of LBP irritability. IMPLICATIONS: Future research is to the package of care. IMPLICATIONS: This study demonstrates
needed to develop an irritability construct and test its value for that a study with this subgroup of LBP is feasible; however in light
making treatment decisions. KEYWORDS: Low back pain, Lumbar of the sample size calculation some aspects of the design would
spine, Evaluation, Low back pain irritability, Maitland. FUNDING need to be reconsidered prior to a fully powered pragmatic RCT.
ACKNOWLEDGEMENTS: Financial support provided by the Sutter KEYWORDS: Lumbar traction, low back pain, nerve root. FUNDING
Institute for Medical Research and the California Physical Therapy ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
Fund, Inc. In-kind support provided by Jamba Juice Corporation, ETHICS COMMITTEE: Research Ethical Committee of the University
California State University, Sacramento College of Health and of Ulster
THE NECK DISABILITY INDEX PREDICTS CHANGES IN PAIN EFFECT OF RELATIVE AND ABSOLUTE FATIGUE PROTOCOLS
AND NECK ROM OUTCOMES IN ACUTE WHIPLASH IN THE ASSESSMENT OF NECK MUSCLES FATIGUE IN
MacIntyre D1 , Redenbach D1 , Purssell R2 , McKnight D2 , WOMEN WITH CHRONIC NECK PAIN
Buchanan J3 ; 1 School of Rehabilitation Sciences, University of British Laliberté M1 , Larochelle J1 , Dumas J2 , Bilodeau M3 , Arsenault B1 ;
Columbia, Vancouver, Canada; 2 Division of Emergency Medicine, 1 University of Montreal and CRIR-Montreal Rehabilitation Institute,
University of British Columbia, Vancouver, Canada; 3 Emergency Montreal (Qc), Canada; 2 McGill University, School of Physical
Department, Vancouver General Hospital, Vancouver, Canada and Occupational Therapy, Montreal (Qc), Canada; 3 University
PURPOSE: The purpose of this study was to determine whether of Ottawa, School of Rehabilitation Sciences, Ottawa (Ont), Canada
standardized measures of neck pain, range of motion (ROM) and
disability at acute presentation (<24 hours) in patients sustaining a PURPOSE: To contrast the discriminating power of two fatigue
whiplash injury predicted subsequent outcomes at 48 hours, 3 and protocols, one involving relative and the other absolute force, when
6 weeks post injury, and to determine if there was a correlation studying neck muscle fatigue in women with non traumatic chronic
amongst the three outcome measures. RELEVANCE: Knowledge neck pain compared to healthy women. RELEVANCE: When evaluat-
of which standardized measures for a whiplash injury at initial ing neck muscle fatigue a relative protocol is often used with subjects
presentation are able to guide treatment choices and increase sustaining a proportion of their maximal voluntary contraction (MVC).
the accruacy of prognosis is valuable to clinicians. Demonstration
However, the real MVC may not be produced because of pain/fear
of a relationship between these outcome measures enhances
in individuals with chronic neck pain. Consequently, a an absolute
their usefulness separately or as a group in evaluating progress.
PARTICIPANTS: Patients presenting to the Emergency Department protocol, imposing the same load to all subjects, for the fatigue test
within 24 hours of sustaining a whiplash injury following a motor may be more appropriate. No study has compared such different
vehicle accident (MVA) were evaluated by an Emergency physician. protocols. PARTICIPANTS: Thirty women with chronic ( 1 year)
Those classified as WAD stage II (whiplash associated disorder neck pain (CW) aged 31.1±8.3 years and 25 healthy women (HW)
with no neurological involvement) and meeting the defined criteria aged 33.0±8.5 years participated in this study. For the CW, mean
of “otherwise healthy” were invited to participate in the study. Ten score on the Neck Disability Index was 9.57±3.97. METHODS: For
subjects, ages ranging from 18-47 years qualified, consented to the each subject, the MVC was first recorded in isometric neck extension
study, and participation in the follow-up sessions (48 hours, 3 and in a sitting position. They then performed two 10s fatigue tasks,
6 weeks). METHODS: The standardized outcome measures used one using a relative load, the other an absolute load. The relative
were: Neck Pain evaluated with the Visual Analogue Scale (VAS); task imposed a 75%MVC load in extension, while the absolute
Neck Disability as measured by the Neck Disability Index (NDI); and
one imposed the same load (16.7Nm) to all subjects. This load
Neck ROM measured according to Clarkson (2000). The VAS is a
was equivalent to the 75%MVC of a sample of healthy women
self-report scale rating pain on a 10 cm line between two point of
“no pain” and “worst pain”. The NDI is a 60 item self-administered (n=15) previously evaluated. EMG signals were recorded with pairs
questionnaire in which patients select phrases that best represent of surface electrodes placed bilaterally on the splenius. Torque
their level of ability, expressed as a percentage. Neck ROM is a was measured in reference to C7-T1. The fatigue index used was
series of linear measures (cm) performed by a trained clinician using the slope (Hz/s) of a series of EMG median frequencies (250 ms
a measuring tape. ANALYSIS: Paired t-tests were used to evaluate windows) over time during the respective task. ANALYSIS: Three
changes over time in each outcome measure. Pearson product way ANOVAs with repeated measures were used to compare the
moment correlations were used to evaluate the relationships among fatigue index between the two groups, the two fatigue tasks and both
the measures. RESULTS: Measures on the VAS, neck ROM, and 2 sides. A t-test compared the strength between the two groups
NDI deteriorated between 24 and 48 hours post MVA, then showed (alpha = 0.05). RESULTS: The CW (15.91±6.85 Nm) presented
improvement by 3 weeks with further improvement at 6 weeks. Strong significantly less strength (19.61%) than the HW (19.79±6.26 Nm) in
correlations were shown between NDI and neck extension ROM at extension. For the splenius, no differences were found in the fatigue
48 hours (r = −0.80) and NDI and pain at 3 weeks (r = 0.81). The NDI
indices between protocols, sides and groups (e.g. fatigue indices
score at 48 hours predicted changes in subsequent NDI scores at
for the left splenius: CW=-0.21 ±0.81 Hz/s; HW= −0.27±0.64 Hz/s).
3 weeks (r = 0.79) and 6 weeks (r = 0.78). CONCLUSIONS: Patients
with WAD stage II experienced worse pain, ROM and disability from CONCLUSIONS: Our hypothesis was that CW would present higher
24 to 48 hours post MVA, with improvement at 3 and 6 weeks, levels of fatigue than HW in the absolute protocol. However, the
although not full recovery. The NDI predicted disability scores at CW did not present increased fatigability. It should be noted that
3 weeks and 6 weeks and correlated with reduced neck extension 5 subjects from the CW and one from the HW were not able to
and pain. IMPLICATIONS: These standardized outcome measures complete the absolute task. The present absolute protocol aimed to
are simple to apply and have potential to predict which patients impose 75%MVC. However, the task really corresponded to 94%MVC
will go on to experience limitations in ability following whiplash in HW and to 129% in CW. It appears that the development of an
injury. KEYWORDS: whiplash, neck disability index, pain. FUNDING absolute protocol that can be generalized to different subjects is
ACKNOWLEDGEMENTS: Canadian Institute for the Relief of Pain rather complex and would require measurements on larger samples
and Disability. CONTACT: [email protected] of subjects in order to obtain the proper level of targeted load.
ETHICS COMMITTEE: Clinical Research Ethics Board, University of IMPLICATIONS: A relative protocol appears to be appropriate to
British Columbia
use with non-traumatic chronic neck pain women when studying
fatigue of neck muscles. KEYWORDS: Fatigue, neck muscles,
EMG. FUNDING ACKNOWLEDGEMENTS: Institut de recherche
Robert-Sauvé en santé et en sécurité du travail (IRSST), Ordre
Professionnel de la Physiothérapie du Québec (OPPQ). CONTACT:
[email protected]
ETHICS COMMITTEE: Ethics Committee of Center of Interdisci-
plinary Research in Rehabilitation of Greater Montreal
DOES ACROMIOCLAVICULAR JOINT STIFFNESS CAUSE EFFECTIVENESS OF CORE-CONDITIONING EXERCISES USING
DYSFUNCTION OF THE SHOULDER? A STRETCH-POLE ON THE SPINAL REALINGMNET AND FLEX-
IBILITY: A SINGLE-BLINDED RANDOMIZED CONTROL TRIAL
Miyamoto H1,4 , Muraki T1 , Oshiro S1 , Takasaki H5 , Fujii M1 ,
Hidaka E1 , Izumi T1 , Uchiyama,MD,PhD E3 , Aoki,MD,PhD M2 ; Sadakiyo M1 , Sugino S1 , Gamada K2 , Yamamoto D3 , Yokoyama S4 ;
1 Graduate school of health science Sapporo medical university, 1 Department of Rehabilitation, Sadamatsu Hospital, Omura,
Sapporo, Japan; 2 Department of Physical Therapy,Sapporo Medical Japan; 2 Department of Physical Therapy, Hiroshima International
University of Health Science, Sapporo, Japan; 3 Department of University, Higashi-Hiroshima Japan; 3 Department of Rehabilitation,
Anatomy Section II, Sapporo Medical University of the School Kijima Hon-In Clinic, Yao, Japan; 4 Department of Physical Therapy,
of Medicine, Sapporo, Japan; 4 Sapporo Orthopaedic Cardiovascular Seirei Christopher College, Hamamatsu, Japan
Hospital, Sapporo, Japan; 5 Sapporo Shinoro Orthopaedic Clinic,
PURPOSE: Spinal realignment often plays an important role in
Sapporo, Japan
physical therapy (PT) programs for spinal disorders. Little evidence is
PURPOSE: Acromioclavicular joint stiffness can occur in patients available to conclude that an exercise is effective. CoreConditioning™
(CC) program has been introduced to “flatten” the spinal curve and
who suffer from shoulder osteoarthritis, frozen shoulder, and
is widely used among athletes, fitness centers, and orthopaedic
rotator cuff tears. However, it is unclear whether or not it causes
clinics in Japan. The CC program includes upper and lower extremity
shoulder dysfunctions such as subacromial impingement or other
and trunk movements on the StretchPole™ (SP) (a modified Foam
joint restrictions.The purpose of this study is to examine the
Roller), when subjects receive pressure (i.e. direct force) at the
influence of acromioclavicular joint stiffness on scapular mobility
lower sacrum, mid thoracic spine, and posterior head. The objective
and shoulder motion. RELEVANCE: This study contributes to
of this randomized control trial (RCT) was to determine if the CC
application of physical therapy for the treatment of shoulder pain exercise program is more effective than conventional static stretching
and contracture. PARTICIPANTS: Five frozen-thawed transthoracic programs on spinal realignment and improvement of flexibility of
specimens from fresh cadavers were used. Anatomical structures the spine and proximal joints. RELEVANCE: Evidence regarding a
of the whole spine, thoracic cage, and bilateral upper extremity safe, easy and effective exercise program for spinal realignment is
were preserved in the transthoracic specimens. Specimens with required in present PT practices. This study will be an important
rotator cuff tears, osteoarthritis, and severe shoulder contracture step in building such evidence. PARTICIPANTS: After obtaining
were excluded. METHODS: In this study, we focused on the range an IRB approval, 39 young, healthy individuals were recruited and
of shoulder flexion, abduction and upward rotation of the scapula. randomly assigned, either to the CC, static stretching (SS) or
The transthoracic specimens were fixed in an upright position on control group. Exclusion criteria were: (1)history of major orthopaedic
a wooden pole jig to allow free passive movement of the arm and injuries, (2)presence of shoulder/hip pain or lumbar back pain (LBP),
scapula. In order to simulate acromioclavicular joint stiffness, we (3)scoliosis/spinal deformity, (4)pregnancy, (5)psychiatric problems
used two crossing Kirschner wires for fixation of the joint. Then, we and (6)other medical risks. METHODS: The intervention period
measured the maximum range of passive flexion and abduction of was 4 weeks during which the CC group performed basic-seven
the shoulder pre- and post- fixation. The angle of upward rotation exercises (including upper/lower extremity and trunk exercises lying
of the scapula was measured at 30º, 60º, 90º, 120º, and the supine on a SP). The SS group performed 10 static stretching
maximum angle of shoulder flexion and abduction pre- and post- exercises, and the control group performed no exercises. All groups
fixation. These angles were measured by an electromagnetic tracking refrained from participating in other sports or strenuous activities
device (3SPACE FASTRAK, Polhemus, Vermont) with six-degree- during the intervention period. Outcome measures included sagittal
of-freedom. ANALYSIS: A paired t-test was used to examine the spinal alignment from plain radiography in the upright position, flexed
differences in the shoulder and scapular angles between the two and extended standing postures, as well as flexibility measurements,
conditions. The a-level of significance was set at 0.05. RESULTS: including seated trunk rotation, prone trunk extension, passive
There were no significant differences in the maximum angle of straight leg raises, and passive shoulder flexion. ANALYSIS: Two-
shoulder flexion and abduction between the two conditions. There way repeated measure ANOVA with a Tukey/Kramer post-hoc test
were no significant differences in the angle of upward rotation were used for comparisons. The level of significance was set at
of the scapula during passive flexion and up to 60 degrees of p < 0.05. RESULTS: None of the 39 consenting participants reported
negative effects by performing the exercise program. Statistical
shoulder abduction.However,beyond 60 degrees of shoulder abduc-
differences in the spinal curvature were found in the CC group
tion,acromioclavicular joint fixation resulted in a significant reduction
in the upright (p = 0.042) and trunk extended (p = 0.033) positions
in the scapular rotation angle (p < 0.05). CONCLUSIONS: The results
between the pre- and post-intervention measurements. Flexibility
of the present cadaveric study indicated that beyond 60 degrees
measurements did not show significant differences after Bonfferoni
of shoulder abduction,acromioclavicular joint stiffness can influence
correction. CONCLUSIONS: CC was effective in spinal realignment
the angle of upward rotation of the scapula.Unchanged maximum
in upright and trunk extension positions in young, healthy individuals.
shoulder flexion and abduction may imply abnormal compensatory The post-hoc test revealed that there was a decrease in the
movements at the glenohumeral joint. Thus, in view of the present lordosis at L5/S1 and increase at L1/L2 and T12/L1 levels in
results,it may be inferred that acromioclavicular joint stiffness may upright, while there was an increase in lordosis at L1/L2 in trunk
alter the kinematics of the shoulder joint complex during vocational extension. The SS and control groups showed no adverse effects in
and sports activities;consequently,it may lead to shoulder dysfunc- any groups. IMPLICATIONS: CC was safe and effective for spinal
tion. IMPLICATIONS: Our findings suggest that evaluation and realignment, more specifically reducing lordosis of the lower lumbar
treatment of acromioclavicular joint stiffness should be considered in spine and increasing lordosis (hyperextension) of the upper lumbar
patients with shoulder dysfunction. KEYWORDS: Acromioclavicular spine, in the short term. This information should be taken into
joint, kinematics, shoulder. FUNDING ACKNOWLEDGEMENTS: No consideration when developing an exercise program intended for
grants or outside funding were received in support of this research. spinal realignment. KEYWORDS: foam roller, spinal realignment,
CONTACT: [email protected] lumbar lordosis. FUNDING ACKNOWLEDGEMENTS: This study
ETHICS COMMITTEE: Institutional Review Borad of Sapporo was supported by the Japanese CoreConditioning Association,
Medical University research funding program. None of the authors received salaries or
any other financial benefit by participating in this study. CONTACT: status in a variety of patient types, including carpal tunnel syndrome,
[email protected] back pain, and high blood pressure. The practice of Yoga may
ETHICS COMMITTEE: Ethics Committee of the Faculty of Health provide an option for individuals with PD to improve or maintain
Sciences, Nagasaki University physical function and mental outlook in a non-medical environment.
PARTICIPANTS: Ten subjects with PD (7 men and 3 women) were
volunteers from the local Parkinson’s Disease Association. All had
Research Report Poster Display a Hoehn and Yahr score of stage 3 or less. METHODS: One-way
21-17 Monday 4 June 14:00 repeated measures design was used. After completing the informed
VCEC Exhibit Hall B & C consent form and medical history, subjects were evaluated initially,
DEXTERITY IN PATIENTS WITH HAND OSTEOARTHRITIS passed 8 weeks with no change in usual activity, were evaluated
REFFERED FOR MULTIDISCIPLINARY HAND TREATMENT a second time prior to participation in an 8 week adaptive Yoga
Van den Ende C, Hoogland A, de Ruiter R, Veerman-Duiveman E, program On completion of the program, subjects were evaluated
Van Lankveld W; Rheumatology Centre, St Maartenskliniek a third time. The Yoga program included breathing techniques,
relaxation, meditation, and poses. Poses had potential to improve
PURPOSE: The purpose of this study is to compare pain, dexterity alignment, flexibility, balance, strength, and motor control. Subjects
and functioning between patients with hand OA and patients with were encouraged to practice at home, and practice calendars were
RA referred to a multidisciplinary treatment because of loss of kept each week. Outcome measures included: Unified Parkinson’s
hand function. RELEVANCE: Osteoarthritis (OA) is most commonly Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression
associated with monoarticular destruction in the hip or knee. Hand Scale (HADS), the anxiety and depression measures of the HADS,
OA is less common. However, in this subgroup of OA patients the the Berg Balance Scale (BBS), the Modified Dynamic Gait Index
hands can seriously affected by the condition. Patients report loss (DGI), the 30 second chair stand, hamstring length tests (Sit and
of hand functions in activities of daily life, dexterity, and higher Reach), and shoulder/upper back flexibility (Apley’s Scratch Test).
levels of distress(1). So far it is unclear to what extent hand OA ANALYSIS: Difference between initial measures, measures after the
can affect dexterity and functioning. PARTICIPANTS: Consecutive control phase, and measures after the intervention phase were done
patients of the St Maartenskliniek with OA or RA according to ACR using one-way Anova with follow-up T Tests and Friedman’s two-
criteria referred in 2005 to multidisciplinary hand treatment were way ANOVA by ranks with follow up Wilcoxin Signed-Ranks Test.
asked to participate in this study. METHODS: All patients were RESULTS: Analysis revealed the following measures reached or
assessed in a standardized way. An occupational therapist assessed approached significant improvement after intervention: the Modified
the Sequential Occupational Dexterity Assessment (SODA). The DGI (p = 0.15), BBS (p = 0.24), HADS (p = 0.06), Depression Measure
SODA measures observed hand related functions under controlled of HADS (p = 0.002), 30 Second Chair Stand (p = 0.03), and Sit and
conditions. In addition, grip strength was assessed by a physical Reach (p = 0.02). CONCLUSIONS: Change in measures of strength,
therapist. Participants completed the Arthritis Impact Measurement ROM, mobility, gait, balance and psychological health indicate a
Scales (AIMS,) questionnaire (higher score reflect worse outcome) positive effect of Yoga for people with Parkinson’s Disease supporting
and the Michigan Hand Questionnaire: MHQ) (higher scores reflect further study using randomized controlled research design with more
better come). ANALYSIS: Differences between OA and RA patients subjects. Further research using larger sample sizes and randomized
in parameters of dexterity were compared using T-tests. RESULTS: subject selection are needed to confirm effectiveness of Yoga for
49 patients with OA (12% male, mean (SD) age 59.3 (7.5) years) individuals with PD. IMPLICATIONS: Since flexibility, balance, and
and 90 patients with RA (14% male, 57.8 (12.9)) were included motor control, as well as depression and lack of ability to concentrate
in the study. In both dexterity as assessed by the SODA was are problems in individuals with PD and are addressed with the
severly limited. No differences in hand strength and functioning practice of Yoga, Yoga may be an effective intervention to improve
as measured by the AIMS and MHQ were found. OA patients or maintain physical, mental and emotional status in individuals
reported more pain than RA patients during performing activities with PD. The current health care model generally does not provide
of the SODA, whereas observed dexterity as measured by the ongoing rehabilitation, but clinic or community Yoga programming
SODA were comparable in both groups. CONCLUSIONS: These would allow individuals to remain actively involved in their health
findings confirm previously reported findings on the impact of hand and wellness at moderate cost. KEYWORDS: Yoga, Parkinson’s
OA on hand function. Dexterity is impaired in OA as well as in Disease, Alternative Medicine. FUNDING ACKNOWLEDGEMENTS:
RA. OA-patients suffer from more pain during performing hand The Parkinson’s Disease Association of Northern California provided
activities. IMPLICATIONS: These findings underline the need to financial support. The City of Sacramento Department of Parks and
develop a specific treatment program for this group of patients. Recreation provided class space. CONTACT: [email protected]
KEYWORDS: Hand function, osteoarthritis, rheumatoid arthritis. ETHICS COMMITTEE: f) This project was approved by the California
FUNDING ACKNOWLEDGEMENTS: This project was unfunded. State University Committee for the Protection of Human Subjects
VCEC Exhibit Hall B & C EVALUATION OF A COMMUNITY-BASED EXERCISE
EFFECT OF AN EIGHT-WEEK ADAPTIVE YOGA PROGRAM ON PROGRAMME FOR PEOPLE WITH PARKINSON DISEASE
MOBILITY, FUNCTION, AND OUTLOOK IN INDIVIDUALS WITH Reinikka K1 , MacLeod A; 1 St. Joseph’s Care Group, Thunder Bay,
PARKINSON’S DISEASE Canada
Boulgarides L, Coleman-Salgado B, Barakatt E, Choo D, Williams K,
PURPOSE: The Northwestern Ontario Parkinson Society Support
Morales A, El-Zahr M; California State University, Sacramento
Group and rehabilitation staff at St. Joseph’s Care Group (SJCG)
PURPOSE: The purpose was to determine the effect on strength, Thunder Bay, Canada, identified the absence of and need for
ROM, balance, gait, depression, and anxiety of 8 weeks of partic- an ongoing, physical activity programme for people living with
ipation in an adaptive Yoga class in ten subjects with Parkinson’s Parkinson Disease (PD). An exercise programme delivered in, and by
Disease (PD). RELEVANCE: The scope of physical therapy practice community partners was hypothesized to be one solution. An eight-
includes wellness and health promotion as well as rehabilitation. The week exercise programme was developed by physiotherapists and
practice of Yoga has been found to improve physical and mental delivered in the community by a fitness facilitator trained using a
competency based education approach. This study evaluated the able to perform pressure relief on their own. For these patients,
impact of the eight-week exercise programme upon performance various methods of pressure relief have been practiced in the clinic.
and self-report measures in participants with PD. RELEVANCE: PARTICIPANTS: Thirty-eight subjects with SCI in clinically stable
A number of obstacles to receiving rehabilitation services in state (14 were tetraplegic and 24 were paraplegic) METHODS: We
communities across Northwestern Ontario were previously identified, measured the buttock pressure in five different sitting positions on
and included: lack of services, lack of funding for services, services wheelchair using the Tekscan pressure measurement system (Big-
not available when needed, specific expertise required but not Mat 2000, a flexible sensor mat with a 2064 cell (43×48) matrix,
available, and lack of continuity and follow-up. The need for Nitta Co., Osaka, Japan). These positions were 1) neutral position
alternative forms of health care services and programme delivery (control); the subjects sat upright on their prescribed wheelchairs
are, therefore, apparent. PARTICIPANTS: 11 participants (6 men, at rest in a neutral position, 2) forward-leaning; the subjects were
5 women; mean age: 70.45 ±1.98; mean length of disease: 3.27 assisted into the forward-leaning position with chest on thighs,
years) with Idiopathic PD, Hoehn & Yahr stages 1.0 to 2.5 and 3) lateral bending; the subjects bended their body left side and
stable medication use, were recruited through the assistance of the relief right buttock pressure, 4) catch grip; the subjects caught
Northwestern Ontario Chapter of the Parkinson Society of Canada, the left grip of wheelchair and relief right buttock pressure, 5)
and the Neurology Day and Movement Disorder Clinics, both held backward tip; we tipped the wheelchair back to 35 degrees from the
at SJCG in Thunder Bay. METHODS: A prospective, single group vertical. ANALYSIS: The maximum pressure points in all subjects
pre/post test design was used. The Unified Parkinson Disease were at the ischial tuberosities.The data from both areas were
Rating Scale motor subsection (UPDRSm), Berg Balance Scale compared with values recorded in the at control. Calculations were
(BBS), Timed Up and Go (TUG), Parkinson Disease Questionnaire- made with the Scheffe anaiysis of variance (ANOVA). The level of
39 (PDQ-39), and Activities-specific Balance Confidence Scale significance was set to 0.05. RESULTS: In subjects with tetraplegia,
(ABC scale) were assessed at baseline and after eight weeks. the pressure at ishial tuberosities in control, forward-leaning,
Attendance rates and occurrence of any adverse events were lateral bending, catch grip and backward tip were 123.5±62.6
recorded by the fitness facilitator ANALYSIS: A paired Student’s (mean ± SD) mmHg / 139.6±66.3 mmHg (right/left), 41.5±19.8
t-test was used to assess statistical significance of any changes mmHg / 44.4±22.1 mmHg, 67.0±36.2 mmHg / 125.7±68.75
in outcome measures as well as any correlations. Effect size was mmHg,136.1±74.4 mmHg / 107.6 ±41.2 mmHg, and 97.9±53.5
established using Cohen’s d. RESULTS: Data analysis resulted in mmHg / 96.5±42.1 mmHg, respectively. In both side, significant
the removal of one participant outlier. Analysis of the remaining pressure relief were observed in the forward-leaning (P < 0.01).
10 participants demonstrated a statistically significant decrease In subjects with paraplegia, the pressure at ishial tuberosities in
in the UPDRSm (7.70, p = 0.001), and a statistically significant control, forward leaning, lateral bending, catch grip and backward tip
increase in TUG scores (2.03, p = 0.005). Significant effect size was were 156.3±69.0 mmHg /168.9±64.9 mmHg (right/left), 40.3±33.4
demonstrated for all outcome measures. All participants completed mmHg /37.7±25.6 mmHg, 62.7±48.1 mmHg /95.3±42.4 mmHg,
the study with 90.8% attendance in the exercise programme 131.0±56.5 mmHg /136.4 ±42.8 mmHg and 119.6±63.9 mmHg
and no adverse events. CONCLUSIONS: A community- based /131.3±62.4 mmHg, respectively. In both side, significant pressure
exercise programme, developed by physiotherapists and delivered relief were observed in the forward-leaning and lateral bending
by a community fitness facilitator, can be safely provided to a (P < 0.01). CONCLUSIONS: The results of our study demonstrated
group of people with Parkinson Disease. The exercise programme that of the four positions forward-leaning position might be far superior
appears to be of sufficient intensity to elicit changes in motor in decreasing pressure over the ischial tuberosities for patients with
function and demonstrates potential for change in all outcome SCI. Moreover, significant pressure relief was shown in the lateral
measures. Future studies are needed to assess long-term effects bending position in only patients with paraplegia. IMPLICATIONS:
of participation in the exercise programme in terms of participant This study illustrated the importance of evaluating the efficacy of
outcomes and utilization of rehabilitation services. These results may rehabilitation procedures routinely used in the clinic. KEYWORDS:
help define the role of community programmes within the health spinal cord injury,pressure relief,Tekscan pressure measurement
care system. IMPLICATIONS: It is hoped that this unique process of system. FUNDING ACKNOWLEDGEMENTS: no funding.
identifying and addressing the needs of a specific client population in ETHICS COMMITTEE: Kibikogen Rehabilitation Center’s ethics
Northwestern Ontario will help to facilitate the ongoing development committee
of physiotherapy initiatives which address the changing reality of
health care. KEYWORDS: Parkinson disease, exercise, community-
based. FUNDING ACKNOWLEDGEMENTS: Funding was received
through St. Joseph’s Care Group and the Rehabilitation Network, 24-09 Monday 4 June 14:00
as well as the Thunder Bay Community Foundation. CONTACT: VCEC Exhibit Hall B & C
[email protected] RELIABILITY AND VALIDITY OF THE KINESTHETIC AND
ETHICS COMMITTEE: St. Joseph’s Care Group (Board Ethics VISUAL IMAGERY QUESTIONNAIRE FOR ASSESSING MOTOR
Committee); Lakehead University (Research Ethics Board) IMAGERY IN PERSONS WITH STROKE
Malouin F1,2 , Richards C1,2 , Jackson P2,3 , Lafleur M4 , Durand A5 ,
Research Report Poster Display Doyon J6 ; 1 Department of Rehabilitation, Laval University,
Quebec City, Qc., Canada; 2 Center for Interdisciplinary Research
in Rehabilitation and Social Integration (CIRRIS); 3 École de
psychologie, Laval University; 4 Hôpital Robert-Giffard; 5 Institut
MEASUREMENT OF PRESSURE RELIEF POSITIONS IN SEATED de réadaptation en déficience physique de Québec; 6 Department
PERSONS WITH SPINAL CORD INJURY of Psychology and Unité de neuroimagerie fonctionnelle, Institut
Takeda M, Furusawa K; Kibikogen Rehabilitation Center for universitaire de gériatrie, University of Montreal, Qc, Canada
Employment Injuries,Kibityuo,Okayama Pre.Japan
PURPOSE: To benefit from mental practice training after stroke, one
PURPOSE: The purpose of this study was to compare the four must be able to engage in motor imagery and thus reliable motor
methods of pressure relief in seated patients with spinal cord imagery assessment tools tailored to persons with sensorimotor
injury (SCI). RELEVANCE: It is necessary for patients with SCI to impairments are needed. The aims of this study were to 1)
relief the buttock pressure during sitting on wheelchair. Push-ups examine the test-retest reliability of the Kinesthetic and Visual
are most effective methods of pressure relief. However, patients Imagery Questionnaire (KVIQ-20) and its short version (the KVIQ-
with decreased upper extremity strength and endurance are not 10) in healthy subjects and subjects with stroke; 2) investigate
the internal consistency of both KVIQ versions and 3) explore the the aerobic capacity and functional ability were assessed by the
factorial structure of the two KVIQ versions. RELEVANCE: We have symptom-limited exercise testing and Barthel index, respectively. In
developed the KVIQ-20 because the self-reporting nature and the addition, the ratio of total cholesterol (TC) to high-density lipoprotein
high physical demands of several items of existing motor imagery cholesterol (HDL), the predictor of cardiovascular events, was also
questionnaires make them unsuitable for persons with physical evaluated by the enzyme autoanalyzer. ANALYSIS: A two-tailed,
disabilities. PARTICIPANTS: Nineteen persons who had sustained independent Students t-test was applied to compare the aerobic
a stroke (CVA group) and 46 healthy persons (CTL group) took part capacity and TC/HDL level between exercise and control groups.
to the test-retest reliability study. Construct validity was studied in Mann-Whitney U test was used to compare the Barthel index
a group of 131 persons. METHODS: For the reliability study, the scores between two groups. RESULTS: After aerobic exercise
KVIQ was administered twice by the same examiner 10 to 14 days training, the patients’ absolute peak oxygen consumption (VO2)
apart. The KVIQ assesses on a 5-point ordinal scale the clarity of was increased (P < 0.01), and absolute VO2 at anaerobic threshold
the image (visual: V subscale) and the intensity of the sensations was also increased (P < 0.01). However, no significant changes in
(kinesthetic: K subscale) that the subjects are able to imagine from these variables were noticed in the control group. After the exercise
the first-person perspective. ANALYSIS: Total KVIQ-20 scores and intervention, the exercise group had better Barthel index scores than
subscores from the V and K subscales were averaged for each group. the control group (P < 0.05). Also, the TC/HDL level was significantly
The test-retest reliability was assessed using intraclass correlation reduced (P < 0.05) in the exercise group, but did not change in the
coefficients (ICC). The internal consistency of the two KVIQ versions control group. CONCLUSIONS: Our findings show that long-term
was evaluated with the Cronbach’s alpha and the latent structure was exercise intervention is beneficial to aerobic capacity and functional
assessed with the principal factor extraction technique and oblique ability for stroke patients with prior CAD. It also reduces the risk
rotation. RESULTS: In the CVA group, the ICCs ranged from 0.81 to factor of cardiovascular events in these patients. IMPLICATIONS:
0.90 and from 0.72 to 0.81 in the CTL group. Cronbach’s alpha values With a well-designed exercise protocol, aerobic exercise training
were respectively: 0.94 (V) and 0.92 (K) for the KVIQ-20 and 0.89 (V) could be incorporated into the clinical treatment to improve the
and 0.87 (K) for the KVIQ-10. The factorial analyses indicated that 2 prognosis of stroke patients with prior cardiovascular disorders.
factors explained 63.4% and 67.7% of total variance, for the KVIQ- KEYWORDS: ischemic heart disease, cerebrovascular accident,
20 and KVIQ-10 respectively. CONCLUSIONS: Both versions of the oxygen consumption. FUNDING ACKNOWLEDGEMENTS: This
KVIQ present similar psychometric properties that support their use study was partly supported by the National Science Council
in healthy individuals and in persons post-stroke. IMPLICATIONS: (Grant No. NSC95-2320-B-006-019 and NSC94-2314-B-075B-003)
Since the KVIQ-10 can be administered in half the time, it is a in Taiwan.
good choice for the assessment of persons with physical disabilities. ETHICS COMMITTEE: The Ethics Committee of Medicine at
KEYWORDS: Stroke, mental practice, motor imagery questionnaire. National Cheng Kung University
FUNDING ACKNOWLEDGEMENTS: This work was supported by
the Quebec Provincial Rehabilitation Research Network (FRSQ) and
the CIHR. CONTACT: [email protected]
ETHICS COMMITTEE: Ethics committee of the “Institut de 26-01 Monday 4 June 14:00
réadaptation en déficience physique de Québec”. VCEC Exhibit Hall B & C
PHYSICAL PERFORMANCE AND SELF-REPORTED HEALTH IN
A GROUP OF DISABILITY PENSIONERS WITH BACK PAIN
24-17 Monday 4 June 14:00 Magnussen L1 , Indredavik G1 , Strand L2 ; 1 Department of
VCEC Exhibit Hall B & C Physiotherapy, Faculty of Health and Social Sciences, Bergen
University College, Bergen, Norway; 2 Department of Public Health
EFFECTS OF LONG-TERM EXERCISE INTERVENTION ON and Primary Health Care, Section for Physiotherapy Science,
AEROBIC CAPACITY AND FUNCTIONAL ABILITY IN STROKE University of Bergen, Bergen, Norway
PATIENTS WITH PRIOR CORONARY ARTERY DISEASE
PURPOSE: The study is part of a larger project aiming to motivate
Yang A1 , Su C2 , Lin K3 ; 1 Department of Physical Therapy, College
disability pensioners with back pain to return to work. Previ-
of Medicine, National Cheng Kung University, Tainan, Taiwan;
2 Department of Occupational Therapy, College of Medicine, ously,disability pensioners with back pain have not been examined
systematically. The aim of this study was to examine physical
National Cheng Kung University, Tainan, Taiwan; 3 Departments of
functioning and self-reported health in this group of pensioners.
Physical Medicine and Rehabilitation, Veterans General Hospital –
RELEVANCE: Functional and mental assessments seem crucial
Kaohsiung, Kaohsiung, Taiwan
when deciding who is entitled to receive sickness benefit and
PURPOSE: It is known that regular exercise improves physical disability pension(DP). Several studies have described work-related
fitness in patients with cardiovascular disorders, as well as stroke functional ability of individuals on short and long term sick leave
patients. The aim of the present study was to investigate effects of due to LBP. However, little is known about functioning in disability
long-term exercise intervention on aerobic capacity and functional pensioners. PARTICIPANTS: Eighty-nine individuals (65% women)
ability in stroke patients with prior coronary artery disease (CAD). receiving DP due to back pain participated in the study. Mean age
RELEVANCE: Aerobic exercise training for functional recovery and was 49.0 years (SD=5.4) ranging from 36 to 56 years. Eligible
physical fitness after either stroke or CAD has been emphasized for the study were all individuals on DP due to back pain in the
clinically. Thus, the effects of exercise intervention on the prognosis county of Hordaland, Norway (n=431), being under 56 years of
for stroke patients with concurrent CAD should be of concern. age having received full DP for more than one year. The disability
PARTICIPANTS: Twenty-six stroke patients with hemiparetic gait pensioners (n=431) were identified through the National Insurance
disturbance and prior CAD were recruited and randomly divided into Administration. METHODS: Physical performance was assessed
exercise and control groups, respectively. The Ethics Committee of with UKK test battery comprising 1)The UKK walking test, based
Medicine at National Cheng Kung University approved all procedures, on 2 km walking, to measure aerobic capacity. A fitness index
and informed consent was obtained from all patients for their is calculated based on performance time for the walk, heart rate
participation in this study. METHODS: Thirteen patients (exercise immediately at the finish, body mass index [BMI], and gender
group) underwent the aerobic exercise training consisting of walking and 2) The UKK test battery comprised of five tests to assess
on a treadmill at 50–60% of their heart-rate reserve for 6 months. musculoskeletal fitness [neck and shoulder flexibility, static balance,
The remaining 13 patients (control group) did not receive any dynamic balance, dynamic sit-ups, and modified push-ups]. The
aerobic exercise intervention. Before and after the intervention, Back Performance scale (BPS) which is a sumscore of 5 physical
performance tests of daily activities, was used to measure dynamic test of Mann-Withney, after verifying normality with the Kolmogorov-
mobility of the trunk. Self-reported physical functioning and health Smirnov Test. RESULTS: 47 workers were studied, 26 (55.3%)
were also registered. ANALYSIS: Descriptive statistics were use received intervention and 21 (44.7%) no. Women 42 (89.4%). There
to describe physical performance and self-reported functioning and aren‘t differences in both groups as far as age, sex and years of work-
health. The tests results were compared to similar data obtained from ing activity length. Forty one workers (87.2%) present a FRI between
the general population in Norway RESULTS: Eighty-five participants 0-20%, 5 (10.6%) FRI between 21-40% and 1 (2.1%) with FRI>60%.
(96%) answered the questionnaire about self-reported physical Both groups improved. The improvement in the treated group was of
functioning and health, and 70 participants (79%) completed the 1.16 (ED ±3.8) points, in contrast to the group nontaken part that was
UKK musculoskeletal tests and 53 participants (60%) completed the of 0.71 (ED±3). The improvement in both was statistically significant
UKK walking test. The mean score of the fitness index were 64.24 (p = 0.00). When both groups compare themselves to each other, the
(SD 37.98) in men and 69.50 (SD 21.02) in women. The fitness improvement degree did not show statistically significant differences
index scores were considerably below the average scores obtained (p = 0.66). CONCLUSIONS: Although the prevention program gave
in the general population. The mean score of the 5 musculoskeletal rise to an improvement in the functional capacity and level of pain
tests varied from 2.21 (SD 1.41) to 1.04 (SD 0.20) in men and in the intervention group with respect to the non-treated group, the
from 2.30 (1.38) to 1.20 (SD 0.54) in women (1 is considerably differences were not statistically significant. This can be related to
below the average in the general population, 2 is somewhat below, the high number of workers who start off with FRI under (87.2% have
3 is average, 4 is somewhat above, and 5 is considerably above FRI <20%) and therefore with little margin of being able to improve
average). Only 22.2% of the participants reported to have very good with the preventive intervention. IMPLICATIONS: The programme
or good health, which is considerably below ratings obtained in of preventive exercises for back pain has not shown to be effective
the general population. CONCLUSIONS: Disability pensioners with short term in workers who leave from low levels of FRI (little initial
back pain have considerably poorer physical functioning and self- pain). One doesn’t discard that in the long term and/or with workers
reported health compared to the general population. IMPLICATIONS: who present initially moderate-severe back pain, this programme
Improvement of physical functioning and health might be important in can be effective. KEYWORDS: Exercise,trial randomized, back pain.
future vocational rehabilitation programmes aiming to bring disability FUNDING ACKNOWLEDGEMENTS: Department of Physiotherapy.
pensioners with back pain to return to work. KEYWORDS: Disability University of Coruña. CONTACT: [email protected]
pensioners, physical functioning, physical performance, perceived ETHICS COMMITTEE: Ethic Comitte of Clinical Research of Galicia
health. FUNDING ACKNOWLEDGEMENTS: The authors thank The
Norwegian Foundation for Health and Rehabilitation for funding. Research Report Poster Display
CONTACT: grethe. [email protected]
ETHICS COMMITTEE: The study was approved by the Norwegian
Ethics Committee for Medical Research, Health Region west
AN EVALUATION OF THE ADAPTABILITY OF GAIT AMONG
COMMUNITY-DWELLING ELDERLY PEOPLE USING THE
STANDARDIZED WALKING OBSTACLE COURSE (SWOC)
26-05 Monday 4 June 14:00 Sakamoto Y, Ohashi Y; Ibaraki Prefectural University of Health
VCEC Exhibit Hall B & C Sciences, 4669-2 Ami Ami-machi, Inashiki-gun Ibaraki, 300-0394
Japan
PREVENTIVE INTERVENTION FOR THE BACK PAIN IN
HOSPITAL NURSERY SHIP WORKERS PURPOSE: The purpose of this study is to evaluate the adaptability
Rodriguez Romero B, Riveiro Temprano S, Saleta Canosa J, Patiño of gait in community-dwelling elderly people to different walking con-
Nuñez S, Raposo Vidal I, Fernandez cervantes R; University of ditions. RELEVANCE: The result of this study might support the po-
A Coruña tential capability of the SWOC as a clinical tool investigating gait and
balance problem in geriatric field. PARTICIPANTS: Forty elderly peo-
PURPOSE: Back pain is one of the most important complaints by ple (mean age 76.1 ±3.8), living in the community and 18 young peo-
pain. Among the nurses and auxiliary nurses evidences of a high ple (mean age 22.4 ±4.4) were participated in this study. Inclusion cri-
incidence of injuries and back pain exist. Since exercise is widely teria for participation were that participants must be able to rise from a
recommended in the treatment and prevention of the back pain, we chair and ambulate independently with or without an assistive device.
have designed and applied a protocol of active prevention based on Methods and procedures used in this study were approved by the
a programme of exercises for the nursery personnel of Complejo Ethics Committee at Ibaraki Prefectural University of Health Sciences.
Hospitalario Universitario Juan Canalejo (CHUJC). RELEVANCE: All the participants gave informed concent. METHODS: The SWOC,
The aim of this study was to diminish the incidence of back pain 12 m long and 0.92 m wide walkway with three directional changes
in the nursery personnel of the CHUJC, and to improve its functional and obstacles, was fabricated based on the original article (Taylor and
capacity through the accomplishment of exercises before initiating Gunther, 1998). Each participant was asked to walk at normal speed
the working day. PARTICIPANTS: Nurses and auxiliary nurses of on SWOC with and without obstacles. Young participants were also
the CHUJC. METHODS: Prospective Randomized, double-blind, asked to walk on SWOC at their maximum speed. Elderly participants
controlled study. We studied 47 workers, which allows to detect an were also asked to walk 11 m straight walkway at their normal and
improvement in the functional capacity of at least 10 points in the maximum gait speeds. Ambulation time was measured using a digital
Functional Ranting Index(FRI), with a statistical power 93% for a stopwatch and recorded in seconds. ANALYSIS: Correlation analysis
bilateral interpretation. At the beginning of the study the functional was used to examine the relationship between ambulation times on
capacity and intensity of the back pain by means of the FRI were the straight walkway and on SWOC. To examine the adaptability of
evaluated by 2 physiotherapists. A group of workers was taught a gait to the obstacles, the two-way repeated ANOVA was used for
protocol of heating, stretching and strengthening exercises during ambulation times on SWOC with and without obstacles. RESULTS:
8 sessions of one hour each one. From then this group did the There was no significant correlation between the variation of gait
exercises daily during 15 minutes before beginning each working day. speed on straight walkway and the ambulation time on SWOC in
The other group didn’t receive any intervention. A later evaluation of two conditions. While the existence of obstacles did not show any
the FRI, to both groups, was made 6 months after. ANALYSIS: The significant effect on normal ambulation times on SWOC in young
quantitative variables are expressed as the average and ED (standar people, the elderly people took longer to walk on the SWOC with ob-
deviation). The qualitative variables are expressed in absolute values stacles than walk on the SWOC without obstacles. CONCLUSIONS:
and percentage. For the comparison of averages we made a t-test or This study showed the placement of obstacles affected ambulation
time only in elderly people. Interestingly, elderly people who showed Research Report Poster Display
faster gait speed on straight walking were not necessarily walked 27-17 Monday 4 June 14:00
faster on SWOC, indicating that SWOC evaluation with and without VCEC Exhibit Hall B & C
obstacles may provide us with information of gait not captured by an EFFECTS OF PERCEPTUAL LEARNING EXERCISES OF FOOT
evaluation on straight walkway. The further study about the interaction SOLE ON STANDING POSTURE BALANCE IN ELDERLY
between the nature of obstacles and directional changes of walkway Morioka S1 , Kataoka Y2 , Matsuo A1 , Odagiri M1 , Hiyamizu M1 ;
is planed. IMPLICATIONS: Gait problems in elderly people are 1 Department of Physical Therapy, Kio University, Nara, Japan;
complex and require evaluations from multi angles. The evaluation 2 Department of Rehabilitation, Atago Hospital, Kochi, Japan
using SWOC may provide us with a view of underlying mechanisms
of the problems. KEYWORDS: Obstacle course, elderly people, gait. PURPOSE: The role of somatosensation from human foot sole on
FUNDING ACKNOWLEDGEMENTS: This study has been supported postural sway has been discussed in many studies. Of particular
by a Grant-In-Aid for Scientific Research by the Ministry of Education, interest is the degree to which alteration in inputs from cutaneous,
Culture, Sports, Science and Technology (MEXT) of Japan, grant No. pressure and proprioceptive sensation alters postural sway. The
17700451. CONTACT: [email protected] current study investigated the influence of perceptual learning
ETHICS COMMITTEE: Ibaraki Prefectural University of Health exercise for hardness discrimination of sponge rubber by the soles on
Sciences Ethics Committee postural sway in elderly. RELEVANCE: To investigate the relevance of
perceptual learning exercise effectively improves outcome measures
of standing posture balance in elderly. PARTICIPANTS: Fourteen
Research Report Poster Display healthy men aged 61-71 participated in this study. Informed consent
27-13 Monday 4 June 14:00 was obtained from all participants prior to participation in the
VCEC Exhibit Hall B & C study. They were divided into two groups of 7 each at random:
perceptual learning exercise group and a control group. METHODS:
T’AI CHI VERSUS STRENGTH TRAINING: WHICH IS THE BEST For hardness discrimination, sponge rubbers 5, 10, and 15 mm thick
INTERVENTION TO PROMOTE DECREASED FALL RISK IN THE were combined to change the thickness of rubber to 5, 10, 15, 20,
ELDERLY? and 25 mm. After blocking the visual sense using an eye mask.
McKenna M1,2 , Lewis R1,2 , Lineberry B1,2 , Lyons A1,2 , Hardness discrimination task was performed by a pair of participants.
Thornbury R1,2 ; 1 Elmhurst House of Friendship, Wheeling, WV, The partner provided sponge rubber with 5 kinds of hardness, and
USA; 2 Montani Towers, Wheeling, WV, USA the trainee guessed their hardness in standing. Knowledge of results
was given immediately after the trainee gave answers. After 30 sec of
PURPOSE: This study was to compare the outcomes of two interven- resting, 10 times of task were given according to the random table.
tions to determine their efficacy in decreasing the risk of falls in the During this time of task, knowledge of results was not given. The
elderly. RELEVANCE: Falls in the elderly population are a relatively number of erroneous answers in these 10 trials was used as the
common occurrence. Interventions to reduce the likelihood of these results of learning. A total of 10 times of hardness discrimination
are a benefit to those people who are individuals at risk and to those task were given in 2 weeks. The center of pressure measured using a
who care for and support this sector of the population. The two inter- stabilometer (Zebris Co. Ltd., PDM system) was used as the indicator
ventions chosen for this study, T’ai Chi or strength training, can be in- for postural sway. Postural sway was measured for 30 seconds with
corporated into any physical therapy setting or offered at an appropri- eyes open and closed before and after hardness discrimination task.
ate community facility. PARTICIPANTS: 30 independent community- Also the limit of stability in the forward direction by the Functional
dwelling people over the age of 65 volunteered to participate in one Reach Test (FRT) was examined. ANALYSIS: Statistical analysis
or other of the stated interventions. These volunteers live in two was performed for length, area of ellipse and FRT value. The mean
of the retirement facilities in this local area and were allocated an number of incorrect answers of each of the 10 trials in the hardness
intervention program based on their residential location. METHODS: discrimination task performed for 10 days was analyzed by one-
The study was approved by the University’s IRB and each participant way ANOVA with repeated measures. Student’s t-tests were used
signed an informed consent. Pre and post testing was conducted at for differences in the selected parameters before and after hardness
each end of the study period. The tests included the Berg Balance discrimination task. All statistical tests were completed at the 0.05
Scale, Timed up and Go, ABC scale, and lower extremity strength alpha levels. RESULTS: The dispersion of erroneous answers in
using a hand held dynamometer. The interventions were conducted hardness discrimination task decreased as the frequency of trials
in a class format at each site for one hour once a week for a period of increased (p < 0.01), and improved learning ability was indicated.
ten weeks. Every participant was also encouraged to practice the in- Postural sway after task showed a significant decrease compared
tervention at least once during the week between classes. The Tai Chi to sway before task in the exercise group (p < 0.05). And FRT
group was taught the beginning moves of the 24-posture Short Form value after task showed a significant increase compared to value
and the strength group performed an exercise regime which focused before task in the exercise group (p < 0.05). However, there was
mostly on the large muscles of the lower extremity. ANALYSIS: One no change on postural sway in the control group. CONCLUSIONS:
within subjects factor ANOVA, one between subjects factor ANOVA, These data indicate that the ability of the elderly participants to
and a covariate analysis, p-value set at <0.05 were used in this regulate their standing posture improved with improvement of the
study. RESULTS: Both interventions yielded significant improvement perceptive ability of the soles. IMPLICATIONS: It is suggested that
in balance, balance confidence, and strength in both of the study the hardness discrimination task by the foot sole is effective as
groups as evidenced by the results of the tests listed above. No a simple balance exercise as a clinical approach. KEYWORDS:
significance was found in functional mobility. CONCLUSIONS: The elderly, perceptual learning exercise, standing posture balance.
results of the study showed that either T’ai Chi or LE strength training FUNDING ACKNOWLEDGEMENTS: This work was supported by
can improve strength and balance and may decrease the risk of falls the Meiji Yasuda Life Foundation of Health and Welfare. CONTACT:
in the elderly. IMPLICATIONS: Both T’ai Chi and strength training [email protected]
exercise programs or classes can be implemented in many areas, ETHICS COMMITTEE: This presentation obtained the approval of
possibly through senior citizen centers. These can offer the benefits the ethical committee on Kio university.
of a low cost or no cost strength, balance, and coordination program
to the elderly population that is at risk for falls, as well as providing
social interaction. KEYWORDS: balance, falls, elderly. FUNDING
ACKNOWLEDGEMENTS: No funding was received for this study.
ETHICS COMMITTEE: IRB of Wheeling Jesuit University
TRUNK POSITION SENSE IS ASSOCIATED WITH FALLS AND WALKING VARIABLES DIFFERENTIATING FALLERS FROM
BALANCE CONFIDENCE IN COMMUNITY-DWELLING OLDER NON-FALLERS
ADULTS Newstead A1 , Walden J2 , Gitter A2 ; 1 University of Texas
Goldberg A, Schepens S, Wallace M; Mobility Research Laboratory, Health Science Center at San Antonio; 2 Audie Murphy Veterans
Department of Health Care Sciences, Wayne State University, Administration Hospital Gait Laboratory
Detroit, Michigan, USA
PURPOSE: The purpose of this study was to determine the
PURPOSE: The purpose of this study is to determine if there is an qualitative and temporal-spatial quantitative differences between two
association between trunk flexion position sense, falls, and balance groups of older adults, fallers (F) and non-fallers (NF), during
confidence in community-dwelling older adults. RELEVANCE: Valid over-ground walking compared with a task of obstacle clearance.
screening tests are needed for clinicians to predict those at risk for RELEVANCE: Falls among adults represent a serious problem with
a fall. Controlling the flexing trunk is important in avoiding a fall loss of quality of life and high expenses. Falls frequently occur
after losses of balance. Trunk position sense tests, assessed as during negotiation of obstacles in the home or community. A need
trunk repositioning errors (TREs), incorporate control of the flexing exists for early identification of walking variables that differentiate
trunk. Studies have shown TREs to correlate with commonly-used people at risk for falls can help rehabilitation professionals perform
clinical balance measures. The relationship between TREs, falls, interventions that may delay falls and loss of functional mobility.
and balance confidence has not been investigated. Establishing PARTICIPANTS: Forty-eight community dwelling older adults (F=18;
this relationship may facilitate inclusion of TREs in falls screening NF=30) participated. The mean age of the participants was 78.1±7.2
batteries in geriatric physical therapy clinical practice, and lead years (F) and 75.8±5.1 years (NF). METHODS: A repeated
to more comprehensive assessments of older adults’ risk for measures design was used to examine the effects of differing
falls. PARTICIPANTS: Twenty community-dwelling older adults (16 walking capacity during one visit for four conditions: 1) baseline
females) with a mean age of 73.5 years (range 61-82 years) were walking; 2) slow walking; 3) fast walking; 4) 5 cm obstacle clearance.
recruited from urban community senior centers and health fairs. ANALYSIS: Qualitative and quantitative analyses of temporal-spatial
Nine participants (45%) reported falling at least once in the 12 walking measures were analyzed in SPSS version 13 using a Chi-
months prior to testing. METHODS: Participants completed a medical Square analysis (qualitative) an independent t-test (quantitative) with
history, including a report of the number of falls in the previous 12 a Bonferroni adjustment (p < 0.008). RESULTS: Qualitatively, the
months and the Activities-specific Balance Confidence (ABC) Scale. fallers increased knee flexion during both over ground walking and
Trunk positioning capabilities were assessed with an inclinometer at obstacle clearance (Chi Square = 8.10; p < 0.004) and consistently
the level of the T4 spinous process. Participants flexed the trunk took several small steps immediately prior to the obstacle clearance
to an angle of 30º (position 1). After returning to upright, they (Chi Square = 9.30; p < 0.002). During a self-selected walk, the fallers
attempted to reproduce the previously attained angle (position 2). displayed a slowed, but non significant over-ground walking velocity
Difference in degrees between positions 1 and 2 was defined as compared with the non-fallers (F=0.9±0.2 m/s; NF=1.2±0.2 m/s;
TREs. Five trials were conducted. The most and least accurate were p = 0.018; ES=0.24). Shortened stride length (p < 0.001; ES=0.09)
discarded, with the mean of the remaining 3 scores representing a and reduced single and double support (p < 0.001; ES=0.78-0.81)
participant’s TREs. ANALYSIS: Differences between fallers and non- were significantly different between groups during the self-selected
fallers in number of falls, balance confidence scale, and TREs were walk. During the slow walk, stride length (p = 0.008), single support
calculated with independent samples t-tests. Correlations between (p = 0.001) and second double support (p < 0.001) were significant
TREs, number of falls, and balance confidence were calculated using between groups, however velocity was not (p = 0.121). No statistically
Pearson’s correlation coefficient (r). Sensitivity and specificity values significant differences existed during the fast walk (F=1.2 m/s ±0.2;
were calculated to determine the utility of TREs as a test for predicting NF=1.5 m/s ±0.3m/s; p = 0.03). During the obstacle clearance, the
fall status. Significance was set at p < 0.05. RESULTS: There was fallers walked significantly more slowly than the non-fallers (0.7±0.2
a significant difference in TREs in fallers (5.48º) versus non-fallers m/s F; 1.0±0.2 m/s NF; p < 0.001; ES=0.23), along with a shortened
(2.47º) (p < 0.05). There was a positive correlation between TREs stride (p < 0.001; ES=0.22). Compared with self-selected walking,
and number of falls (Pearson’s r=.62; p < 0.05), and a negative non-fallers adjusted their stride during obstacle clearance (p < 0.005)
correlation between TREs and balance confidence (Pearson’s r= - whereas fallers did not. CONCLUSIONS: There are significant
.51; p < 0.05). Using a cut-off score of 3º for a positive TRE test, differences in qualitative walking characteristics and quantitative
TREs exhibit excellent sensitivity (89%) and specificity (91%) in temporal-spatial variables between fallers and non-fallers during over-
predicting falls status. CONCLUSIONS: These data suggest that ground walking at various velocities and during obstacle clearance
impairments in trunk position sense are associated with increased that differentiates fallers from non-fallers. IMPLICATIONS: Clinicians
numbers of falls and lower balance confidence in older adults. are thus encouraged to assess walking at various speeds and under
TREs may be sensitive and specific indicators of risk for falls. differing task conditions during baseline examination to determine
Future studies should prospectively investigate the role of TREs the individual’s ability to perform walking tasks when challenged.
as a predictor of falls. IMPLICATIONS: Physical therapy clinicians KEYWORDS: Walking, fallers, non-fallers, obstacle, stride, velocity,
should consider adding trunk positioning sense tests to their battery double support, single support. FUNDING ACKNOWLEDGEMENTS:
of falls risk measures in older adults. KEYWORDS: Trunk position This research was funded by the Texas Physical Therapy Education
sense, falls, balance. FUNDING ACKNOWLEDGEMENTS: Funded and Research Foundation. CONTACT: [email protected]
by a Del Harder award from the Rehabilitation Institute of Michigan. ETHICS COMMITTEE: University of Texas Health Science Center at
CONTACT: [email protected] San Antonio, Audie Murphy Veterans Administration Hospital and the
ETHICS COMMITTEE: Human Investigation Committee of Wayne General Clinical Research Center
State University.
EARLY DIAGNOSIS AND TREATMENT INTERVENTION FOR RELATIONSHIPS AMONG GROSS MOTOR FUNCTIONS AND
LYMPHEDEMA: A CASE CONTROL SERIES HEALTH-RELATED QUALITY OF LIFE IN CHILDREN WITH
CEREBRAL PALSY
Gergich N1 , Washington F2 , Pfalzer L3 , McGarvey C4 ; 1 National
Naval Medical Center, Bethesda, Maryland, USA; 2 University Hou Y1,2 , Liu W1,3 , Wong A1,3 , Chen C1,4 , Lin P1 , Hong J5 ;
1 Graduate Institute of Rehabilitation Science, Chang Gung
of Maryland School of Medicine College Park, Maryland, USA;
3 University of Michigan – Flint, Flint, Michigan USA; 4 National University, Kweishan, Taoyuan, Taiwan, R.O.C.; 2 Department
Institutes of Health, Bethesda, Maryland, USA of Physical Medicine and Rehabilitation, Chang Gung Memorial
Hospital – Chiayi Branch, Chiayi Hsien, Taiwan, R.O.C.;
3 Department of Physical Medicine and Rehabilitation, Chang Gung
PURPOSE: To investigate the efficacy of a prospective screening
method to diagnose early stage lymphedema and an early interven- Memorial Hospital – Taoyuan Branch, Kweishan, Taoyuan Hsien,
tion for lymphedema management in patients recently diagnosed and Taiwan, R.O.C.; 4 Department of Pediatric Physical Medicine and
treated for breast cancer. RELEVANCE: The current incidence of Rehabilitation, Chang Gung Memorial Hospital – Lin-Kao Children’s
breast cancer related lymphedema is approximately 15% of all breast Hospital, Kweishan, Taoyuan Hsien, Taiwan, R.O.C.; 5 Department
cancer patients following axillary lymph node dissection (AXLND) of Physical Medicine and Rehabilitation, Kaohsiung Children’s
and 33% of patients treated with AXLND and radiation therapy (RT) Hospital, Niausung Shiang, Kaohsiung, Taiwan, R.O.C.
(Petrek 2000). Lymphedema impacts quality of life; range of motion PURPOSE: Gross motor (GM) functions and health-related quality
(ROM), pain, and strength (Armer 2003, Box 2002). Methods used of life (HRQL) are both considered important outcome indicators in
to measure LE have included circumferential limb girth using a tape health care for children with cerebral palsy (CP). The purpose of
measure (anthropometric), water displacement (volumetric), infrared this study was to examine the relationships among GM functions
optoelectronic, and most recently, bioimpedence. Traditionally these and physical component, as well as psychosocial component, of
methods are employed after the condition becomes clinical apparent HRQL in children with CP. RELEVANCE: This study identified the
(visually detected), resulting in delayed diagnosis and treatment of lack of correlation between the GM functions and the psychosocial
an irreversible stage of LE which will require ongoing therapeutic component of HRQL in children with CP. This finding provides an
management. Complete Decongestive Therapy is the current evidence to support the importance of addressing psychosocial
standard of care for lymphedema in advanced stages (ISL 2001). aspects of children with CP in the physical therapy management.
There is currently no evidence-based standard treatment outlined PARTICIPANTS: Using a cross-sectional design, a purposive sample
in the literature for early stages of lymphedema. PARTICIPANTS: of convenience included 90 children with CP aged 5 to 14 years
A subset of eleven women with lymphedema, ages ranged from of age. METHODS: Gross Motor Function Measure (GMFM) was
used to quantify their GM functions. Their HRQL was determined
51 to 73 with a mean of 60 years, identified from those enrolled
by the Child Health Questionnaire-Parent Form 50 (CHQ- PF50),
in a prospective IRB approved study. METHODS: This was a case
completed by their caregivers. ANALYSIS: Descriptive statistics was
control study with the subjects unaffected arm designated as the
used to describe their gross motor functions and HRQL. Pearson
control. Lymphedema was defined as a>3% limb volume change
product-moment coefficient of correlation calculations were used
in their affected limb as compared to their pre-operative volume as to examine the relationships among gross motor functions and
measured by the optoelectronic volumeter (Perometer® )at 1, 3, 6, HRQL. RESULTS: There were different correlations among GM
9, 12 month follow-up. Diagnosis of lymphedema was made by the functions and components of HRQL for children with CP. A significant
PT at their regular follow up visit or when the patient presented with moderate positive correlation (r = 0.73, p < 0.01) existed for physical
signs of lymphedema. Upon diagnosis of early stage lymphedema summary scores of CHQ-PF50 and GMFM-66 scores. Psychosocial
an intervention was instituted using a ready-made compression summary scores of CHQ-PF50 were weakly related to GMFM-66
garment of 20 to 30mmHg, worn daily for 2 weeks. ANALYSIS: scores in CP (r = −0.13, p = 0.23). CONCLUSIONS: GM functions
The data were analyzed using a 2-way Repeated ANOVA of limb may be good at predicting the physical component of HRQL, but
volume with Arm and Time as repeated factors and mean values. appears to be weak at predicting the psychosocial component of
RESULTS: At baseline no statistically significant difference was HRQL in children with CP. IMPLICATIONS: In order to promote
identified in limb volume within the group between the Unaffected the optimal outcomes of children with CP, professionals should
arm (UA) and Affected arm (AA) (p = 0.349). Upon diagnosis of facilitate not only their GM functions, but also need to address the
lymphedema a statistically significant difference in limb volume was psychosocial aspects of their HRQL. KEYWORDS: health-related
identified between the subjects UA and AA (p = 0.001). From baseline quality of life (HRQL); gross motor (GM); cerebral palsy (CP).
to intervention the average duration was 8.2 months which was FUNDING ACKNOWLEDGEMENTS: The authors would like to thank
significant (p = 0.07). From diagnosis to Post-intervention a significant the National Science Council of the Republic of China, Taiwan, for
decrease in AA volume (p = 0.010) was noted. Post-intervention there financially supporting this research under Contract No. NSC95-2614-
was no statistically significant difference in limb volume between H-182–002. CONTACT: [email protected]
the UA and AA (p = 0.701) within the group. CONCLUSIONS: The ETHICS COMMITTEE: Institutional Review Board Chang Gung
compression garment provided a successful intervention for early Memorial Hospital, Taiwan
stage lymphedema and, with future investigation, may emerge as
a cost-effective standard of care. IMPLICATIONS: Pre-operative Research Report Poster Display
measurement and assessment of women diagnosed with breast 30-13 Monday 4 June 14:00
cancer is imperative for the early detection and management VCEC Exhibit Hall B & C
of impairments including lymphedema. Conservative treatment
INTENSIVE MOTOR TREATMENT OF CHILDREN WITH
interventions, such as ready-made garments, may be efficacious
CEREBRAL PALSY: A PARTICIPATORY APPROACH
in managing early stage lymphedema. KEYWORDS: Lymphedema,
case control, compression. FUNDING ACKNOWLEDGEMENTS: Benz R, Søiland W, Gundersen H, Iversen S, Larsen E; Stavanger
University Hospital, Norway
none. CONTACT: [email protected]
ETHICS COMMITTEE: National Institutes of Health IRB and National PURPOSE: In Norway parents of children with cerebral palsy (CP)
Naval Medical Center IRB. Protocol # B01-52 have increasingly asked for intensive motor treatment approaches.
In 2004 Stavanger University Hospital initiated a 2-year project undesirable spontaneous movements. RELEVANCE: Early detection
in order to develop an approach, which actively included parents of CP is critical to the success of federally-mandated early-start
and local municipal professionals. By focusing on parental and programs. However, many children are not diagnosed until noticeable
local inclusion, we aimed at developing a treatment approach delays in milestones and impairment of mobility occur. This novel
which led to functional improvement for the children involved, but approach to the assessment of the infant born preterm may allow
also increased practical knowledge concerning motor treatment for earlier identification. PARTICIPANTS: Eighty infants born at
for important persons in the children’s lives. RELEVANCE: While <30 weeks gestational age. METHODS: Archived video recordings
intensive motor treatment approaches for children with CP lately have (recorded in the infant’s home) of spontaneously moving supine
been recommended based on research findings, evidence is scarce infants at 12 weeks corrected-age (CA) were retrospectively analyzed
with regard to long-term effects as well as comparison between quantitatively. Using a pediatric motion analysis tool designed for
specific types of programs. Health policy and organization differ the study, 5-minute digitized video clips were observed. Frequency
between countries, and choice of approaches should be matched and duration were recorded for two undesirable motor behaviors-
to local structures in order to optimize effects. DESCRIPTION: obligatory asymmetric tonic neck reflex and “surrender” position of
Principles from participatory action research were applied as the arms and two desirable motor behaviors- midline head and hand
framework. A project-team consisting of 4 physiotherapists were positioning. The primary investigator and second evaluator were both
responsible for developing and implementing the approach, which masked to infant outcome and inter-rater reliability agreement was
consisted of the following main elements: 1)Visiting the child, family 89%. Bayley II and neurologic examinations were made at 18 and
and local professionals in their daily environment – registration of the 30 months. ANALYSIS: The above four spontaneous movement
child’s interests and activity-profile. This information was used during variables, considered to discriminate between normal and abnormal
treatment to optimize motivation. 2) Open discussions with parents early motor patterns, were quantified. A ratio score of total unde-
regarding choice of treatment goals. Over 90% of the registered sirable/desirable spontaneous movements was calculated for each
goals were on the functional level of activity. 3)Intensive group- infant, and a score of >1.0 was considered abnormal. This ratio score
sessions for either 6 weeks(3x150 minutes pr week) or daily 3 was then assessed for sensitivity, specificity, accuracy, and ability to
hour sessions for 3 weeks at the hospital. During sessions parents positively and negatively predict (PPV and NPV) Bayley II scores
and local professionals took part and actively assisted the child. at 18 months CA and a diagnosis of CP by 30 months. RESULTS:
4) Follow-up consultations based on individual and local needs. Eighty-four to 94% of infants with more desirable than undesirable
During the project three groups consisting of 5-6 children attended spontaneous movements early in life had age-appropriate behavior
one treatment period, while two groups received two treatment at 18 months CA. By diagnosis and testing, the following was found:
periods. A total of 30 children and 83 parents and local professional 1) CP at 30 months (n = 67) – sensitivity 67%, specificity 78%,
participated. EVALUATION: All children were assessed with the PPV 32%, NPV 94%, accuracy 76%. 2) Testing at 18 months CA (n
Gross Motor Function Measure (GMFM) and Goal Attainment Scaling = 59): MDI – sensitivity 50%, specificity 80%, PPV 44%, NPV 84%,
(GAS) before and after treatment. Depending on individual needs, accuracy 73%; PDI – sensitivity 67%, specificity 80%, PPV 38%,
additional standardized measures were applied. After each treatment NPV 93%, accuracy 78%. CONCLUSIONS: Findings suggest that
period parents and local professionals anonymously answered a this new method of quantifying specific early movement variables
questionnaire. An open participatory evaluation was also undertaken into a movement ratio at 12 weeks CA is a modest predictor of
locally for each child. The results from the questionnaires were in later developmental outcome. A study weakness is that sample sizes
accordance with the local participatory evaluations. Although a clear differed at the two testing times. Continued study of the predictive
majority of the children showed positive changes at the GMFM, only a power of movement variables appropriate at other developmental
minority of the findings were statistically significant. 81% of the GAS stages may be beneficial. IMPLICATIONS: This inexpensive, non-
registrations showed improvement regarding specific skills training. invasive method of early assessment of infants born preterm may
The participants responded positively towards the children’s enjoy- be performed by any trained professional in conjunction with other
ment during sessions, as well as intensity, pedagogically aspects and developmental testing, which may be particularly beneficial for
cross-over effects. All parents wanted their children to attend another infants in geographical areas without MRI access. KEYWORDS:
treatment-period. CONCLUSIONS: Participatory intensive motor CP, spontaneous movements. FUNDING ACKNOWLEDGEMENTS:
treatment for children with cerebral palsy was evaluated as valuable Innovations in Patient Care; Lucile Packard Children’s Hospital at
in order to obtain specific treatment goals chosen by parents. Stanford Medical Center. CONTACT: [email protected]
Active learning and participation by parents and professionals during ETHICS COMMITTEE: Human Subjects Review Board at Stanford
sessions seem to have a positive cross-over effect to the child’s daily Medical Center in Palo Alto, California.
environment. IMPLICATIONS: Physiotherapists should encourage
active parental participation during treatment and choice of treatment
goals for children with cerebral palsy. Cross-over effects of intensive Research Report Poster Display
motor group treatment are more likely to happen when local 31-21 Monday 4 June 14:00
professionals are in included as active participants. KEYWORDS: VCEC Exhibit Hall B & C
Intensive motor treatment, cerebral palsy, participatory approach. AN INVESTIGATION INTO THE FACTOR WHICH MOTIVATES
FUNDING ACKNOWLEDGEMENTS: The Norwegian Directorate of PATIENTS TO ATTEND FOR OUTPATIENT PHYSIOTHERAPY
Health and Social Affairs. CONTACT: [email protected] O’Sullivan E, Murtagh R, Cooney M; Trinity College Dublin, School
of Physiotherapy, Dublin, Ireland
Research Report Poster Display PURPOSE: The aim of this study was to establish the main
30-17 Monday 4 June 14:00 motivating factor that prompts patients to attend outpatient physio-
VCEC Exhibit Hall B & C therapy treatment. RELEVANCE: In Physiotherapy related literature
EARLY DETECTION OF CEREBRAL PALSY FROM ANALYSIS pain is reported as the symptom that motivates patients to seek
OF FOUR SPONTANEOUS MOVEMENTS treatment. This claim, while widely accepted does not appear to
be evidence based as there are no published articles available
Byrne E, Butler E, Constantinou J; Lucile Packard Children’s
to substantiate these beliefs. PARTICIPANTS: Patients attending
Hospital at Stanford Medical Center Palo Alto, CA USA
physiotherapy who were over 18 years, English-speaking and without
PURPOSE: The study purpose was to assess a novel method cognitive impairments were invited to participate. METHODS: A two-
of early detection of cerebral palsy (CP) that uses a pediatric part questionnaire was administered to all participants Information
observational motion analysis tool for quantification of desirable and regarding patient demographics, motivating factor, area of complaint,
duration of complaint and pain intensity(if present) was gathered. Research Report Poster Display
Subsequently the Short-Form-12 (a Quality of Life Questionnaire) 32-05 Monday 4 June 14:00
was completed by all participants. Data was gathered from both VCEC Exhibit Hall B & C
a public and private department ANALYSIS: Descriptive statistics DETERMINANTS OF PHYSICAL ACTIVITY IN COMMUNITY-
generated with Microsoft Excel (2003). Short-Form-12 results were DWELLING AMBULATORY INDIVIDUALS WITH CHRONIC
inputted into Quality Metric SF-12 Scoring Software. RESULTS: DISEASE
A total of 195 patients participated, 60% of whom presented to
Ashe M1,2,4 , Eng J1,2,4 , Miller W1,2,4 , Soon J3,4 ; 1 Rehab Research
physiotherapy with a primary complaint of pain. The majority of
Lab., GF Strong Rehab Centre, Vancouver BC; 2 Rehab Sciences,
patients were female in both the public and the private setting.
University of British Columbia; 3 Faculty of Pharmaceutical Sciences,
Almost three quarters of all complaints were of chronic duration
University of British Columbia; 4 Physical Activity and Chronic
(>3 months). CONCLUSIONS: This is the first study to confirm
Conditions Research Group, UBC
that pain motivates a majority of Outpatient Physiotherapy patients
to seek treatment, with three out of every five patients attending PURPOSE: The primary objective of this cross-sectional study
because of pain. IMPLICATIONS: This study has confirmed the need was to determine the predictors of physical capacity and physical
to assess and measure pain in the Outpatient Physiotherapy setting. activity participation in older community-dwelling individuals living
KEYWORDS: Pain, Outpatient Physiotherapy, Motivating Factor. with different chronic diseases. The secondary objective was to
FUNDING ACKNOWLEDGEMENTS: This work was unfunded. evaluate the risk of inactivity associated with chronic disease and
ETHICS COMMITTEE: Ethical approval was awarded by the Ethics impairments. RELEVANCE: Consistently low rates of physical activity
Committee of Trinity College Dublin, Dublin, Ireland. are reported for older adults and there is even lower participation
if a chronic disease is present. Assessing common impairments
across different chronic diseases can assist in understanding the
Research Report Poster Display contribution to participation in physical activity and in the development
32-01 Monday 4 June 14:00 of function-based interventions. PARTICIPANTS: 200 community
VCEC Exhibit Hall B & C dwelling ambulatory participants living with 2 or more chronic
SELF EFFICACY, DISABILITY AND PHYSICAL OUTCOMES OF disease were assessed. METHODS: It was a descriptive cross-
PATIENTS WITH CHRONIC PAIN FOLLOWING A PROGRAM OF sectional investigation of physical capacity (physiological potential)
GRADED PHYSICAL EXERCISES AND CBT and physical activity participation (recorded engagement in physical
activity). This study was approved by the local hospital and university
Abd Aziz K1 , Mohd Hashim A; 1 Physiotherapy Department, Kuala
ethical review boards. ANALYSIS: Multiple regression and odds
Lumpur Hospital, Kuala Lumpur, Malaysia
ratios were used to investigate determinants of capacity (6 Minute
PURPOSE: The study is to define the characteristics of chronic pain Walk Test) and participation (Physical Activity Scale for Individuals
patients attending a chronic pain clinic and to investigate whether with Physical Disabilities Questionnaire; 3 day pedometer record).
a program of graded physical exercise and CBT have effect on self RESULTS: Sixty-five percent (65%) were women and the mean age
efficacy, functional disabilities and physical outcome. RELEVANCE: was 74±6 years (range 65-90 years). Mobility (Timed Up and Go)
Chronic pain is a complex in nature and results from many factors was a consistent determinant across all 3 primary outcomes. For
not solely a function of pain or pathology.A physiotherapist must take the Six Minute Walk Test, determinants included mobility, BMI, grip
into account the psychological variables such as self-efficacy when strength, number of medications, leg strength, balance and Chronic
treating patients with chronic persistance pain. PARTICIPANTS: 77 Disease Management Self Efficacy Scale (r2=0.58; P = 0.000). The
patients with persisting pain more than 6 months. METHODS: A determinants for the self-reported participation measure (Physical
prospective study. Data were collected from 77 patients attending Activity Scale for Individuals with Physical Disabilities Questionnaire)
pain management programs from 2002-2006. The management was mobility (r2=0.04; P = 0.007). For the mean daily pedometer
program consists of cognitive behavioral therapy, relaxation and steps, the determinants included mobility, body mass index (BMI),
physiotherapy in the form of program of exercise to improve flexibility, age and Chronic Disease Management Self-Efficacy Scale (r2=0.27;
strength and endurance. Self efficacy was measured using Pain Self P = 0.000). There were higher risks for inactivity associated with
Efficacy Questionnaires (PSEQ), functional disability was measured impairments compared with the presence of a chronic disease.
using Roland Morris disability questionnaires. DASS questionnaires In addition, over one-third of participants had sufficient physical
was used to measure the level of anxiety, stress and depression. capacity, but did not meet minimal recommendations of physical
Physical function measurement was 20 m timed walk and numbers activity. CONCLUSIONS: This study suggests that it is easier to
of stairs climbed in 2 minutes. Data were collected at the beginning, predict an individual’s physical capacity more than their actual
and the end of program and at one month after the program. physical participation. IMPLICATIONS: Physiotherapists are key
ANALYSIS: SPSS version 11.0 RESULTS: Data obtained from 32 providers who can assess individuals and develop programs for those
males (41.6%) and 45 females (58.4%) were analysed. Pain self seniors at risk of inactivity. KEYWORDS: physical activity, capacity,
efficacy were significantly but negatively correlated with functional participation, chronic disease. FUNDING ACKNOWLEDGEMENTS:
disability (r = 0.27, p < 0.05), stress (r = 0.31, p < 0.05), depression We gratefully acknowledge the support of the Canadian Institutes
(r = 0.24, p < 0.05) and showed positive correlation with active coping for Health Research (CIHR) Team Development Grant. We also
(r= 0.55, p < 0.05). Pain self efficacy measurement improved from thank CIHR (JJE) and Michael Smith Foundation for Health Research
26% to 67.5% (PSEQ score>40) one month after the program. There (MCA, JJE, WCM) for Investigator support.
were also significant changes in physical function in the form of 20 ETHICS COMMITTEE: University of British Columbia Clinical Ethics
m timed walked and numbers of stairs climbed CONCLUSIONS: Review Board
Self efficacy improved after a graded exercise program and CBT.
Improvement of self efficacy was also associated with improvement
of in functional disability measurement and physical outcomes.
IMPLICATIONS: Self efficacy can be driven by the reinforcement that
comes from engaging successfully in a given task. Graded exposure
to physical exercise can be a positive reinforcement on self-efficacy.
This was shown by the changes in self-efficacy measurement
after the program. KEYWORDS: chronic pain, self efficacy, pain
management program. FUNDING ACKNOWLEDGEMENTS: the
work is unfunded. CONTACT: [email protected]
Research Report Poster Display Columbia, and Teaching grant for Strategic Objective 1.1, The Hong
33-09 Monday 4 June 14:00 Kong Polytechnic University. CONTACT: [email protected]
VCEC Exhibit Hall B & C ETHICS COMMITTEE: Ethics committee in both University of British
COMPARISON OF TEACHING AND LEARNING OUTCOMES Columbia and The Hong Kong Polytechnic University
BETWEEN VIDEO-LINKED, WEB-BASED, AND CLASSROOM
TUTORIALS
Jones A1 , Dean E2 , Hui-Chan C1 ; 1 Department of Rehabilitation 33-13 Monday 4 June 14:00
Sciences, The Hong Kong Polytechnic University, Hong Kong; VCEC Exhibit Hall B & C
2 School of Rehabilitation Sciences, University of British Columbia
PATIENT-SATISFACTION WITH PHYSIOTHERAPY
PURPOSE: Interactive videoconferencing (IVC) has been reported to Eriksdotter A1 , Graver V2 , Andreassen G2 ; 1 Department of Physical
be a powerful tool that has facilitated sharing specialized expertise Medicine and Rehabilitation and Department of Physiotherapy,
across geographic regions within a country and across countries. Ullevaal University Hospital, Oslo, Norway; 2 Department of
We examined the effect of IVC on teaching and learning outcomes Physiotherapy, Ullevaal University Hospital, Oslo, Norway
in physical therapy professional education cross culturally, i.e.,
between Canada and Hong Kong (HK). The primary purpose of PURPOSE: The purpose of this study, carried out in an outpatient
this study was to compare across an eastern and a western physiotherapy clinic at Ullevaal University Hospital, Norway, was to
culture, teaching and learning outcomes of three formats of assess patients’satisfaction, predictors of satisfaction and to see if
professional education, including video-linked tutorials in combination proffesionals in the department were able to predict areas referred
with web-based tutorials (VL+WB), web-based tutorials only (WB), to as problematic by the patients. RELEVANCE: Patient satisfaction
and conventional classroom tutorials (CC). Secondarily, we were is increasingly applied to monitor patient perception concerning
interested in identifying challenges of VL teaching cross culturally quality of health care services. Patient satisfaction can be one
to share experiences with others. RELEVANCE: Although IVC indicator of the quality of care. PARTICIPANTS: One hundred sixty
may be a powerful adjunct to physical therapy education between six patients with muscular skeletal disorders who had completed
universities within and between countries, the related literature is outpatient physiotherapy treatment (mean age 46.6 (SD13.2), 97
scant. Further, computer-based teaching and learning strategies women, 66 men and three patients with unknown gender) were
in universities have been largely in the domain of high-income included. Twenty two per cent of the patients did not have the
countries. If we could further elucidate its potential role, IVC Scandinavian languages as their mother tongue. In addition, 20
could benefit physical therapy education in middle- and low-income proffesionals in the department (doctors and physiotherapists) were
countries as well. As the demand for physical therapists increases included in the survey. METHODS: A questionnaire developed
globally, IVC as a strategy in physical therapy education may help by the authors was sent to 277 patients and 30 proffesionals.
address the shortage of qualified instructors worldwide. Increasing All participants answered anonymously. The proffesionals were
clinical competence and standards of practice globally may be asked to answer in accordance with what they thought patients
long-term secondary benefits of IVC in entry-level physical therapy would answer. The questionnaire consisted of three global effect
programs. PARTICIPANTS: Physical therapy student volunteers in variables and twenty one questions measuring various aspects of
Canada and HK who were studying critical care, were assigned satisfaction with physiotherapy. Age, gender and language were
to one of three groups at each site (sample size range 9- registered. ANALYSIS: The significance of associations between
17). METHODS: We compared three instructional formats, i.e., the global questions and the different other items were investigated
international VL tutorials in combination with WB tutorials (VL+WB), by means of univarieted and multivariated regression analyses,
WB tutorials only (WB), and conventional classroom tutorials Chi-square test and Kruskall-Wallis test. Kruskall-Wallis and Chi-
(CC).Two critical care topics were selected for this circumscribed square tests were performed to determine the differences between
application, and an instructor from each of Canada and HK the answers of the patients and the proffesionals. RESULTS: A
contributed equally to the VL sessions. Instruction time was balanced total of 166 (60.4%) questionnaries were returned from the 277
for the VL+WB groups and CC groups; four hours. There was patients and 20 (66.7%) from the 30 professionals. The majority
no restriction on time on the web for students whose groups of the patients where satisfied with the treatment and services
had a WB component. The learning outcomes included grades and wanted to recommend the physiotherapy outpatient clinic
and feedback from the students about their learning experience. (p < 0.0001), although a large number of patients reported that
In addition, the instructors provided written feedback on their their condition had not improved (p < 0.0001). Environmental factors
experience with the instructional formats. ANALYSIS: Descriptive (premises, accessibility and cleaning) were identified as areas with
statistics were used to summarize and tabulate the objective great potential for improvement but they were not strongly correlated
data. A three-way ANOVA [between-group (2 sites x 3 groups) to overall satisfaction. Age and gender had little influence on the
and within-subject (2 quiz questions] was used to analyze the results. Patients not having a Scandinavian language as their mother
results, and pair-wise comparisons with Bonferroni adjustment tongue were less satisfied with the treatment on an overall basis
were used for the post hoc tests. The learning experience was (p = 0.01). There were significant diffrences between the anserwers
evaluated in writing by the students, and interviews with the of the proffesionals and the patients in two-third of the questions.
groups by independent education consultants. These comments CONCLUSIONS: Patient satisfaction was highly associeted with
were compiled systematically. RESULTS: Overall, the students’ proffesional skills, information and communication. Environmental
grades were superior for the VL+WB groups compared with the factors had less impact on the results. The proffesionals had
other two groups (p > 0.05). No difference was observed between great difficulty predicting the patients opinions. Non-Scandinavian
the WB and the CC groups. The VL+WB groups valued learning language was a strong predictor of dissatisfaction. In order to
about cultural differences in physical therapy education. Also, the give minority groups of patients’relevant treatment and service,
instructors acknowledged that preparation for VL tutorials was we are doing another follow up study. IMPLICATIONS: Earlier
unique and challenging. CONCLUSIONS: IVC may enhance the studies have shown that qualitative studies are needed to study
professional education of undergraduate physical therapy students patients’ perspective. Patient’s perspective and expectaions are
cross culturally. IMPLICATIONS: Cross cultural interaction may of importance for how they perceive satisfaction. In our survey
further enhance student learning. KEYWORDS: interactive video we have shown that to know what is of importance to the
conferencing, learning, physical therapy education, teaching, web- patients you have to ask them. It is also important to focus on
based instruction. FUNDING ACKNOWLEDGEMENTS: Teaching measurements of dissatisfaction, this can be a step forward in
and Learning Enhancement Fund Award of the University of British improving patient satisfaction and thereby the quality of treatment
and services. KEYWORDS: physiotherapy, patient-satisfaction and Research Report Poster Display
questionnarie. FUNDING ACKNOWLEDGEMENTS: No external 35-01 Monday 4 June 14:00
founding. CONTACT: [email protected] VCEC Exhibit Hall B & C
PSYCHOSOCIAL VARIABLES IN PATIENTS WITH SUBACUTE
Research Report Poster Display LOW BACK PAIN. AN INCEPTION COHORT IN PRIMARY CARE
PHYSICAL THERAPY IN THE NETHERLANDS
VCEC Exhibit Hall B & C Heneweer H1 , Aufdemkampe G1 , van Tulder M2 , Kiers H1 ,
Vanhees L3 ; 1 Research department Lifestyle and Health and
PSYCHOSOCIAL IMPACT OF CHILDHOOD DISABILITY ON
Department of Physical Therapy, University of Professional
FAMILIES OF CHILDREN 0−6 YEARS
Education, Utrecht, The Netherlands; 2 Institute for Research in
Ajagbe O; Brothers of Charity Disability Services, Cork City, Extramural Medicine, VU University Medical Center, Amsterdam,
Republic of Ireland The Netherlands and Institute for Health Sciences, Faculty of Earth &
PURPOSE: This study seek to examine the Psychosocial Impact of Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands;
3 Department of Rehabilitation Sciences, Faculty of Kinesiology and
childhood disability on families with children 0-6years. RELEVANCE:
The result of this study would assist service providers and policy Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium
makers to help families to overcome the difficulty encountered in and Faculty Chair research department Lifestyle and Health,
relation to the birth and care of a child with disability. PARTICIPANTS: University of Professional Education, Utrecht, The Netherlands
Participants involve families (n=68) who have at least a child PURPOSE: To study the association between psychosocial factors
with intellectual disability whose age range is between 0-6 years. and the transition from acute or sub acute low back pain to chronic
METHODS: A standardised questionnaire ‘Impact of illness on low back pain in primary care physical therapy. RELEVANCE: Given
families (Adapted version) developed by Stein and Jessop,(2003)’ the serious consequences of chronic LBP, it is important to study
was used to determine the Psychosocial Impacts of child’s disability interventions that may prevent acute complaints becoming chronic.
on families. The quality of life of family was measured by ‘The Beach Psychosocial factors have long been believed to be associated with
Family Quality of life Scale’. ANALYSIS: The data were subjected to chronic pain only. More recent research1-8 focuses on psychosocial
both quantitative and qualitative statistical analysis. The quantitative factors associated with acute or sub acute pain. Physical therapy
analysis involves the use of simple descriptive and inferential analysis in primary care may play an effective role in identifying patients at
using Microsoft Excell, 2000 and Statistical Package for Social risk of developing chronic LBP. PARTICIPANTS: The participants
Sciences (SPSS) to calculate the means, Standard deviation with (n=56) in the study were consecutive new referrals consulting their
ANOVA to calculate the level of significance and non significance. The physical therapist for the first time with a first or new episode of
qualitative component was analysed by identifying commom themes LBP. Subjects were recruited from 20 primary care physical therapy
in relation to Resources and competencies available for family, the centers in the Netherlands between September 2002 and September
other impact the child’s disability has on family and the form of 2004. All subjects were referred by their general practitioner or
help needed by family. RESULTS: The result shows no significant medical specialist. The main inclusion criterion was non-specific low
difference in the mean scores of the Psychosocial Impact of child’s back pain preceded by a pain-free period of at least 3 months in
disability on families in relation to Severity of disability across group which no physical therapist was seen for treatment. METHODS:
for Total Impact, Social Relation, Coping and Finance,(p > 0.05, df 2, At baseline subjects were asked to complete a comprehensive
65), however there is a significant difference in the means score for set of questionnaires including sociodemographic characteristics,
General Impact domain (p < 0.05).In relation to the quality of life of cause and further development of LBP, fear-avoidance, anxiety,
family, the result show no significant difference between the quality of depression, kinesiophobia and pain-coping behavior. Follow-up
life of Parents in relation to Severity of disability (p > 0.05).Concerning questionnaires, administered by post at week 2, 4, 8 and 12,
the resources and competencies available for family, the master measured pain intensity, disability and overall improvement. Except
theme that emerged is Multidisciplinary intervention, Respite care for the sociodemographic characteristics, all baseline measurements
and intervention of social worker. The other theme is that they got were repeated in week 12. ANALYSIS: The effect of the predictor
help in local pre-school and help with entitlements. In relation to variables on the risk of non recovery was assessed in logistic
the other Impact the child’s disability has on family, the theme that regression models. All the variables were studied one at a time
emerged is that the care of child with disability creates emotional, in a base model, followed by stepwise approaches (pin <0.05,
social, financial and psychological problems.Another theme is that pout>0.10). A receiver operating characteristic curve was used
the care of child with disability is stressful,and affects the overall day to compare the accuracy of the models without the use of a
to day planning of families.Regarding the expected help by families specific cutoff point. RESULTS: At week twelve, 35 patients (51%)
the main theme identified is that family needed home support, judged their status as ‘not recovered’ of whom six (17%) reported
involvement of social worker and support group. The other theme work absenteeism. A multivariate logistic regression including the
is that family needed an improved service and better intervention. Acute Low Back Pain Scale (ALBPSQ), Fear Avoidance Beliefs
CONCLUSIONS: There is no significant difference in both the Questionnaire, Tampa Scale for Kinesiophobia and Pain Coping
Psychosocial impact of childhood disabity and quality of life of families Inventory resulted in a model in which the ALBPSQ appeared
in relation to severity of disability. IMPLICATIONS: Service providers to be the only significant variable. Scores on the subscale ‘pain’
and Policy makers are now called to assist family in alleviating of the ALBPSQ proved to be the strongest risk factor (p .001)
the difficulty encountered by family in relation to the care of their with an overall accuracy of 75.4%. Predicted scores resulted in a
child with disability. KEYWORDS: Psychosocial, Disability, Child relative risk of 3.09 (95% CI 1.64%-5.82%) for not being recovered
and Family. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT: after 12 weeks. CONCLUSIONS: The study revealed pain-related
[email protected] items to be essential factors in the development of chronic low
ETHICS COMMITTEE: Management of Brothers of Charity services back pain and long-term disability in primary care physical therapy.
(St. Gabriel’s School) The development of chronic low back pain can be considered as
a dynamic system of health-related items. Small differences in
the initial state of the host and in intensity, quality, and meaning
of the nociceptive stimulus can produce major differences in the
manner in which this process unfolds. IMPLICATIONS: Results
suggest pain management should be a priority in patients with
acute and sub acute low back pain. KEYWORDS: acute low back
pain, prediction, psychosocial. FUNDING ACKNOWLEDGEMENTS: grant from Queen Margaret University College Small Project Fund
The work was funded by the Hogeschool Utrecht, University of (RDSSC/06/7).
Professional Education. CONTACT: [email protected] ETHICS COMMITTEE: Lothian Research Ethics Committee

VCEC Exhibit Hall B & C MODIFIED TIMED UP AND GO TEST FOR JAPANESE LIFE
PAIN AND COGNITIVE-BEHAVIOURAL FACTORS AS BARRIERS STYLE
TO COMPLIANCE WITH WALKING EXERCISE IN PATIENTS WITH Fujita H, Shiomi T, Kaneko J, Maruyama H; International University
PERIPHERAL ARTERIAL DISEASE – PRELIMINARY EVIDENCE of Health and Welfare
Roche P1 , Belch J2 , Ellis B3 , Raza Z4 ; 1 School of Health Sciences,
PURPOSE: The ability to maintain dynamic balance control is critical
Queen Margaret University College, Edinburgh, UK; 2 University
for the successful performance of most daily living. Timed up and
Department of Medicine, Ninewells Hospital, Dundee, UK; 3 School
Go Test (TUG) is one of the widely used performance test for
of Health and Social Care, Glasgow Caledonian University, Glasgow,
dynamic balance ability. Standing-up from a floor is indispensable
UK; 4 Vascular Surgery Department, Royal Infirmary, Edinburgh, UK
activity for the Japanese lifestyle. TUG dose not reflect the Japanese
PURPOSE: A pilot study to assess pain and psychosocial factors lifestyle. In this study, we designed a new performance test including
in Peripheral Arterial Disease (PAD) and to test these as baseline standing-up from floor modified from TUG. The purpose of the
measures for patient’s compliance with prescribed daily exercise for present study was to determine the reliability and usefulness of
PAD. RELEVANCE: Peripheral Arterial Disease (PAD) is a significant this newly developed performance test (Modified Timed up and
cause of morbidity in the middle aged & elderly. Physical therapists go test: MTUG). RELEVANCE: Dynamic balance ability is one
play a major role in the exercise management of patients with PAD yet of the essential components of moter functuion and its evalution
patient’s compliance with prescribed exercise in PAD is between 10% prerequisite for the physical therapy intervention. PARTICIPANTS:
and 50% and is therefore poor. This study examined IC (pain in the Ten elderly community-dwellers (Three males and seven females,
calf while exercising), in detail, and investigated the potential need averaged age was 81.4 y.o.) participated in this study. METHODS:
for psychosocial screening, as a means of improving compliance Measurement items were TUG, MTUG, and walking time. We also
with exercise instructions in PAD. PARTICIPANTS: were thirty-one surveyed their style of the bedding and their usual life style (sitting
out-patients with PAD. The average age was 70.5 years. Patients on floor or sitting on chair) at mealtime by using the questionnaire.
were attending a vascular out-patient unit, or podiatry clinic. Each We divided them into two groups, Japanese style dwellers (JSD)
had been prescribed daily walking for their condition. They were and Western style dwellers (WSD) as the results of questionnaire.
included in the study if Ankle Brachial Pressure Index (ABPI) and We conducted TUG according the original Podsiadlo’s method. We
Edinburgh Claudication Questionnaire (ECQ) scores indicated stable measured MTUG as follows: subjects postured long sitting stand
IC. METHODS: Participants consenting to a 40 minute interview up from floor, they walk toward a 3m ahead target and turn it, go
reported whether he / she continued walking after the onset of back to original position and sitting down on the floor. We measured
calf pain. Self-rated measures were a 10 cm VAS scale of pain the required time for this series of motion by using the stopwatch.
intensity, the McGill Pain Questionnaire (MPQ), the Roland & Morris Walking speed was calculated by the required time measured on
Disability Questionnaire (RDQ), the Tampa Scale of Kinesiophobia a 10m flat walkway at their comfortable speed. ANALYSIS: We
(TSK) and the Pain Self-Efficacy Questionnaire (PSEQ). Wording calculated the intra-rater coefficients and inter-rater coefficients as
on questionnaires was adapted to refer to leg pain. Three 10 cm a reliability of measurements. The significant differences of means
VAS scales measured frustration, anger and helplessness due to and deviations were determined by using the Mann-Whitney’s U test.
calf pain. ANALYSIS: Measures of central tendency and correlation RESULTS: High reliability of measurements was obtained in MTUG
analysis described average scores and relations between clinical both ICC(3,1) = 0.83 and ICC(1,2) = 0.99. MTUG of WSD significantly
and psychosocial measures. The percent use of the MPQ word took much time compared with JSD at mealtime (p < 0.01). There
list and average scores of the rank of words chosen gave a 20- were no significant differences between JSD and WSD both in
dimensional illustration of IC. T-test for independent samples tested 10m walk speed and in TUG. CONCLUSIONS: MTUG has a high
for significant (p < 0.05) differences between participants who did, reliability, and is a suitable performance test to evaluate mobility for
or did not, continue to walk with IC. RESULTS: Fifty-two percent Japanese life style dwellers. IMPLICATIONS: This new performance
test is applicable for physical thrapy intervntion. KEYWORDS:
of participants stopped walking at the onset of IC. Average pain
Timed up and Go Test,Modified Timed up and go test,performance
severity in the calf (VAS = 5.31 +/− 1.64; MPQ-PRI = 25.29 +/− 10.4)
test. FUNDING ACKNOWLEDGEMENTS: This work was Unfunded.
was moderate to severe. RDQ scores were significantly correlated
with scores of ABPI (.542, p < 0.001), pain severity (.377, p < 0.05),
fear of movement (.484, p < 0.05), frustration (.475, p < 0.01) and
perceived helplessness (.549, p < 0.01). Low scores of self-efficacy Research Report Poster Display
were negatively and significantly associated with high scores of 36-13 Monday 4 June 14:00
perceived disability (−0.737, p < 0.0001). A sub-group (N=13) was VCEC Exhibit Hall B & C
revealed however, who had high scores of self-efficacy and who RELIABILITY AND VALIDITY OF A TIMED TWO-MINUTE
continued to walk, despite similarly high levels of ABPI, pain and WHEELCHAIR TEST IN OLDER ADULT RESIDENTS OF
fear of movement as ‘non-walkers’. CONCLUSIONS: Preliminary LONG-TERM CARE CENTRES
results suggest that IC pain is severe and that cognitive-behavioural
Connelly D, Pellegrino E, Hutchinson A, Lueck D, Richard J; School
factors linked with pain-related disability play a significant role in self-
of Physical Therapy, The University of Western Ontario, London,
reported walking behaviour with PAD. IMPLICATIONS: The results
ON, Canada
have informed the development of a larger proposal to study the
psychological determinants of structured exercise behaviour in PAD. PURPOSE: To determine reliability and construct validity of a
They also support the inclusion of a wider range of psychosocial timed two-minute wheelchair test (2MWCT) by long-term care (LTC)
measures of self-efficacy and related constructs such as acceptance residents who use a manual wheelchair for mobility. RELEVANCE:
of pain. KEYWORDS: Compliance; Psychosocial; Peripheral Artery Functional mobility measures usually have an ambulation component
Disease. FUNDING ACKNOWLEDGEMENTS: Supported by a making them inappropriate to assess mobility of those who are
wheelchair dependent. In addition, existing wheelchair mobility can be used in a variety of practice settings. A short walk test
measures include tasks that do not reflect the daily activities or documenting gait velocity and the Gait Stability Ratio can provide
the environments of older adult wheelchair-users. PARTICIPANTS: insight balance instability during walking PARTICIPANTS: University
Forty residents recruited from three LTC centres, who were 70 years faculty, senior housing and assisted living facilities (n=107 mean age
or older and able to self-propel their wheelchairs, were studied = 80 +10 yrs) who were independent walkers, including those using
(mean age = 86 ±7 years, 32 women). Eight subjects withdrew a cane or walker (AD), and received a score >3 on the Six Item
for reasons unrelated to the study. METHODS: Subjects wore a Mental Status. METHODS: Subjects received a brief demographic
heart rate monitor and completed one practice and two measured questionnaire to self-report chronic conditions, health status and fear
trials of the 2MWCT with each rater (intra-rater and inter-rater) of falling. Subjects then walked at their normal walking speed for a
on two separate occasions one week apart (test-retest). Distance minimum of 50 feet on a level surface. Start and stop lines were
travelled in two minutes, Borg Rating of Perceived Exertion, and marked on the floor and included 10 feet for the initial acceleration
resting and maximum heart rates were collected for each trial. Energy phase and the deceleration phase. Expert recorders recorded the
cost was calculated from the heart rate data. On a third occasion, time and steps to complete the 8-foot and the 20-foot distance.
subjects completed two questionnaires, the Nursing Home Life Space The study was approved by the University’s Institutional Review
Diameter (NHLSD) and the Physiotherapy Functional Mobility Profile Board. ANALYSIS: Data were entered into SPSS 14.0 Statistical
(PFMP), and the Nursing Home Physical Performance Test (NHPPT) Package. Descriptive statistics were used to characterize the sample.
in order to address validity of the 2MWCT. ANALYSIS: Descriptive Regression analysis was used to analyze the parameters of the walk
statistics for the group (mean + one standard deviation) were tests; cadence, velocity and Gait Stability Ratio (GSR). RESULTS:
calculated for each outcome. Intra-rater reliability was calculated from The majority of subjects self-reported no problems with balance,
a one-way repeated measures analysis of variance (RM ANOVA) and walking or strength, and 56% used an AD. The most common co-
reported as an intraclass correlation coefficient model 1,1 (ICC1,1). morbidities were poor vision (93%) and arthritis (66%). The following
Separate two-way RM ANOVAs were completed for inter-rater were significant (all p < 0.0001): Cadence 8-foot predicted 97% of
reliability and test-retest reliability and reported as ICC2,1. Pearson r Cadence 20-foot = 0.969(Cadence 8-foot); Velocity 8-foot predicted
correlations were used to describe the relationship between distance 96% of PF Velocity 20-foot = 1.043(PF Velocity 8-foot); GSR 8-foot
wheeled and NHLSD, NHPPT, and PFMP, as well as the relationship predicted 98% GSR 20-foot = 0.95(GSR 8-foot). CONCLUSIONS:
between the NHPPT quantitative and prompting scores. RESULTS: When space limitations occur, the 8-Foot Walk Test can be used
Trial one of the 2MWCT showed excellent test-retest (ICC2,1 = 0.92, in place of a longer walk test and values converted to the 20-
0.83–0.96), intra-rater (ICC1,1 = 0.97-0.99, 0.92–1.0) and inter-rater Foot Walk Test. IMPLICATIONS: Additional testing incorporating
(ICC2,1 = 0.97, 0.94–0.99) reliability. For trial one, standard error clinical outcomes will occur in other practice settings to ensure the
of measure was 4.16 m and the minimal detectable change was validity of the 8-Foot Walk Test. Physiotherapists can use the 8-Foot
11.50 m. The NHLSD and NHPPT fairly correlated with the 2MWCT, Walk Test when a longer walk test is compromised due to space
r = 0.51 (p < 0.01) and r = 0.44 (p < 0.05), respectively. The NHPPT limitations as evidenced in the home setting, Emergency Department,
quantitative score showed an excellent correlation with the NHPPT hospital room or other practice settings. KEYWORDS: older adults,
prompting score (r = 0.85, p < 0.01). CONCLUSIONS: The 2MWCT is gait, assessment. FUNDING ACKNOWLEDGEMENTS: College of
a reliable outcome measure for functional mobility of older residents Health Professions, Temple University, Philadelphia PA. CONTACT:
of LTC centres who primarily use a wheelchair. Further investigation [email protected]
of construct validity is warranted, in particular known groups, ETHICS COMMITTEE: Temple University Institutional Review Board
convergence and discrimination. IMPLICATIONS: The 2MWCT is
an inexpensive, time-efficient outcome measure of seated mobility
with relevance to both clinical and research environments. This
seated mobility measure has the potential to assess endurance, 37-21 Monday 4 June 14:00
independent mobility, the effects of an intervention, and provide a VCEC Exhibit Hall B & C
functional addition to qualitative measures. KEYWORDS: reliability, AQUATIC RESPIRATORY EXERCISES IN THE RESPIRATORY
validity, seated mobility. FUNDING ACKNOWLEDGEMENTS: This MUSCLE STRENGTH AND DYSPNEA OF SUBJECTS WITH
work was unfunded. CONTACT: [email protected] FIBROMYALGIA
ETHICS COMMITTEE: Health Sciences Review Ethics Board, The Ritomy Ide M1 , Tanaka C2 , Borges Ferreira C3 , Chueire de Andrade
University of Western Ontario J M3 , Imai M3 ; 1 Division of Physical Therapy, University of the West
of Paraná, Brazil; 2 PhD, Division of Physical Therapy, School of
Research Report Poster Display Medicine, University of Sao Paulo, Brazil; 3 Physical therapy student
36-17 Monday 4 June 14:00 PURPOSE: This study aims to identify changes in the respiratory
VCEC Exhibit Hall B & C muscle strength and incidence of dyspnea in subjects with FM. It still
CAN THE 8-FOOT WALK TEST REPLACE THE 20-FOOT WALK aims to verify the effects of an aquatic respiratory exercises program
TEST? in the respiratory muscle strength and dyspnea of these subjects.
RELEVANCE: There is no studies about respiratory exercises in sub-
Newton R1 , Cromwell R2 , Klima D3 , Lidicker J4 ; 1 Department
jects with fibromyalgia. PARTICIPANTS: 35 women with fibromyalgia,
of Physical Therapy, Temple University, Philadelphia PA, USA; 2
selected through interview. METHODS: 40 women with FM initiated
Physical Therapy Department, University of Texas Medical Branch,
the study. The dyspnea was assessed through Visual Analogue Scale
Galveston TX, USA; 3 Department of Physical Therapy, University
(VAS) and the respiratory muscle strength through the measure
of Maryland-Eastern Shore, MD, USA; 4 Center for Statistical
of the inspiratory and expiratory maximum pressures (IPmax and
and Information Science, College of Health Professions, Temple
EPmax), using a manovacuometer. The 40 women were randomized
University, Philadelphia PA, USA
into 2 groups (GA and GB). Thirty-five subjects concluded the
PURPOSE: To validate the 8-Foot Walk Test to assess velocity, study (GA = 18, GB = 17). GA performed aquatic respiratory
cadence and the Gait Stability Ratio. RELEVANCE: Impaired balance exercises (4 times a week, 4 weeks, 1-hour each session) and GB
and gait are two of the most significant risk factors for limited was the control group (subjects performed sedentary activities, as
mobility and increase risk of falls in older adults. Because the lectures, once a week). ANALYSIS: Quantitative analysis: IPmax
practice of physiotherapy occurs in multiple settings and often times and EPmax were compared with the expected to age, through
where space is restricted, assessment of gait may not be practical. paired t-test. Baseline and post-test scores differences were also
There is a need to develop and validate a short walk test that analyzed through paired t-test. RESULTS: The average age of the
subjects who concluded the study was 46.33±9.11years. Of these, statistically through Pearson’s correlation coefficient. The change in
71.42% described some degree of dyspnea (mean = 3.97±3.07). MWS measured before and after the study period was analyzed using
The IPmax and EPmax baseline scores were significantly lower two-way ANOVA. RESULTS: There were no significant differences in
from the expected to the age in normal subjects (IPmax – mean the clinical characteristics between the 2 groups. MWS measured
of 29.4±12.68 and 80.2±4.46, for found and expected, respectively; was significantly lower in group A than that in group B (P < 0.01).
EPmax – 41.4±23.51 and 77.7±5.56), with p = .001 for both IPmax There was a significant and positive correlation between PA time
and EPmax. The maximum respiratory pressures did not improve and MWS in group A before the study (r = 0.44, P < 0.01). MWS
after exercise program (p = .0254 and 0.092 for IPmax and EPmax, decreased significantly after the study in non-exercise patients of
respectively). However, the dyspnea improved significantly post-test group A as compared with that before the study (P < 0.01), although
(p = .040). It was not observed correlation between the changes in MWS showed no significant change in exercise patients. On the
the dyspnea with changes in IPmax (p = -.188) and EPmax (p = - other hand, there were no significant correlation between PA time
.196). CONCLUSIONS: The respiratory muscle strength is reduced and MWS in group B before the study and no significant changes in
in subjects with FM. A high incidence of dyspnea is observed in these MWS before and after the study in both exercise and non-exercise
subjects. The aquatic respiratory exercises reduces the dyspnea of patients of group B. CONCLUSIONS: HD patients should maintain
women with FM, although do not improve the respiratory muscle the PA for 60 minutes and more a day as PA time, to prevent the
strength in these subjects. IMPLICATIONS: The results of this study deterioration of walking ability. IMPLICATIONS: This study suggests
justify aquatic respiratory exercises to subjects with fibromyalgia to that physical therapists should evaluate PA level when educate HD
help in dyspnea control. It also proves that this kind of exercises are patients in daily life. KEYWORDS: physical activity, walking ability,
not indicated to improve respiratory muscle strength in this subjects. chronic renal failure. FUNDING ACKNOWLEDGEMENTS: None.
KEYWORDS: Aquatic exercise; Respiratory exercise; Fibromyalgia. CONTACT: [email protected]
FUNDING ACKNOWLEDGEMENTS: This study did not receive ETHICS COMMITTEE: Ethics Committee of Kitasato University
financial support. CONTACT: [email protected]
ETHICS COMMITTEE: This work was approved by the Ethic Comitee
of the University of the West of Paraná.
Research Report Poster Display EFFECTS OF PELVIC FLOOR EXERCISES WITH OR WITHOUT
38-01 Monday 4 June 14:00 ELECTRICAL STIMULATION AMONG FEMALE OLDER ADULTS
VCEC Exhibit Hall B & C WITH URINARY STRESS INCONTINENCE
PHYSICAL ACTIVITY LEVEL NECESSARY TO PREVENT Meir J1 , Smudey J1 , Luyckx-Baestaens G2 , Village D1 ; 1 Andrews
DETERIORATION OF WALKING ABILITY IN PATIENTS OF University, Berrien Springs, MI, United States; 2 LB Physical
CHRONIC RENAL FAILURE ON MAINTENANCE HEMODIALYSIS Therapy, St. Joseph, MI, United States
Kutsuna T, Matsunaga A, Nanri Y, Saitoh M, Yonezawa R,
PURPOSE: The purpose of this study was to compare the effects
Matsumoto T, Ishii A, Yamamoto K, Sato T, Sawairi T, Masuda T;
of pelvic floor exercises alone or in combination with electrical
Graduate School of Medical Sciences, Kitasato University
stimulation in older adult females with urinary stress incontinence.
PURPOSE: To prevent the deterioration of walking ability in the pa- RELEVANCE: Urinary incontinence is becoming more prevalent in
tients of chronic renal failure undergoing maintenance hemodialysis a burgeoning older adult population. Physical therapists provide
(HD), it is essential to establish an appropriate exercise guidance conservative treatment, including exercise and electrophysical modal-
as well as medical management. The patients on HD are known itites, to alleviate this problem. Very few studies have examined
to have poorer physical activity (PA) as compared with healthy the combined effects of using exercise and electrical stimulation
sedentary adults, because HD imposed the restriction on the free for the treatment of urinary incontinence. PARTICIPANTS: The
time available to them and induced dialytic symptoms. As the sample population was obtained from a outpatient clinic and included
evaluation of PA is meaningful for maintenance and improvement 35 females 55 years of age. All participants had a medical
in the motor function including walking ability, the present study diagnosis of urinary stress incontinence. Patients with other types
investigated PA level that prevented HD patients from reducing the of urinary incontinence were excluded. Subjects were assigned to
walking ability. RELEVANCE: The physical therapy was related to either the exercise group or the exercise and electrical stimulation
a part of the preventive education in daily life for HD patients. group using a consecutive assignment strategy. METHODS: For
PARTICIPANTS: Thirty-seven male and 64 female HD patients, both groups, a completed bladder health questionnaire, protective
63±11 years of mean age and 8.4±6.4 years of the duration on pads used (self-report), and EMG reading were collected during
HD, were divided into the following 2 groups according to PA time the subject’s first and last sessions. The questionnaire consisted of
(a total time during walking and running per day): group A (PA 5 items, each with 5 force-choiced answers. For the biofeedback
time<60 minutes) and group B (PA time60 minutes). Moreover, each EMG reading, a vaginal tube-like probe was used to assess
group consisted of another subgroups: the patients performing the changes in pelvic floor musculature. Each group received education
home-based exercise training (exercise patients), and those who did regarding bladder irritants and home exercise along with 6 weeks
not any exercise (non-exercise patients). METHODS: The patients’ of treatment by a physical therapist. The home exercise program
clinical characteristics including age, duration on HD, body mass consisted of completing quick and slow contractions of the pelvic floor
index, hematocrit and serum albmin were before the 6-month study musculature. Subjects were instructed to perform quick contractions,
period. PA time and maximum walking speed (MWS) were measured consisting of a 2-second hold followed by 4 seconds of relaxation,
before and after the study period. PA time was recorded over a and slow contractions consisting of a 5-second hold followed by 10
week using an accelerometer (LifeCorder, Suzuken), and MWS was seconds of relaxation. During the first week, 5 repetitions of quick
measured as walking ability while the patient walked a distance of and slow exercises were to be performed 4-6 times per day, and for
10 meters at maximum walking speed. The home-based exercise the remaining 5 weeks, 10-12 contractions of each were expected
training program consisted of training with an elastic tubing and own- to be performed 2-3 times daily. Proper technique of performance
weighted training, and was performed for 2 months. Physical therapist of the exercise was ensured by a weekly session with the therapist;
adjusted the exercise intensity appropriately to suit the patients’ motor compliance was encouraged by completing a daily exercise log. For
function and condition. ANALYSIS: The clinical characteristics and the exercise in combination with electrical stimulation group, electrical
MWS were compared between the two groups using unpaired t- stimulation was administered once per week for 15 minutes. An
tests. The correlation between PA time and MWS was evaluated intermittent 5 seconds on 15 seconds off cycle was used at 50 Hz
and the amplitude was based upon patient tolerance. Prior to any program, time at initiation of treatment program, and severity of
treatment, subjects read and signed an informed consent form after diastasis. CONCLUSIONS: The identification of risk factors for
opportunity was given for questions. Ethics approval was provided diastasis of the recti abdominis suggest the need for selected
by the Andrews University Institutional Review Board. ANALYSIS: screening in obstetrical populations. The condition is amenable
Descriptive, Independent t-tests, Repeated Measures ANOVAs, to treatment. Further study in a larger sample may delineate
Mann-Whitney U test, and Wilcoxin statistics were calculated. factors which hasten recovery. IMPLICATIONS: Recognition, specific
RESULTS: The results of this study indicate that both treatment management education, and appropriately modified exercise in
groups showed improvement over time for each category, but early postpartum period can hasten recovery and may reduce
neither treatment group improved significantly more than the other the probability of recurrence. Recovery can be enhanced through
over time. CONCLUSIONS: Electrical stimulation provided as an a regime of appropriate exercise prior to and during pregnancy.
adjunct to pelvic floor exercises for the treatment of urinary stress KEYWORDS: diastasis recti abdominis, pregnancy, physiotherapy.
incontinence does not appear to enhance outcomes. The results FUNDING ACKNOWLEDGEMENTS: Provided by B.C. Women’s
of this pilot study should be interpreted cautiously until a follow-up Hospital & Health Centre.
studies with a larger participant pool is conducted. IMPLICATIONS: ETHICS COMMITTEE: B.C. Women’s Research Co-ordinating
Though electrical stimulation for stress incontinence may not be Committee and University of British Columbia Ethics Committee
necessry in all cases, certain individuals, such as those with
poor kinesthetic awareness, may require this additional modality.
KEYWORDS: Urinary incontinence, pelvic floor exercise, electrical
stimulation. FUNDING ACKNOWLEDGEMENTS: This work not 39-17 Monday 4 June 14:00
funded. CONTACT: [email protected] VCEC Exhibit Hall B & C
ETHICS COMMITTEE: Andrews University Institutional Review LOW-BACK PAIN ON PREGNANT WOMEN: INFLUENCE IN
Board CENTER OF PRESSURE DISPLACEMENT, PLANTAR PRESSURE
DISTRIBUTION, HEALTH AND FUNCTIONAL STATUS PROFILES
Research Report Poster Display Rosado J1 , Cabri J2 ; 1 Caritas Diocesan of Coimbra, Portugal;
2 Faculty of Human Movement Studies, Technical University of
VCEC Exhibit Hall B & C Lisbon, Portugal
DIASTASIS OF THE RECTI ABDOMINIS IN PREGNANCY: RISK PURPOSE: Low-back pain (LBP) occurs on the majority of pregnant
FACTORS AND TREATMENT women. During pregnancy, women suffer physical, psychological
Lo T, Candido G, Janssen P; B.C. Women’s Hospital & Health and social changes. These changes can interfere in balance and
Centre, Vancouver, B.C., Canada plantar distribution and in health and functional status, which can
be influenced by LBP. The aims of this study were: to compare
PURPOSE: The purpose of this study was to a) determine risk pregnant women with (WLBP) and without low-back pain (wLBP)
factors for diastasis of the recti abdominis in pregnancy, b) to for center of pressure (COP) displacement, plantar pressure (PP)
describe an in-hospital and follow-up postpartum treatment program distribution and health status profile; to characterize pregnant women
and c) to ascertain factors modifying rate of recovery from diastasis. WLBP for functional status profile. RELEVANCE: This study can
RELEVANCE: Diastasis recti abdominis (DRA) is a condition in be relevant for physical therapy because none of the previous
which the rectus abdominis muscle bellies separate (widen) at studies about LBP on pregnant women examine COP displacement
the midline along the linea alba. In pregnancy, a combination of and PP distribution. Additional information on health and functional
histochemical changes mediated by alterations in maternal hormones status can help to understand the influence of LBP on pregnant
and increased tension imposed by the expanding uterus predisposes women. PARTICIPANTS: Forty four volunteer women on the third
to separation. Diastasis can occur in varying degrees during trimester of pregnancy took part (gestation: 34.55±3.57 weeks; age:
pregnancy and may not resolve spontaneously in the postpartum 27.38±5.04 years; wLBP: 27, WLBP: 17). METHODS: Pregnant
period. Consequent lack of muscle integrity may lead to back women completed Medical Outcomes Study – 36 item Short Form
injury and cosmetic defects. Thus, it is important for this condition (MOS SF-36) and Roland-Morris Questionnaire (RMQ) to collect
to be recognized by physiotherapists and treated accordingly. data on health and functional status (RQM was complete only
PARTICIPANTS: 55 cases were identified by physiotherapists from by women WLBP). A pressure platform (FootScan) was used to
routine testing of early postpartum women attending physiotherapy collect data on COP displacement (bi/unipodal) and PP distribution
classes and by referral from physicians and nurses and were defined (static/dynamic). ANALYSIS: Mann-Whitney test was performed to
as women with a paplable midline gap of more than 2.5 cm. or compare pregnant women WLBP and wLBP for kinetic variables of
any visible bulging along the linea alba on exertion. METHODS: COP displacement and PP distribution and for profile of health status.
This was a case-control study, done between 1992 and 1995, Significance level was set at p < 0.05. Profile of functional status
comparing women with diastasis in a tertiary maternity centre with was analyzed with descriptive statistics. RESULTS: The presence
the general hospital population. Data collection was retrospective of LBP doesn’t interfere with COP displacement (uni/bipodal) neither
and utilized hospital records and physiotherapy records. ANALYSIS: with PP distribution on static bipodal support. The PP distribution on
Cases and controls were compared on demographic and pregnancy dynamic bipodal support was significantly different between groups:
related factors using t-tests for continuous variables and chi-square the WLBP group present larger time of contact under hallux of left
for dichotomous discrete variables. The type 1 error was set at foot (p = 0.007); higher load rate under first metatarsal head of left
0.05. Contribution of factors influencing recovery time were analyzed foot (p = 0.015); lower peak pressure under fifth metatarsal head of
using linear regression analysis. This analysis addressed only right foot (p = 0.017) and higher peak pressure under hallux of left
those patients who participated in the exercise program. RESULTS: foot (p = 0.005). Women WLBP had lower levels of health status only
Women with diastasis were more likely to be older, of higher parity on vitality (p = 0.002) and mental health (p = 0.003) dimensions of
(p < 0.001), have had twins, bigger babies, and birth by cesarean MOS SF-36. Pregnant women WLBP presented a lower limitation
section (p < 0.01). There was no difference in gravidity or weight level of functional status (RMQ = 7.19±3.97). CONCLUSIONS:
gain. Although differences did not reach statistical significance in this On the third trimester of pregnancy, the presence of LBP doesn’t
small data set, our data suggest that earlier recovery may also be appear to interfere with COP displacement and PP distribution on
associated with lower parity, singleton birth, weight gain under 35 static bipodal support. By the contrary, LBP seems to influence
pounds, birth of baby less than 3600 grams, increased activity levels the PP distribution on dynamic bipodal support. LBP seems to
before, during, and after pregnancy, compliance with the treatment negatively influence only vitality and mental health dimensions of
health status. Women WLBP doesn’t appear to have significant IMPLICATIONS: To maximize the safety of these mobilization
restrictions on functional status. IMPLICATIONS: The generated practices, patients should be screened by the healthcare team for
knowledge can be useful for physical therapists to improve prevention cognitive status and overall medical condition. Furthermore, proper
and intervention strategies in pregnant women. KEYWORDS: Low- orientation and education about the structure, purpose, and inherent
back pain, pregnancy. FUNDING ACKNOWLEDGEMENTS: The risks of each type of femoral line should be encouraged for all
work was unfunded. CONTACT: [email protected] healthcare professionals to increase the practice of mobilization.
ETHICS COMMITTEE: Scientific Board of the Faculty of Human KEYWORDS: mobilization practices; physical therapists; intensive
Movement Studies, Technical University of Lisbon care unit. FUNDING ACKNOWLEDGEMENTS: The investigators
would like to gratefully acknowledge the funding support received
from the Allied Health Research Fund, University Health Network,
Toronto Canada. CONTACT: [email protected]
01-15 Monday 4 June 15:30 ETHICS COMMITTEE: Research Ethics Board, University Health
VCEC Exhibit Hall B & C Network; Research Ethics Board, University of Toronto
CURRENT MOBILIZATION PRACTICES OF ONTARIO PHYSIO-
THERAPISTS IN PATIENTS WITH INDWELLING FEMORAL LINES
Cote N1 , Fenton A2 , Hawn T3 , Quan V4 , Heck C5 ; 1 University Research Report Poster Display
Health Network, Toronto Canada; 2 University Health Network, 01-19 Monday 4 June 15:30
Toronto Canada; 3 University Health Network, Toronto Canada; VCEC Exhibit Hall B & C
4 University Health Network, Toronto Canada; 5 University Health
RESPIRATORY MUSCULAR ELECTROMYOGRAPHIC ACTIVITY
Network, Toronto Canada DURING THE ERGOMETRIC TEST AND RESPIRATORY
PURPOSE: To determine current mobilization practices of physical ENDURANCE
therapists (PTs)working with patients with indwelling femoral lines, Costa D, Riedi C, Bueno Tesch C, de Jesus Guirro R; Methodist
and to make recommendations regarding promoting safe practices for University of Piracicaba, Piracicaba, Brazil
healthcare professionals working with this population. RELEVANCE:
In clinical practice, early mobilization in patients with indwelling PURPOSE: The purpose of this study was to compare the
femoral lines may be delayed due to the belief that mobilization electromyography respiratory muscular action during the respiratory
may result in perforation of the vessel, movement of the line, muscular endurance test (RMET) and during an ergometric test (ET).
and/or dislodgement of the line. While there is little reported in RELEVANCE: The electromyography exploration of the respiratory
the literature to support or restrict mobilization in this population. muscles during physical effort has been an important object of study
PARTICIPANTS: A sample of convenience consisting of PTs from to elucidate the respiratory functional evaluation of these muscles
33 healthcare facilities in Ontario (response rate = 87.8%) and and for its application on the clinical practice area. PARTICIPANTS:
17 PTs from our facility completed a questionnaire regarding their A total of 28 volunteers participated of the study (12 men and
mobilization practices in patients with indwelling femoral lines. 16 women), sedentary, no smoking, and without a history of
METHODS: An electronic questionnaire, and follow-up email three cardiopulmonary diseases. METHODS: The electric activity of the
weeks later to non-responders, was sent in January 2006. The respiratory muscles was analyzed by an EMG 100 module for
questionnaire solicited information on demographics, characteristics capturing signal (Lynx, Brasil). Three bipolar active surface electrodes
of current working environments, current mobilization practices with coming out of two Ag/AgCl bars were used with a 2000Hz frequency
four femoral lines (arterial, central venous, rigid and semi-rigid range. The electrodes were positioned: between the mandible angle
vascular catheters) issues, concerns and rationale supporting current and the earlobe, at the muscular womb of the sternocleidomastoid
practice. ANALYSIS: Descriptive statistics were used to characterize muscle, 4cm bellow the mastoid process at the third intercostals
the demographic profile and mobilization practices of the subjects. space, 3 cm paraesternal, to the external intercostals muscle and at
Differences in mobilization practices between PTS at our facility and the seventh intercostals space of the mammilar line to the diaphragm
facilities external to UHN were compared using analysis of variance. muscle. The RMET were prepared with an IMT® threshold and the
RESULTS: The majority of respondents were female (76.5%), had volunteers initiated the test with a load of 30% of the maximum
received Baccalaureate degrees (82.4%), worked full-time (97.5%), inhalation pressure, with increments of 5 cmH2O on every 2 minutes.
had over ten years of work experience (53.2.1%) and worked in The ET was prepared in a Monark® ciclergometer, with a degree
large (>300 beds) community hospitals (76.7%) or teaching hospitals protocol and increments of 25 watts. The electromyography data
(23.3%). Approximately half of respondents practiced in the MSICU. analysis was applied during the initial rest, at the beginning of
Almost all of the PTs reported working with patients with arterial lines the test, at 50% and 100% of the test and on the final rest.
(88%) and central venous lines (96%) but less so with rigid (53%) The RMS (mV) value of the signals were normalized by the peak.
and semi-rigid (69%) vascular catheters. Although over 50% reported ANALYSIS: After the normality analysis of the data, it was applied
mobilizing patients by dangling, transfering, and hip range of motion the Wilcoxon procedure to compare the different results of the tests.
(ROM) up to 90º with all lines except the rigid vascular catheter RESULTS: Despite observing an increase on the RMS value with
there was a significantly higher percentage of PTs from teaching than the load increasing, on both of the tests, it was noticed that on
community hospitals that engaged in these types of mobilizations. Of the RMET this increase was higher than the one on the ET, for all
the factors guiding clinical practice, the majority cited safety concerns the muscles, highlighting the sternocleidomastoid muscle that, on
and clinical experience. For those respondents in teaching hospitals the maximum off the exercise, showed an RMS of 0.10±0.05 mV
evidence from the literature (11.5%) and a previous critical incident on the ET, while 0.15±0.03 mV on the RMET. CONCLUSIONS:
(23.8%) were cited as factors influencing practice. Physiotherapists Facing these results, it was concluded that the respiratory muscles
believed that line occlusion, breaking and shifting, as well as are more demanded during specific exercises, such as the RMET,
internal/external bleeding, present safety concerns when mobilizing than during general exercises, like the ET. IMPLICATIONS: It was
patients with indwelling femoral lines. There were no between also noticed that the accessories muscles are more requested than
group (hospital type or line type) differences. CONCLUSIONS: the rest, on the physical effort. KEYWORDS: electromyography,
There appears to be some differences in practice of mobilizing respiratory muscles, ergometric test, respiratory endurance test.
patients with indwelling femoral lines in teaching and community FUNDING ACKNOWLEDGEMENTS: CAPES/Prosup. CONTACT:
facilities. In general PTs in teaching hospitals may implement more [email protected]
aggressive practices (i.e. a higher percentage do more mobilization) ETHICS COMMITTEE: aproved by the Ethical Comitte of the
and have few safety concerns than those in community hospitals. Institution, protocol 98/04
CAN THE PAO2/FIO2 RATIO INFORM CLINICAL REASONING BREATHING EXERCISES FOLLOWING GASTROPLASTY:
FOR REHABILITATION IN THE GENERAL INTENSIVE CARE ANALYSIS OF BREATHING PATTERN AND
UNIT? THORACOABDOMINAL MOTION
Thomas A1 , Tose D3 , Mill L2 , Sirivol S1 , Reffold O1 ; 1 King George Tomich G1 , França D2 , Britto R3 , Sampaio R3 , Diniz M4 , Franco
Hospital, Ilford, United Kingdom; 2 The Wellington Hospital, St Johns Parreira V3 ; 1 Master Program at the Federal University of Minas
Wood, United Kingdom; 3 Kings College, London, United Kingdom Gerais, Belo Horizonte, MG, Brazil; 2 Physiotherapist; 3 Physical
PURPOSE: An evidence base for the initiation of rehabilitation Therapy Department at the Federal Univsersity of Minas Gerais,
in critically ill patients does not exist, although several guidelines Belo Horizonte, MG, Brazil; 4 Surgery Department at the Federal
for “safe” mobilisation have been published. In one guideline, a Univsersity of Minas Gerais, Belo Horizonte, MG, Brazil
PaO2/FiO2 ratio greater than 300 is suggested when determining PURPOSE: To evaluate breathing pattern and thoracoabdominal mo-
respiratory reserve for exercise in the critically ill patient. The purpose
tion in subjects with obesity after gastroplasty during three breathing
of this analysis was to determine the incidental PaO2/FiO2 ratio
exercises: diaphragmatic breathing (DB), incentive spirometry (IS)
associated with rehabilitation tasks performed by patients in a general
with a flow-oriented device (Triflo II) and IS with a volume-oriented
Intensive Care Unit. RELEVANCE: There are no published reports
device (Voldyne). RELEVANCE: Breathing exercises based on deep
interpreting the PaO2/FiO2 ratio prior to rehabilitation of the critical
and slow inspirations are frequently used in chest physiotherapy for
ill patient. This quantitative analysis will identify the ability of the
treatment of patients during post-operative period. Besides many dif-
PaO2/FiO2 ratio to inform clinical practice and benchmark PaO2/FiO2
values for a variety of rehabilitation tasks commonly performed with ferents regimes of treatment have been used, there is still no specific
the critically ill. PARTICIPANTS: 45 patients (mean age 63±17.5yrs) and universally acceptable therapeutic concept. PARTICIPANTS:
admitted consecutively to the general Intensive Care Unit over a Twenty-four subjects (18 women, 6 men), aging 37 ±11 years (mean
4-month period were included in the analysis. METHODS: Data ±standard deviation), with obesity levels II and III, and body mass
was collected regarding all physiotherapy sessions during a 4-month index of 44 ±3 Kg/m2 were studied on second post-operative day.
period, consisting of the mode of ventilation, PaO2 and FiO2 prior METHODS: Sample size of 23 participants was calculated based
to treatment and rehabilitation task performed (positioning, passive on pilot study performed with the first ten subjects; taken into
movement, active limb exercises, sitting on bed edge, standing consideration the level of significance of 0.05 and the power of 0.80.
transfers, hoist transfers and walking). ANALYSIS: Descriptive statis- Respiratory inductive plethysmography was used to measure volume
tics were calculated describing the incidence of each rehabilitation and time components of breathing pattern and thoracoabdominal
activity as a percentage of the total sessions. The mean, standard motion. The following variables were analyzed: tidal volume (Vt),
deviation and range (min & max) of pre treatment PaO2/FiO2 ratios respiratory frequency (f), minute ventilation (VE), inspiratory time
(mmHg) were calculated for each rehabilitation task. RESULTS: 287 (Ti), expiratory time (Te), respiratory total time (Ttot), inspiratory duty
individual treatment sessions were analysed. No adverse events were cycle (Ti/Ttot), mean inspiratory flow (Vc/Ti), rib cage contribution
recorded during any rehabilitation activity. 70% of the treatments to Vt (RC/Vc), inspiratory phase relation (PhRIB), phase angle
included body positioning yielding a mean (±SD) PaO2/FiO2 ratio (PhAng) and labor breathing index. ANALYSIS: For comparisons
of 253±125 (range 74–821). Passive movements (50%) recorded between rest breathing (baseline) and breathing exercises periods,
the lowest mean PaO2/FiO2 ratio (237±146, range 74-689), and ANOVA for repeated measures followed by pairwise comparisons
active movements (35%) a mean ratio of 301±133 (range 106–821). was used, when data distribution was normal, or Friedman test
Sitting on the bed edge (10%) was performed with a mean ratio followed by Wilcoxon, when distribution was not normal. Level of
of 276±148 (range 136–821), while participation in a hoist transfer significance was set at 0.05, with Bonferroni corrections to adjust
(9.5%) was 279±98 (range 155–489). Standing transfers revealed this level according to number of comparisons performed. RESULTS:
the highest mean ratio (317±146, range 136-689) and walking was Comparisons between baseline and breathing exercises periods
performed with a mean PaO2/FiO2 ratio of 282±86 (range 158–476). showed an increase in Vt and a decrease in f during all exercises,
The minimum PaO2/FiO2 ratio data showed a tendency to be lowest with an increase in VE only during exercise with Triflo II (p < 0.008).
for positioning and passive movement (74), greater than 130 in all There was increase in Ti during DB and Voldyne, in Te and Ttot during
activities requiring weight bearing and highest (158) in patients who all exercises, and in Ti/Ttot during exercise with Voldyne(p < 0.008);
could mobilise. CONCLUSIONS: While the mean PaO2/FiO2 ratio
in the comparisons between exercises, there were a higher Vt during
associated with rehabilitation tasks reflected little overall differences
IS compared to DB, a lower f during Voldyne compared to Triflo II
and a wide range of scores, the clinically relevant values were
and a higher VE during IS compared to DB (p < 0.008). There were
the minimum PaO2/FiO2 ratios observed. Active rehabilitation tasks
a higher Ttot during Voldyne compared to Triflo II and a higher Vt/Ti
were successfully initiated when PaO2/FiO2 ratio’s were greater
during Triflo II compared to DB (p < 0.008). Comparisons between
than 130 while walking was initiated when the ratio exceeded 150.
IMPLICATIONS: Rehabilitation activities were successfully initiated baseline and exercises did not showed significant changes in RC/Vt
in the patient with critical illness when the PaO2/FiO2 ratio was and labor breathing index. Considering PhRIB and PhAng, variables
less than 300. The minimum PaO2/FiO2 ratio data reported may be of thoracoabdominal asynchrony, there were an increase in PhRIB
used for the preparation of evidence-based guidelines that inform the during DB and Triflo II and an increase in PhAng during IS compared
clinician when reasoning the safety of rehabilitation in the critically to baseline (p < 0.008). Comparisons between exercises with respect
ill patient. KEYWORDS: PaO2/FiO2 ratio,Rehabilitation,Intensive to thoracoabdominal motion showed no significant differences.
Care. FUNDING ACKNOWLEDGEMENTS: Nil. CONTACT: midaz_ CONCLUSIONS: Considering variables analyzed during breathing
[email protected] exercises performed by subjects with obesity following gastroplasty
and physiologic principles of these techniques of chest physio-
therapy based on deep and slow inspirations, best performance
occurred during exercise with volume-oriented incentive spirometer.
IMPLICATIONS: This study give a contribution on comprehension
about the influence of three different ways of performing deep
and slows inspirations on breathing exercices performance on post-
operative period. KEYWORDS: Diaphragmatic Breathing, Incentive
Spirometry. FUNDING ACKNOWLEDGEMENTS: Partly supported interdisciplinary education. FUNDING ACKNOWLEDGEMENTS:

by CNPq and CAPES, Brazil. CONTACT: [email protected] none. CONTACT: [email protected]
ETHICS COMMITTEE: University Federal of Minas Gerais Ethics ETHICS COMMITTEE: Full ethical approval was given by the Faculty
Research Committee approved the study and all subjects gave of Health and Social Care Sciences ethics committee.
written informed consent.

VCEC Exhibit Hall B & C EFFECTS OF RANDOM APPLICATION OF CIRCUMFERENTIAL
THE REINFORCEMENT OF DELIVERING CLINICAL SKILLS PRESSURE AND TENS ON MOTONEURONE EXCITABILITY IN
ONLINE WITH BLENDED LEARNING ACROSS DIFFERENT NORMAL HUMAN SUBJECTS
HEALTH DISCIPLINES
Kennedy E1 , Wood L2 , Nicol J2 ; 1 Division of Physiotherapy,
Younis A1,2 ; 1 St. George’s, University of London; 2 Faculty of Health School of Health and Social Care, Glasgow Caledonian University,
and Social Care Sciences, Kingston University Glasgow, Scotland, UK; 2 Department of Biological and Biomedical
Sciences, School of Life Sciences, Glasgow Caledonian University,
PURPOSE: Demand for educating health professionals for teamwork Glasgow, Scotland, UK
is increasing. In order to achieve effective, efficient education,
emphasis should be placed on initiatives to reach large groups of PURPOSE: To investigate the effects of non-noxious cutaneous
students, across disciplines. Clinical skills are a major part of the stimulation on the excitability of the motoneurone pool of triceps
curriculum in all health care sciences. Time needed for preparation surae. RELEVANCE: Following an Upper Motor Neurone Lesion
and teaching is vast, especially when sessions need to be repeated (UMNL), the excitability of the motoneurone pool is increased,
to reach increasing large cohorts of students. Extensive resources, resulting in increased muscle tone. We have previously demonstrated
including personnel, are also required. An added difficulty is the acute that pressure, applied circumferentially around the lower limb can
lack of clinical placements and limitations on the choice of suitable alter reflex excitability in neurologically intact subjects. In the current
patients. The purpose of this study is to evaluate the suitability of study we investigated whether similar effects are produced when
online and blended learning delivery methods for teaching clinical pressure is applied in a non-incremental fashion and also compared
skills across different disciplines. RELEVANCE: Blended learning the effects of pressure application with transcutaneous electrical
is a combination of clinical skills teaching online and face to nerve stimulation (TENS). This may be of relevance in treating
face clinical skills sessions. Online learning reduces repetition of increased muscle tone in subjects with spasticity. PARTICIPANTS: A
classes and enables students access to materials for revision. convenience sample of 22 neurologically intact individuals between
PARTICIPANTS: 54 students from the 2 different disciplines at St the ages of 20 and 60 years were recruited. Local ethical approval
Georges University London and the Faculty of Health and Social Care was obtained and all provided informed consent. METHODS:
Sciences at Kingston University participated in the study. METHODS: The tibial nerve was stimulated in the popliteal fossa with a
Clinical skills designed to be used initially by physiotherapy and 1ms pulse duration at 1.1 times the H-reflex threshold. Surface
paramedic students were delivered online and by traditional face- electromyographic recordings were recorded from the skin overlying
to-face techniques. A questionnaire in a Likert Scale format was the lateral head of gastrocnemius. H-reflexes were elicited every 10s
distributed to all year 1 physiotherapy and paramedics students to and their amplitude recorded. Circumferential pressure was applied
obtain their views. ANALYSIS: Non-parametric statistics included for 90s around the lower right leg, using a blood pressure cuff, to
Mann-Whitney U test and cross tabulation to establish the difference magnitudes of 20, 40, 60 and 80mmHg in a pseudo-randomised
and/or agreement between Physiotherapy and Paramedics students, order. Control measures of H-reflex amplitude were obtained prior to
as well as frequency distribution, minimum and maximum, range, application of pressure. H-reflex amplitude was also measured upon
mean and standard deviation (SD). The data was analysed using the pressure release. In addition, high frequency, low intensity TENS
Statistical Package for Social Sciences (SPSS) version 13. The level was applied for 20 minutes to the skin overlying the triceps surae,
of significance was calculated at 5% (0.05), where if the P value is distal to the stimulating and recording electrodes. During this time, at
more than (P > 0.05) the results will not be significant. RESULTS: In 5 minute intervals, H-reflexes were elicited and amplitude recorded
general the majority (n=36, 66.7%) of the participants agreed that 10 times at a frequency of 0.1Hz. Control H-reflex amplitudes were
online Clinical Skills were “very beneficial for my clinical education”, recorded prior to and 5 minutes after the TENS. ANALYSIS: The
and a minority (n=12, 22.2%) held a neutral opinion. Overall, it was mean amplitude of the H-reflex was calculated for each test period
clear that there was no statistically significant difference between for each subject and expressed as a percentage of the control.
the disciplines (P > 0.05) except for the variable “Online skills helped An ANOVA was performed on the mean H-reflex for each pressure
me to answer the relevant questions in my practical exam”, where condition / TENS time frame. RESULTS: When pressure was applied,
P=0.001 (<0.05). CONCLUSIONS: Online Teaching can be used as there was a progressive decrease in mean H-reflex to 52% of the
a means to enhance the acquisition of Clinical Skills. The results control values. This occurred under the highest pressure magnitude,
reported here show agreement between both groups of students regardless of the order in which the pressure was applied and
that online skills should be delivered in a blended learning format. was significantly different to the H-reflex amplitude obtained under
They did not want the number of face-to-face classes decreased 20mmHg (p = 0.002). When TENS was applied, a decrease in mean
and wanted to keep the online information for revision and future H-reflex amplitudes was also observed, to 86% of control values at 20
reference. They were very satisfied with the design and delivery minutes. However this was not related to the length of time of TENS
of the shared modules. IMPLICATIONS: The implication of this stimulation (p = 0.458). CONCLUSIONS: Circumferential pressure
study concerns the provision of support study materials which are applied to the lower limb had an inhibitory effect on motoneurone
available to students at any time, via the intranet. These materials pool excitability: the greater the pressure magnitude, the greater the
are accessible to students wherever they are and enable them to effect. However, the effect of TENS on motoneurone excitability was
revise clinical skills, supported by photographs. They may also be not conclusive as a method of inhibiting motoneurone excitability.
used by students from a range of disciplines, which will decrease IMPLICATIONS: These results support and expand on our previous
the number of lecturers who are involved of the delivery of clinical research proposing the use of circumferential pressure as a method
skills. KEYWORDS: Blended learning, clinical skills, e-learning, of reducing motoneurone excitability and therefore muscle tone in
patients with spasticity. KEYWORDS: motoneurone; pressure; TENS. Research Report Poster Display
FUNDING ACKNOWLEDGEMENTS: None. 09-03 Monday 4 June 15:30
ETHICS COMMITTEE: Glasgow Caledonian University Ethics VCEC Exhibit Hall B & C
Committee. Glasgow Caledonian University, Glasgow, G4 0BA. LYMPHEDEMA EDUCATION IN PHYSICAL THERAPY
Scotland PROGRAMS
Rinehart-Ayres M, Dinkel E, Donohoe K, Goodman J, Hartman J;
Thomas Jefferson University, Jefferson College of Health
Research Report Poster Display Professions, Philadelphia, PA USA
VCEC Exhibit Hall B & C PURPOSE: The purpose of this study was to determine what
principles of lymphedema and lymphedema management are taught
PAIN RELIEF IN LABOUR BY TRANSCUTANEOUS ELECTRICAL in accredited entry-level physical therapy education programs and
NERVE STIMULATION: A RANDOMIZED CONTROLLED TRIAL to determine if there is a difference between programs awarding
Racunica K1 , Scepanovic D1 , Premru Srsen T2 , Zgur L2 ; 1 University an entry-level masters degree and those awarding an entry-
of Ljubljana, College of Health Studies, Department of Physiotherapy, level doctorate in physical therapy. RELEVANCE: Graduates of
Ljubljana, Slovenia; 2 University Medical Centre Ljubljana, physical therapist educational programs are expected to have basic
Department of Obstetrics and Gynaecology, Ljubljana, Slovenia knowledge and skills to enable them to provide care for individuals
with lymphedema. At this time it is unclear what is being taught
PURPOSE: For several years Transcutaneous Electrical Nerve about this condition in Masters and DPT educational programs.
Stimulation (TENS) has been used in the management of chronic PARTICIPANTS: One hundred ninety eight accredited Physical
and acute pain. The aim of this randomized controlled trial was to Therapy programs in the United States were asked to participate
determine its effectiveness in providing pain relief during labour. in the study. METHODS: The Directors of the Programs were sent
RELEVANCE: To date, there is no ideal analgesic that can give survey questionnaires, via email. Completion of the demographic
complete relief of pain during labour without risking complication. questionnaire and a lymphedema questionnaire provided consent
PARTICIPANTS: The study population included 145 pregnant women to participate in the study. The questions were divided into the
(mean age of 29.8±4.2 years) in the hospital antenatal classes of following five categories: anatomy and physiology, pathophysiology,
Dept of Obst & Gynecol at University Medical Centre in Ljubljana exam/assessment, interventions, and training. Respondents were
during the period of two months. PARTICIPANTS: The study not made aware of the categories ANALYSIS: Frequency of yes
population included 145 pregnant women (mean age of 29.8±4.2 responses were counted and converted into percentages. RESULTS:
years) in the hospital antenatal classes of Dept of Obst & Gynecol Thirty-four percent of physical therapy programs participated in the
at University Medical Centre in Ljubljana during the period of two study, 58% Masters and 42% DPT. There was only a significant
months. METHODS: Women were randomly allocated by use of difference between the Masters and DPT programs in the category
sealed envelopes into 2 groups. The experimental group (receiving of Anatomy and Physiology, with Masters Programs addressing this
TENS by burst – conventional obstetric TENS device) and the more often. There were no significant differences between the two
control group (not receiving TENS) consisted of 77 and 68 women types ofeducational programs in the 4 subcategories of functional
respectively. Pain medication was allowed in both groups on request. outcomes, skills, innovative techniques or traditional techniques.
All women were asked to rate the pain half-hourly according to CONCLUSIONS: Although there was little difference between
the visual analogue scale. The marking took place between the Masters and DPT Programs in the educational content related to
contractions. The questionnaire was completed by women two lymphedema, our findings suggest that the majority of programs
day postpartum. This study was approved by the National Ethics are providing graduates with a sound knowledge base about
Committee of Slovenia. ANALYSIS: Statistical analysis included Chi- lymphedema in all five categories. Less than 60% of the programs are
square tests, Student’s t-test, Mann-Whitney test, Wilcoxon test and teaching students the manual skills necessary to treat patients with
Spearman’s correlation. The level of significance was set at 0.05. lymphedema. However, this is a positive trend and demonstrates an
RESULTS: Women in each group were comparable in age, length overall improvement in the training of physical therapy students when
of gestation, birth-weight, parity, the amount of cervical dilatation compared to a study of educational programs done by Augustine,
on admission to labour word, and surgical induction rate. Other et al seven years ago. IMPLICATIONS: All graduates from physical
data collected showed no significant differences in length of labour, therapy programs have not been taught the manual skills necessary
number of obstetrics interventions, and Apgar scores between the to treat patients with lymphedema. KEYWORDS: Lymphedema,
two groups. There was no difference in the intensity of pain recorded education. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT:
by each group and incidence of epidural analgesia. There was [email protected]
a significant delay in initial narcotic usage (6.19 cm vs. 5.45 cm
cervical dilatation; p = 0.015) in experimental group as compared
to control subject. Moreover TENS significantly decreased the Research Report Poster Display
amount of analgesics administered to individual women (p = 0.002). 09-07 Monday 4 June 15:30
In the experimental group all women would ask for TENS again VCEC Exhibit Hall B & C
during their next labour. CONCLUSIONS: TENS could statistically LOW INTENSITY PULSED ULTRASOUND CAN ACCELERATE
significant reduce the amount of medication necessary and hence OSTEOGENIC POTNTIAL OF HUMAN BONE-MARROW-DERIVED
the side effects to mother and child. Nevertheless, there is a MESENCHYMAL STEM CELLS
clear necessity for more precisely designed randomized controlled
Okubo A, Ishikawa M, Yasunaga Y, Mochizuki Y, Ochi M;
trials to determine effectiveness of TENS in labour pain. The
Department of Orthopaedic Surgery, Graduate Scool of Biomedical
results of this study showed that TENS analgesia is compatible
Sciences, Hiroshima University, Hiroshima, Japan
with nursing practice in a public hospital. The study failed to
demonstrate lower pain scores in the experimental group when PURPOSE: Low intensity pulsed ultrasound (LIPUS) is an es-
compared with the control group. IMPLICATIONS: TENS is going tablished therapy for fracture repair and distraction osteogenesis.
to take its place in a public hospital labour ward beside other Despite its pronounced osteogenetic effects on osteoblastic cells,
forms of pain relief available to women in labour. KEYWORDS: the underlying mechanisms of action of LIPUS remain unclear. The
Transcutaneous electrical nerve stimulation; Labour; Pain. FUNDING purpose of this study was to determine the effect of LIPUS on
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] differentiation of human bone-marrow-derived mesenchymal stem
ETHICS COMMITTEE: National Ethics Committee of Slovenia cells (hMSCs) defined as osteogenic precursor cell. To verify this
osteogenetic effect, mRNA expression of cellular phenotype-specific intake before measurement, the effects of food or water intake on
markers characterizing osteoblasts was studied using real-time PCR the CPX have not been clarified. PARTICIPANTS: The subjects were
analysis. RELEVANCE: LIPUS has been used as an available 12 healthy males who gave consent to this study. METHODS: The
physical therapy procedure targeting bone formation. This study subjects, who had fasted, took 420 ml of water (water), or 420 g of
can provide an important evidence to support the therapeutic jelly containing 400 kcal (jelly) after fasting for more than 12 hours
effect of LIPUS by understanding the action mechanism in vitro. from the previous night, and performed the CPX 30 min after intake.
PARTICIPANTS: After informed consent, human mesenchymal stem Expired gas analysis, heart rate, blood pressure, exercise loading
cells (hMSCs) were derived from adult donor bone marrow as at rest, anaerobic threshold (AT), and maximal exercise level were
osteogenic precursor cell. METHODS: Mononuclear cells were evaluated in each intake condition group. ANALYSIS: Measurements
isolated and expanded in vitro. The cells were followed by passages were expressed as the means ± standard deviation. The parameters
3 times. The purity and characteristics hMSCs were confirmed were analyzed in the 3 intake groups by one-way analysis of
by flow cytometry. Before treatment, the hMSCs were seeded at variance (ANOVA). If there was a significant difference, analysis was
6 well plates and cultured in Dulbecco’s Modified Eagle Medium further performed by the Bonferroni method. A value of p < 0.05 was
with 10% fetal bovine serum and 0.5% antibiotic for one day regarded as significant in all analyses. RESULTS: The respiratory
to facilitate their attachment. The cell density was unified to gas exchange ratio (R) was significantly lower in the water group
3.0×104 cells per well. Then, we exchanged the medium with (0.76±0.06) than in the fasting (0.83±0.01) and jelly (0.83±0.05)
the osteogenesis-induced medium and started LIPUS exposure or groups at rest. There was no significant difference in R between the
sham exposure for 20 minutes per day for a period of 7 or 14 fasting and jelly groups. Food intake is considered to increase the
days. The expression of following genes associated with osteoblast heart rate, stroke volume, and cardiac output because of a reduction
differentiation by real-time PCR analysis: osteocalcin, ALP, Runx2, in total vascular resistance, but there were no significant differences
Dlx3 and Dlx5. ANALYSIS: Statistical significance was determined in the resting heart rate, blood pressure, and oxygen pulse among the
using Bonferroni’s modification of Student’s t-test. The level of intake groups. There were no significant differences in the parameters
significance was set at 0.05. RESULTS: We confirmed that the measured at the AT and maximal exercise level among the intake
major populations of adherent cells used in this study were MSCs. groups. CONCLUSIONS: Under our intake conditions, enhancement
Flow cytometric analysis demonstrated that the bone marrow-MSCs of energy metabolism by food intake was suggested in the water
were CD44 and CD105 positive, but were negative for AC133, and jelly groups at rest, but there were no significant differences in
CD34, CD45, CD14 and CD271. These results were consistent the CPX measurement among the groups. IMPLICATIONS: These
with the properties of the documented bone marrow-derived MSCs. results suggested that blood allocation to skeletal muscles was
The expression of Dlx3 mRNA was up-regulated to about fivefold prioritized at the maximal exercise level even during the digestion
at 7 days and about threefold at 14 days by LIPUS treatment and absorption of food. When fluid replacement or food is taken
(P < 0.05). In addition, ALP and Runx2 gene was also significantly before exercise, it is necessary to determine their amounts and
upregulated by the treatment at 14 days. CONCLUSIONS: Dlx kinds, taking the load on the digestive system during exercise into
genes are key-players of development and have also been pos- consideration. KEYWORDS: cardiopulmonary exercise test, food
tulated to regulate cell differentiation in skeleton including bone. intake, physiological response. FUNDING ACKNOWLEDGEMENTS:
In vertebrates, Dlx3 is expressed in skeletal progenitor cells to Unfunded. CONTACT: [email protected]
promote osteoblast differentiation among the Dlx family. Our findings ETHICS COMMITTEE: Kanazawa University
suggest that LIPUS treatment may have a stimulatory effect on early
stages of osteoblastgenesis and induction sequential expressions
of osteogenic markers. It is well known that LIPUS can induce the
upregulation of mRNA levels of typical immediate-early genes, c- 10-15 Monday 4 June 15:30
fos and COX-2, expressed by transduction of mechanical stress. VCEC Exhibit Hall B & C
Although this process is referred the primitive response arisen by A NOVEL DEVICE FOR TRAINING: A FLOAT WALKING ASSIST
extracellular stimuli, our findings suggest that another cascade or SYSTEM USING POSITIVE AIR PRESSURE
mechanisms can exist in pathway of this appreciation. This is the Kuroki H1 , Sakakima H1 , Ikezoe T1 , Oka T2 , Morinaga T3 , Hama H4 ;
first and meaningful study to identify the expression of Dlx genes 1 Department of Physical Therapy, School of Health Sciences, Faculty
following LIPUS exposure during human osteoblast differentiation. of Medicine, Kyoto University; 2 Department of Physical Therapy,
IMPLICATIONS: For physical therapy practice. KEYWORDS: LIPUS Kyoto Police Hospital; 3 Department of Physical Therapy, Faculty
/ osteogenesis / Dlx3. FUNDING ACKNOWLEDGEMENTS: national of Rehabilitation, Shijo-Nawate Gakuen University; 4 Department of
research grant. CONTACT: [email protected] Occupational Therapy, School of Health Sciences, Bukkyo University
ETHICS COMMITTEE: Hiroshima University.
PURPOSE: Partial weight-bearing walking is one of the most
frequently used methods in physical therapy after surgical treatment
Research Report Poster Display or muscloskeletal disorder of lower extremities. In clinical practice,
09-11 Monday 4 June 15:30 partial weight-bearing was performed as under-water walking,
VCEC Exhibit Hall B & C walking with crutches and walking using suspension devices. We
EFFECTS OF THE SELECTION OF FOOD INTAKE BEFORE have developed a novel device for partial weight-bearing and training
CARDIOPULMONARY EXERCISE TEST using positive air pressure. The purpose of study was to examine
whether this positive air pressure has adverse effect on fatigue
Yokogawa M1 , Ueda K1 , Murase J2 , Miaki H1 , Sasaki M3 , Inoue K1 ,
or muscle metabolism during walking or not. RELEVANCE: For
Susaki T1 , Tachino K1 ; 1 Kanazawa University, Kanazawa, Japan;
2 Kariya Toyota General Hospital, Kariya, Japan; 3 Akita University, evidence-based practice, we should have knowledge not only about
accurate weight-bearing status but also about physiological effects
Akita, Japan
of the walking on fatigue and muscle metabolism. PARTICIPANTS:
PURPOSE: We examined the effects of water and a jelly supplement Ten volunteers (3 women and 7 men, mean age of 25.5 years,
taken before the cardiopulmonary exercise test (CPX) on respiration, mean height of 166 cm and mean body weight of 60 kg) who
heart rate, and blood pressure. RELEVANCE: Evaluation of exercise gave informed consent were participated in the study. METHODS:
prescription or exercise tolerance is performed based on results of Lactic acid level, muscle blood flow, skin temperature and core
the CPX. Generally, prior to the CPX, food intake within 2-3 hours temperature of gastrocnemius muscle were measured during normal
before its commencement is forbidden. Although a small amount of treadmill walking at a speed of 4 km/hr (FWB) and during two
water or food should be taken depending on the condition of meal conditions of 2/3 and 1/2 partial body weight-bearing treadmill walking
using the system (2/3 PWB and 1/2 PWB, respectively). ANALYSIS: regarded as MR signals. ANALYSIS: The bilateral MR signals were
Repeated-measure ANOVAs and Scheffe’s post hoc test were used averaged, and the mean MR signals before and after training were
to compare lactic acid level, muscle blood flow, skin temperature and compared by paired t-test. The significance level was designated
core temperature during FWB, 2/3 PWB and 1/2 PWB. RESULTS: 5%. RESULTS: The mean MR signal for the transversus abdominis
Lactic acid level was 1.4±0.39 mol/ml in FWB, 1.5±0.80 mol/ml before training was 179.3 (SD 27.3) and the corresponding value
in 2/3 PWB and 1.5±0.93 mol/ml in 1/2 PWB, respectively, and after training was 259.6 (SD 57.7), showing a significant difference.
no difference of lactic acid level was observed among FWB, 2/3 The mean MR signal for the musculus psoas major before training
PWB and 1/2 PWB settings. Muscle blood flow of FWB, 2/3 PWB was 110.7 (SD 11.2) and the corresponding value after training was
and 1/2 PWB was 16.1±4.70 ml/min, 13.6±4.17 ml/min, 12.4±3.96 111.4(SD 14.1), showing no difference. The mean MR signal for the
ml/min, respectively. Percent muscle blood flow at 2/3 PWB and musculus rectus abdominis before training was 300.6 (SD 50.8) and
1/2 PWB settings was 84.5% and 76.8% of FWB, respectively, and the corresponding value after training was 301.8 (SD 52.6), showing
significantly differed with FWB (P = 0.00172 and P = 0.00002, no difference. CONCLUSIONS: All of the above-described research
respectively). No difference of skin temperature and core temperature observations indicated selective activity of the transversus abdominis
of gastrocnemius muscle was observed among FWB, 2/3 PWB and by training. IMPLICATIONS: This result showed the effectiveness
1/2 PWB settings. CONCLUSIONS: Although positive air pressure of this training method in conditioning the transversus abdominis.
at 2/3 PWB and 1/2 PWB settings has slightly decreased muscle KEYWORDS: transversus abdominis, MR signal, an unstable plate.
blood flow, there is no adversely effect on fatigue measured by lactic FUNDING ACKNOWLEDGEMENTS: Tokyo Metropolitan University.
acid level and on muscle metabolism measured by skin temperature CONTACT: [email protected]
and core temperature of gastrocnemius. IMPLICATIONS: The float ETHICS COMMITTEE: Ethics Screening Committee of Tokyo
walking assist system using positive air pressure may be able to Metropolitan University
use as a device for training under partial weight-bearing setting.
KEYWORDS: positive air pressure, partial weight-bearing, training.
FUNDING ACKNOWLEDGEMENTS: This study was supported in
part by a grant from the ‘Grant-in-Aid for Scientific Research, Japan’.
ETHICS COMMITTEE: The Committee of Department of Physical 10-23 Monday 4 June 15:30
Therapy, School of Health Sciences. VCEC Exhibit Hall B & C
EFFECT OF EXERCISE INTENSITY ON STATIC BALANCE
Research Report Poster Display Song J

PURPOSE: The purpose of this study was to evaluate the effect
of exercise intensity on static standing balance. RELEVANCE:
INFLUENCE OF TRAINING WITH AN UNSTABLE PLATE ON Balance is essential elements for the performance of activities of
ACTIVITY OF THE TRANSVERSUS ABDOMINIS daily living. To understanding possible contributions of exercise
Nitta O1 , Tawara N2 , Kuruma H1 , Yorimitu Y1 , Yanagisawa K1 , intensity to perturbations on static balance, are useful to plan
Seno A1 , Surya J1 , Uchi M3 ; 1 Tokyo Metropolitan University; 2 Japan exercises in rehabilitation process and to decease secondary injuries
Institute of Sports Sciences; 3 Toho University Oomori Hospital after exercise. PARTICIPANTS: Twenty-five college students without
musculoskeletal diseases such as lower back pain and ankle sprain,
PURPOSE: The study was designed to investigate the influence
neuronal problems, and balance disturbance recently within 3 months
of training on muscles in the deep part by using changes in
participated. METHODS: Exercise intensity was calculated using the
magnetic resonance (MR) signal before and after training as indicator.
maximum heart rate of each subjects. Static balance was assessed
RELEVANCE: Improvements in postures are considered important
before and after running exercise on the treadmill for 20minutes
for prevention of low back pain. In recent years there have been
(50% and 70% intensity) using the KAT3000 (Kinesthetic Ability
many reports on the results of studies, which show that the deep
Trainner). ANALYSIS: Paired t-test were used to compare balance
muscles of the trunk play an important role in the maintenance of
index (BI), forward backward ratio (FB ratio), and right left ratio (RL
postures. However, efficient training has not ever been demonstrated,
ratio) according to exercise intensity. RESULTS: BI in 70% intensity
because it is difficult to evaluate deep abdominal muscle activity from
the body surface. PARTICIPANTS: The subjects were 8 men with a exercise (687.84±634.36mm) was greater than 50% intensity
mean age 21.01 years (20-22), which had no past history of low back (414.08±137.41mm) and pre-exercise (376.20±125.84mm). There
pain. The study was approved by the Ethics Screening Committee of was significant difference between pre-exercise and after 70%
Tokyo Metropolitan University. METHODS: The muscles in the deep intensity exercise (p < 0.05). FB ratio in pre-exercise and 50%
part analyzed were the transversus abdominis and the musculus intensity exercise was not statistically significant difference. However,
psoas major. The musculus rectus abdominis, a superficial muscle, there were significant difference between 50% and 70% intensity
was used as controls. In the training an unstable plate of 320 mm exercise and between pre-exercise and 70% intensity exercise
in diameter was placed under the pelvis of subjects in a supine (p < 0.05). After 70% intensity exercise, weight was shifted from
position. While the pelvis was sustained in the proper position, the backward to forward. RL ratio in pre-exercise and 50% intensity
lower extremities were alternately raised by approximately 20 mm for exercise were 0.80108±2.9706 and 0.90320±.18649 respectively,
20 seconds each, for a duration of 20 minutes. The system used therefore body weight was loaded to right side. RL ratio after 70%
was 1.5-T Magnetom Symphony (SIEMENS, LTD.). The imaging intensity exercise was 0.22492±0.75897. There were significant
technique was True FISP (TR = 4.30 ms, TE = 2.15 ms, NEX = difference between 50% and 70% intensity exercise and between
1, FA = 50degree, scan time = 10 sec, FOV = 400 mm). The site pre-exercise and 70% intensity exercise (p < 0.05). CONCLUSIONS:
of analysis was the 4th lumbar vertebra, each slice was 10 mm in Higher intensity exercise contributed to perturbation on static
thickness, and gap was 2 mm. All the parts of the device for exclusive balance. There were no significant difference between pre-exercise
use were non-magnetic substance. Since the patterns of muscle and 50% intensity exercise on BI, FB ratio, and RL ratio. After 70%
activity were evaluated only from changes in signal, the experiment intensity exercise, ability to maintain static balance was decreased.
was conducted with the subjects, and the device placed in the MR IMPLICATIONS: This study provides information on the disturbing
system. Ranges of interest (ROI) were established in the bilateral effect after higher intensity exercise. KEYWORDS: exercise intensity,
transversus abdominis, the musculus psoas major and the musculus static balance, balance index. FUNDING ACKNOWLEDGEMENTS:
rectus abdominis for the analysis, and the mean values in ROI were None. CONTACT: [email protected]
CHANGE IN PATIENT CONCERNS DESCRIBED USING CRITERION OF ALTERED KINEMATICS AND EMG ACTIVITIES
COMPONENTS OF THE ICF DURING THE FIRST SIX WEEKS IN PATIENTS WITH CHRONIC NON-SPECIFIC NECK PAIN
FOLLOWING PRIMARY TOTAL KNEE ARTHROPLASTY Wang S, Lin J, Tang P, Lin K; School and Graduate Institute of
Rastogi R1 , Chesworth B1 , Davis A2 ; 1 University Of Western Physical Therapy, College of Medicine, National Taiwan University
Ontario, London, Canada; 2 Toronto Western Research Institute, PURPOSE: This study compared the neck kinematics and elec-
Toronto, Canada tromyographic (EMG) activities of neck between patients with chronic
PURPOSE: The objectives of this study were: 1) to quantify how the neck pain and asymptomatic subjects during cyclic cervical flexion
level of importance of items identified by patients changes during and extension movement. RELEVANCE: To define the criterion
the first six weeks following primary total knee arthroplasty (TKA) that could determine whether the patients with chronic neck
and, 2) to determine if this change in importance reflects a shift pain demonstrate motor control abnormality. PARTICIPANTS: Nine
in components of the International Classification of Functioning, asymptomatic adults (aged 50.2±12.8), and 10 patients with chronic
Disability and Health (ICF) over time. RELEVANCE: There is no neck pain (aged 56.9±6.5) were recruited. METHODS: Active neck
published evidence of how patient concerns change during the first extension (EXT) and flexion (FLEX) movement was divided into 4
six weeks following primary TKA. An understanding of the recovery phases by the terminal range (t) of neutral position (n): FLEXtn,
process from the patient perspective will aid clinicians/researchers FLEXnt, EXTtn, and EXTnt phases. Range of motion (ROM), speed,
in selecting appropriate outcome measures when evaluating patients and surface EMG of left and right paraspinal muscles (DOR) and
following primary TKA. PARTICIPANTS: Convenience sampling was sternocleidomastoid (SCM) was recorded. ANALYSIS: Repeated
done to recruit 54 consecutive patients (28 females) undergoing ANOVA was used to test the ROM, speed, normalized integrated
primary TKA at a tertiary care hospital in Southwestern Ontario, electromyography (NIEMG) of DOR and SCM. Receiver operating
Canada. METHODS: Subjects completed a questionnaire pre- characteristic (ROC) curve was used to determine discrimination
operatively and at two, four and six weeks post-operatively to rate level of kinematic and EMG measurement. RESULTS: The patients
the level of importance (1=not important at all 7=important to a very moved significantly slower in all phases (p = 0.019). The NIEMG of
great extent) of 32 items previously identified as important in the SCM of patients with chronic pain is significantly increased in all
six weeks following primary TKA. ANALYSIS: Measures of central phases compared to that of the asymptomatic group (p = 0.043).
tendency and dispersion were calculated to determine the level of The movement speed during EXTtn phase and NIEMG of SCM
importance of each item on the questionnaire for each evaluation during EXTnt and EXTtn phase can be used to correctly estimate
session. The median importance rating of the items within each at least 70% and 88.9% possibility that an individual with chronic
ICF component at each time point of data collection were used to neck pain. CONCLUSIONS: Reduced movement speed and over-
assign a level of importance to that ICF component. RESULTS: activated SCM during neck motion appeared to be a control
Patient concerns about recovery that are related to body function and strategy during pain-related adaptation in patients with chronic
environmental factors are of great importance throughout the first six neck pain. IMPLICATIONS: The speed and NIEMG SCM in the
weeks following surgery. Activity limitations are also important during extension phase could serve to differentiate the movement pattern
this time period but are less important to patients during the first two of patients with chronic non-specific neck pain and asymptomatic
post-operative weeks. Conversely, participation restrictions are not subjects. KEYWORDS: EMG, chronic neck pain, head movement,
important to patients early in their postoperative recovery but rise neck muscles. FUNDING ACKNOWLEDGEMENTS: NHRI-GT-EX
to small importance by post-operative week six. CONCLUSIONS: 89E823C. CONTACT: [email protected]
Concerns of patients change as a function of time even during ETHICS COMMITTEE: Ethic committee of National Taiwan University
this early post-operative phase of recovery. Clinicians should keep Hospital
this in mind so that treatment programs can be designed and
progressed based on patient concerns. Further studies are required
to investigate how patient concerns change after the initial six Research Report Poster Display
weeks of recovery. IMPLICATIONS: When evaluating outcome during 12-11 Monday 4 June 15:30
the first six weeks of recovery following primary TKA, clinicians VCEC Exhibit Hall B & C
should use measures that evaluate impairments (loss of body SEEING MOVEMENT QUALITY THROUGH THE LENS OF NEW
function), activity limitations and the role that their environmental TRAINING ASPECTS
plays in improving or hindering the patients’ function. KEYWORDS:
Skjærven L1 , Kristoffersen K2 , Gard G3 ; 1 Bergen University
Arthroplasty, knee, concerns. FUNDING ACKNOWLEDGEMENTS:
College, Bergen, Norway; 2 University of Bergen, Bergen, Norway;
This work was supported by a Premier’s Research Excellence Award 3 Lund University, Lund, Sweden
from the Ontarion Ministry of Health and Lonterm Care to Dr. Davis
and by the Dr. Jal Tata Research Award from the London district of PURPOSE: The aim was to study a group for expert physiotherapists‘
the Ontario Physiotherapy Association to Ravi Rastogi. CONTACT: experiences of training movement quality based on their clinical work.
[email protected] The phenomenon of movement quality is in earlier studies described
ETHICS COMMITTEE: University of Western Ontario Research as a set of movement processes or a series of events proceeding
Ethics Board for Health Sciences Research Involving Human through time; each of them with certain goals, becoming mini-
Subjects objectives within each learning step. RELEVANCE: Physiotherapists
are trained to attend to the physical body focusing a physical training
model. Training movement quality represents a training philosophy
and therapeutic approach focusing on the awareness on how the
whole person moves; it rests on holistic ground. PARTICIPANTS:
A sample size of 15 peer-designated expert physiotherapists, 5
from each field of neurology, psychiatry and primary health care
participated in the study. They were nominated by physiotherapist
leaders in the region. As a second step in the selection process,
each physiotherapist was contacted and informed. They ensured
their willingness to participate by giving a written informed consent.
METHODS: A qualitative study with phenomenological in-depth obtained from the COM position plus its velocity times the square
interviews was chosen as source for the research. The interviews root of (l/g), where “l” represents leg length and “g” represents
were taped, transcribed and sent to the informants for confirmation. the acceleration of gravity. Three ten-second trials were performed
ANALYSIS: Giorgis‘ recommendation concerning analysis of the and averaged for each gait condition. ANALYSIS: In the statistical
qualitative interview was followed. The data of the lived experienced analysis, we performed one-way layout analysis of variance and
descriptions, told by the physiotherapists, depicted what training Scheffe’s multiple comparison tests. The independent variable was
movement quality meant in their professional context searching assumed to be each gait condition and the dependent variables were
for themes around which the phenomenological synthesis is to be assumed to be the coefficient of variation of the amplitude of XCOM
woven. RESULTS: The most outstanding features found so far in and COM. RESULTS: The coefficient of variation of the amplitude
the analysis are 1) creating the physical environment, 2) creating an of the XCOM increased significantly only with an unstable gait
atmosphere of safety and acceptance, 3) creating an interrelation and (p < 0.05). The value was not reflected by the influence of gait speed
true meeting between patient and therapist, 4) guiding movement changes between the three stable gait conditions (p > 0.05). Though
rather than to correct, 5) focus the being in movement, 6) focus the coefficient of variation of the amplitude of the COM increased
healthy movement resources, 7) inviting the patient to explore significantly with an unstable gait (p < 0.05), significant between-
movement from within rather than to repeat mechanically, 8) use of condition differences were found between the slow condition and the
metaphors in guiding movement, 9) awareness as the gate to learning fast condition and between the normal condition and the fast condition
new movementpatterns, 10) to structure situations for movement (p < 0.05). CONCLUSIONS: The change in XCOM suggested the
experiences and reflections, 11) the role of being a “father” and instability of the gait better than change in COM in this study.
a “mother” as physiotherapist and 12) the movement awareness IMPLICATIONS: The change in XCOM make it possible to evaluate
to the physiotherapist. CONCLUSIONS: The result suggests a gait objectively. KEYWORDS: Dynamic stability, unsteadiness of
development in the nature of movement training that leads toward gait, center of mass. FUNDING ACKNOWLEDGEMENTS: None.
a “know how” concerning the patients resources to move and CONTACT: [email protected]
act. Further clarification of how the training aspects is brought
out therapeutically and pedagogically in clinical physiotherapy is
needed, including what the consequences for the qualification of
the physiotherapist might be. IMPLICATIONS: The findings of the 13-19 Monday 4 June 15:30
study provide a clinical reasoning framework for the adoption of an VCEC Exhibit Hall B & C
emerging model for use in physiotherapy. KEYWORDS: Movement ANALYSIS OF TIBIAL ROTATION THROUGHOUT KNEE MOTION
training, movement quality, rehabilitation, Basic Body Awareness USING MAGNETIC RESONANCE IMAGING
Therapy. FUNDING ACKNOWLEDGEMENTS: Thanks to Faculty of Samukawa M1 , Yamaguchi A2 , Yamamoto T3 , Miyamoto S4 ,
Health and Social Sciences, Bergen University College, Norway for Yamanaka M1 ; 1 Department of Physical Therapy, Faculty of Health
supproting the study. CONTACT: [email protected] Sciences, Hokkaido University School of Medicine, Sapporo, Japan;
2 Department of Radiology, Hokkaido University Hospital, Sapporo,
Research Report Poster Display Japan; 3 Department of Radiological Technology, Faculty of Health
Sciences, Hokkaido University School of Medicine, Sapporo, Japan;
13-15 Monday 4 June 15:30 4 Department of Physical Therapy, Graduate School of Health
Sciences, Sapporo Medical University, Sapporo, Japan
EVALUATION OF GAIT INSTABILITY BASED ON THE
EXTRAPOLATED CENTER OF MASS POSITION PURPOSE: “Screw-home motion,” a well-known component of tibial
rotation, occurs throughout the knee flexion-extension movement.
Shimoda H, Sato H, Suzuki Y; Kitasato University, Sagamihara,
However, precisely just how much tibial rotation occurs during the
JAPAN
movement is unclear. Magnetic Resonance Imaging (MRI) is a non-
PURPOSE: The extrapolated center of mass position (XCOM) was invasive procedure and often used for kinematic studies. The purpose
defined on the basis of the velocity of the center of mass (COM), of this study was to determine the angle of tibial rotation at different
which suggests that it is a measure of dynamic stability. This angles of knee flexion using MRI. RELEVANCE: Tibial rotation with
study was conducted to examine whether the XCOM expresses gait flexion and extension is an important physiological element of knee
instability more efficiently than does the COM position. RELEVANCE: motion. To measure and see the angle of tibial rotation is relevant in
Physiotherapists have to decide whether a patient can walk the comparison of normal and pathological knees. PARTICIPANTS:
independently or not. Because the decision usually depends on the Ten normal subjects (5 male and 5 female) were chosen for the
therapist’s experience, it tends to be made subjectively. Sometimes a study. The mean age was 19.9±1.6 years old; mean weight was
therapist hesitates to determine that the patient can be “independent” 55.9±10.7 kg; and mean height was 162.3±8.4 cm. The subjects
because nobody would help the gait-impaired patient to prevent a had no previous history of knee injuries, and no signs or symptoms
fall when walking alone. Objectively assessing gait instability will of neurological diseases or disorders. METHODS: The Sapporo
help to determine whether patients can walk independently or not. Medical University Ethical Committee approved this study. A clinical
PARTICIPANTS: Eleven participants (11 males; age 21.5±2.1 years, 1.5-T whole-body MR scanner (Magnetom Symphony, Siemens
body mass 61.0 ±5.0 kg, height 170.3±5.0 cm) volunteered for this Medical Solutions, Erlangen, Germany) was used throughout the
study. None of the participants had muscular neurological disorders. study. Each subject was measured in the supine position and a
Although there is no ethics committee in our organization, the custom-built wooden apparatus was utilized to fix the knee and hip
experimental procedures were explained to all participants prior to angles. The subjects lay on the apparatus, which was set on the bed
testing and verbal and written consent were obtained. METHODS: of the MRI machine. The angle of tibial rotation was measured at
To generate an unstable gait condition, we used a separated-belt 30, 60, and 90 degrees of knee flexion. ANALYSIS: The repeated-
treadmill. The treadmill belt could be driven at the same speed measures analysis of variance (ANOVA) test was used to compare
(stable condition) and at different speeds (unstable condition). In the angles of tibial rotation among 30, 60, and 90 degrees of flexion.
the stable condition, the subjects walked at slow (1.0 km/h), normal Tukey’s post-hoc test was used to examine any significant findings.
(2.5 km/h), and fast (5.0 km/h) rates. In the unstable condition, the The interpretation of correlation coefficients was used to see the
subjects were perturbed by randomly decelerating and accelerating relationship between the right and left sides. RESULTS: Internal
one side of the walking-belt (0 km/h – 5.0 km/h). The COM position rotational angles occurred throughout the angles of knee flexion
was calculated from kinematic and anthropometric data with the (4.3±10.9 degrees on the right side and 7.1±4.5 degrees at 30
use of an 8-segment rigid body model. The XCOM position was degrees of flexion; 7.2±6.6 degrees on the right side and 7.2±4.2
degrees on the left side at 60 degrees of flexion; 5.4±4.6 degrees close results. The correlation found between manual goniometry and
on the right side and 5.6±5.6 degrees on the left side at 90 degrees photogrammetry ranged from 0.06 to 0.97. The highest correlation
of flexion). There were no significant differences in the angles of values between angles measurements were Gonio/SAPo for TT
tibial rotation among 30, 60, and 90 degrees (p > 0.05), but there (p = 0.001, r = 0.47), Gonio/Corel for Fl/Ex (p = 0.000, r = 0.48). This
was a significant correlation in tibial rotation angles between the results sound reasonable as the data came from two instruments
right and the left legs (r = 0.400, p = 0.028). CONCLUSIONS: At 30, with different resolutions. CONCLUSIONS: Photogrammetry data
60, and 90 degrees of flexion, the tibial rotation angles were all showed a good parallel reliability when compared to goniometry in
internally rotated. The angle of tibial rotation between the left and all lower extremity angular measures but Q-angle. Future studies
right legs was significantly correlated. IMPLICATIONS: The primary envolving other angular measurements are necessary to improve
result of this study is that the angle of tibial rotation can be used evidence-based assessment in Physical Therapy. IMPLICATIONS:
to treat knee joint pathology with range of motion exercises or joint Physioterapists should be aware of measures obtained by different
mobilization. The muscles, tendons, ligaments, menisci, and capsule postural assessments methods since we didn’t find a good parallel
provide joint stability, and as such, tissue injuries around the knee reliability for the Q-angle. KEYWORDS: photogrammetry, goniom-
are considered to change joint kinematics. Therefore, this result etry, reliability. FUNDING ACKNOWLEDGEMENTS: This work was
would be relevant in the comparison of normal and pathological unfunded. CONTACT: [email protected]
knees. KEYWORDS: tibia, rotation, knee kinematics. FUNDING ETHICS COMMITTEE: The local ethics committee
ACKNOWLEDGEMENTS: The work is supported by the grant-in-
aid of Faculty of Health Sciences, Hokkaido University School of
Medicine. CONTACT: [email protected]
ETHICS COMMITTEE: The Sapporo Medical University Ethical 15-03 Monday 4 June 15:30
Committee approved this study. VCEC Exhibit Hall B & C
THE STUDY OF TRUNK MUSCLE ACTIVITY IN REACHING
PERFORMANCE PATTERNS
Tomita T1 , Egasaki E2 , Shimizu Y3 , Takeda H4 ; 1 Department of
Physical Therapy, Yoshikawa Hospital, Tokorozawa-shi, Saitama,
Japan; 2 Department of Physical Therapy, Nakano General Hospital,
PARALLEL RELIABILITY OF PHOTOGRAMMETRY VERSUS GO- Nakano-ku, Tokyo, Japan; 3 Faculty of Physical Therapy, Saitama
NIOMETRY IN POSTURAL ASSESMENT OF LOWER EXTREMITY Social Insurance, Saitama-shi, Saitama, Japan; 4 Department of
Aliberti S, Queiroz B, Teixeira P, Sacco I; Lab. Biomechanics of Physical Therapy, Faculty of Health Sciences, Mejiro University,
Human Movement and Posture, Physical Therapy, Speech and Iwatsuki-ku, Saitama-shi, Japan
Occupational Therapy Department, School of Medicine, University
PURPOSE: It is a common knowledge that the reach movement
of São Paulo – São Paulo – Brazil
needs not only the upper extremity function but also the trunk
PURPOSE: To verify a parallel reliability of computerized pho- function. Nevertheless, the activity of the trunk muscle at reach is not
togrammetry in relation to goniometry. It was compared four angles clear. The purpose of this study is to clarify the activity of the trunk
measurements in the lower extremity measured by goniometry and muscle in bilateral reaching. RELEVANCE: The approach obtaining
by two different softwares used in photogrammetry: Corel Draw to find the trunk muscle activity in reach with a healthy person
and SAPo. RELEVANCE: This research is relevant for Physical will be good treatment and the evaluation of physical therapy for
Therapy because studying measurements characteristics can be person with the dysfunction of the trunk. PARTICIPANTS: Subjects
useful to improve clinical evaluation process which is essential were healthy 11 volunteer students (6 males and 5 females). Their
for evidence based practice. PARTICIPANTS: Twenty- six young age was from 18 to 19 years. They had no dysfunction of trunk,
healthy volunteers (17 woman, 9 man/ 52 legs), recruited among upper and lower limbs. METHODS: The surface electrodes were
university students, aged 21±5 yr, 62.7±13.5 kg, signed an informed attached to rt. rectus abdominis, bilateral external oblique, internal
consent before their participation in the study. METHODS: The oblique and erector spinae muscles. The norswitch was placed to
subjects were positioned in standardized orthostatic position. It was a palm of researcher. The electromyogram and pressure signals
evaluated the Tibiotarsal angle (TT), the Knee Extension/Flexion were synchronous recorded by TeleMyo2400T V2® (Noraxon).
angle(Fl/Ex), the Quadriceps angle (Q), and the Subtalar angle(S) A sampling frequency was 1500 Hz. After these signals were
with the aid of the universal goniometer (Carci) (Marques, 2003). taken into MyoVideo™ (Noraxon), they were analyzed by using
After that, the subjects in the same position had front-, sagittal- MyoResearch (Noraxon). Each subject was measured maximum
, and back-side-view digital photo taken, with specifics anatomic voluntary contraction (MVC) by manual muscle testing of the grade
landmarks highlighted using 10mm spheres. Lastly, photogrammetry 5 (normal). The measured posture was both sitting and standing.
measurements (Watson, 1998) were calculated with the aid of the Each subject reached forward (task 1), reached to a side (task 2),
softwares Corel Draw v. 12 and SAPo v.0.63 (Brazil). ANALYSIS: and reached to the other side (task 3). The beginning point was
Statistics was done by using repeated-measures ANOVA among the direction of “start” in voice sending a signal to the norswitch
three groups and Pearson correlation (a=5%). The reliability of in the same time, and the terminal point was when the signal was
goniometry and photogrammetry alone has already been discussed received again. The instruction and the judgment were both done
in previous studies (Iunes, et al. 2005). RESULTS: The Means, by same researcher. ANALYSIS: After each data was rectified, it
Standard Deviations and p values were evaluated by the three was normalized amplitude of the MVC. Data was analyzed using
methods.Goniometry (TT: 112.3 ±4.0; S: 7.5 ±3.05; Q: 15.01 ±5.58; a repeated-measure analysis of valiance (ANOVA). Next, it was
Fl/Ex: 184.0 ±4.7) presented similar values (p < 0.05) compared to analyzed using one-way ANOVA. Both of data were compared by
photogrammetry (Corel Draw: TT 112.4 ±3.6; S: 8.07 ±4.52; Q: Tukey-Kramer method with the significant level set at P is less than
13.05 ±7.75; Fl/Ex: 181.7 ±4.1; SAPo: TT: 112.4 ±3.4; S: 8.26 0.05. RESULTS: All muscles did not have a significant difference
±4.39; Q: 13.18 ±7.76; Fl/Ex: 181.6 ±4.3). There was no significant in comparing with reaching pattern of a standing posture and a
difference in the results among the three methods in all measured sitting posture. In external oblique, both task 2 and task 3 of the
angles with the exception of Q-angle. The anatomic landmarks of Q other side muscle increased significantly (p < 0.01). In addition task
come from two different and distant joints (hip. knee). It probably may 3 of the other side muscle was significant (p < 0.05) increased
decrease the reliability of this measure in goniometry assessment. in comparison with task 2 of the other side muscle. The erector
There was a high and positive correlation between the two software’s muscle increased significantly (p < 0.01) in task 1. CONCLUSIONS:
data (Corel Draw and SAPo). suggesting that they provide very In reaching task, we found that activities of the trunk muscle by a
posture were changeless. It is important that the action of external Research Report Poster Display
oblique acts on the trunk fixation and the rotation, and erector 15-11 Monday 4 June 15:30
muscle acts on the trunk fixation in any posture. It is necessary VCEC Exhibit Hall B & C
to research the association of trunk movement and joint movement QUANTITATIVE ANALYSIS OF HEAD, TRUNK AND PELVIS
of legs at reaching in the future. IMPLICATIONS: The activity of MOVEMENTS DURING TILTING REACTION IN SITTING
external oblique and erector spinae muscles are the most necessary POSITION
among the trunk muscles for the acquisition of reaching performance. Takahashi T, Ihashi K, Knazaki H, Minamizawa T; Yamagata
KEYWORDS: trunk muscle, reach, electromyogram. FUNDING Prefectural University of Health Sciences
ACKNOWLEDGEMENTS: We are grateful to the volunteer students
of the Faculity of Health Sciences in Mejiro University, RPT Miss PURPOSE: Tilting reaction is induced when supporting surface is
Jinbo, and physical therapists of Yoshikawa Hospital. CONTACT: tilted to maintain body balance. However, there are few studies
[email protected] that measured movements for all axial segments simultaneously.
The purpose of this study was to quantify the three dimensional
movement of tilting reaction in sitting position. The head, trunk,
Research Report Poster Display and pelvis movements were examined simultaneously and direction
15-07 Monday 4 June 15:30 and the timing of the movement were analyzed. RELEVANCE: This
VCEC Exhibit Hall B & C work offers direction, timing and magnitude of key movements of
EFFECT OF TRUNK RANGE OF MOTION AND ANGULAR tilting reaction in sitting position and the findings can be utilized
VELOCITY ON ISOKINETIC PEAK TORQUE OF TRUNK FLEXOR to assist and instruct the movement to clients in clinical practice.
AND EXTENSOR MUSCLES PARTICIPANTS: Participants were 21 young healthy subjects (11
male, 10 female). All participants provided their written informed
Elhafez S1 , Nassif N1 , Elhafez G1 , Fawaz H1 , Balbaa A2 ; consent. Mean age was 21.3±1.5 (mean ± SD) years, height was
1 Department of Biomechanics, Faculty of Physical Therapy,
164.3±9.7 cm and body weight was 57.0±8.8 kg. METHODS: A
Cairo University, Egypt; 2 Department of Physical Therapy for three dimensional motion analyzer (Vicon 370) with 7 cameras was
Musculoskeletal Disorders, Faculty of Physical Therapy, Cairo used to measure exact angle displacement of all direction of the
University, Egypt head, trunk and pelvis movements. A tilting platform tilted to 20
PURPOSE: This study was conducted to explore the effect of degrees with the tilting velocity of 5 and 10 degrees per seconds
different trunk ROM (30º, 50º and 70º) and different angular velocities to induce the tilting reaction. The movements of flexion- extension,
(30º/sec and 60º/sec) on the trunk flexor and extensor isokinetic lateral flexion, and rotation of the head and trunk, also anterior-
peak torque ratio. RELEVANCE: There is a lack of data concerning posterior tilt, lateral tilt and rotation of the pelvis were measured.
the interpretation of spinal isokinetic parameters with different spinal The order and tilting angle of the platform at beginning of induced
ROM. Thus, the ability to specify the optimal range of motion and movements, also the directions and angle of the movements of each
angular velocity that can develop maximal trunk muscle strength segments at maximum tilt (20 degrees) were analyzed. ANALYSIS:
is not clear. Therefore, the current study was designed to test Statistical analyses were carried out using StatView (ver.5.0). Chi-
the trunk flexors/extensors strength ratio through a different spinal square test, ANOVA and t-test were used to assess statistical
range of movement and angular velocities. PARTICIPANTS: Thirty difference for order of beginning and direction of movements, tilting
healthy male subjects with a mean age of 19.95 years volunteered to angle at beginning of movements of each direction, and movements
participate in this study. They were all free from any musculoskeletal between two velocities respectively. RESULTS: All the movements
impairment. METHODS: The study was carried out using the Biodex were induced before tilting angle was reached 10 degrees. The
system 3 Isokinetic dynamometer. Each subject was instructed to movements that happened in the early stage of the reaction were
perform four trials of consecutive trunk flexion and extension at trunk rotation and lateral flexion to opposite side (TRO and TLFO),
the three trunk ROM in the concentric trunk flexors and extensors head lateral flexion to opposite side (HLFO). The pelvis movements
contraction mode. During each ROM, the subject performed the began in the late stage of the reaction. These findings regarding
trial with 30º/sec velocity and another time with 60º/sec velocity. timing of the induced movements were clear in tilting velocity at
ANALYSIS: Two way ANOVA with repeated measures and LSD 10 º/s. The main directions of the movement at maximum tilt were
multiple comparison post-hoc test were performed to compare HLFO, trunk flexion (TF), TLFO, TRO and opposite side lateral
between the different ROM with the two velocities on the trunk flexors tilt of the pelvis (PLTO). Also the ratio of ROM (induced / active
and extensors. RESULTS: The results indicated that the trunk flexors maximum ROM) of HLFO, TF, TLFO and TRO were 16%, 10%,
PT and the trunk flexors/extensors PT ratio decreases significantly 36% and 16% respectively and other movements were less than
(p < 0.05) with increasing trunk ROM at the two tested velocities. In 10%. CONCLUSIONS: The results indicated that HLFO, TF, TLFO,
contrast, the PT values of the trunk extensors at the two angular TRO and PLTO are key movements of tilting reaction in sitting
velocities increased significantly (p < 0.05) by increasing the trunk position in healthy young subjects. Further study is required to
ROM. Furthermore, the trunk flexors and extensors PT value at clarify other age group and people with neurological dysfunction.
60º/sec angular was lower than that at 30º/sec angular velocity. IMPLICATIONS: From this work, HLFO, TF, TLFO, TRO and PLTO,
CONCLUSIONS: This study revealed that the spinal isokinetic especially TLFO and TRO in the early stage of the reaction are
data is dependent on the spinal ROM. Moreover, the optimal important to balance exercise. KEYWORDS: tilting reaction in sitting
trunk ROM and angular velocity that produce the highest torque position, 3-dimensional analysis, quantitative analysis. FUNDING
of trunk flexor were at the first ROM (30º flexion) using 30º/sec ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
angular velocity. Regarding the trunk extensors peak torque, the [email protected]
highest PT value can be obtained at the third ROM (70º flexion) ETHICS COMMITTEE: Ethics approval for this study was given from
using 30º/sec angular velocity. IMPLICATIONS: The current study the ethics committee of Yamagata Prefectural University of Health
can help physical therapists to accurately specify the optimal Sciences.
trunk ROM and angular velocity that can develop maximal trunk
muscle strength. Furthermore, it may help physical therapists in
designing the preventive and rehabilitative programs for subjects with
trunk disabilities. KEYWORDS: Trunk, Isokinetic, Velocity. FUNDING
ACKNOWLEDGEMENTS: This study was not funded. CONTACT:
[email protected], [email protected]
ETHICS COMMITTEE: Egyptian Physical Therapy Syndicate
IS THERE ANY DIFFERENCE BETWEEN UNILATERAL AND WICH CLINICAL METHODS SHOULD WE USE TO ASSES LEG
SIMULTANEOUS BILATERAL KNEE ARTHROPLASTY ON PAIN LENGTH DISCREPANCY?
RELIEF AND KNEE FUNCTION? Sonsino Pereira C, Silva de Andrade M, de Camargo Neves
Can F, Erden Z, Bozkurt M, Aygul V Sac I; Departament of Speech, Physical Therapy and Occupational
Therapy, School of Medicine, University of São Paulo
PURPOSE: Degenerative arthritis may be seen in both knees PURPOSE: The aim of this study was to find out which clinical
concurrently and may required bilateral Total Knee Arthro- method should be used in clinical practice by examiners to
plasty(TKA).Surgical treatment of bilateral symptomatic arthritis of determine precisely leg length discrepancy. RELEVANCE: Many
the knee is controversial.Simultaneous bilateral TKA than staged anthropometric methods have been used in physical therapy practice
bilateral TKA is known to be cost effective for patients requiring to evaluate leg length discrepancy (LLD), including clinical and
bilateral TKA.The literature has not yet to answer the questions radiological methods. Several studies have described how clinical
about improvements in pain and knee functions as well as patient’s methods can be inaccurate which is unacceptable when you wish
satisfaction.The aim of this study was to compare the results of to correct an asymmetry. It would be usefull to have at least one
pain level, knee functions and patient’s satisfaction in patients efficient clinical method considered as the main tool to evaluate LLD
with unilateral TKA and simultaneous bilateral TKA. RELEVANCE: when the radiographic method can not be done. PARTICIPANTS:
The determining pain levels, restoration of knee mechanism and 230 physically active subjects were studied with mean age 28.7±7.2
knee functions in patients with simultaneous bilateral TKA are years. 47 subjects were randomly chosen to perform the scanogram.
the other important predictors of outcome of TKA in addition to METHODS: Subjects were positioned supine with lower limbs in
analyzing of total cost and complications.To replying those questions anatomic position in order to perform the measurements, which
about efficacy on pain and functions and patient’s satisfaction were acquired twice on each lower limb for each method. Four
which are still unclear in simultaneous bilateral TKA could be a clinical methods were analyzed: from anterior superior iliac spine
guide related to the treatment regime of patients with bilateral (ASIS) to superior border of medial malleolus (MM); from ASIS to
symptoms. PARTICIPANTS: 12 patients (10 females,2 males) superior border of lateral malleolus (LM); from iliac crest to inferior
undergone unilateral TKA with a mean age of 60.75±7.5 years border of MM; and from umbilicus to inferior border of MM. The
and 9 patients (9 females) undergone simultaneous bilateral TKA scanogram was the radiologic method chosen as gold standard. LLD
with a mean age of 66.22±10.58 included in the study.Patients was calculated by subtracting the shorter leg length measurement
who had undergone a revision or corrective surgery and those from the longer leg length measurement. ANALYSIS: LLD data
who had an infection, diabetes, peripheral vascular or motor neuron were compared among five methods using Friedman ANOVA.
disease were excluded. METHODS: All the patients were measured Pearson’s correlation between each clinical method to radiologic
for pain intensity level in rest and in activity according to the method was done. An a of 0.05 was adopted. RESULTS: The
Visual Analogue Scale. Knee score and functional score was mean values of LLD obtained by the methods ASIS/MM, ASIS/ML
recorded using Knee Society Scoring Scale. Patient’s satisfaction and iliac crest/MM (1.0±0.8cm, p ≡ 0.010; 1.0±0.7cm, p ≡ 0.002;
was assessed using a subjective measurement system ranged 0- 0.8±0.6cm, p ≡ 0.013; respectively) were statistically different from
10 points. To measure overall satisfaction a score graded 0-4 was the scanogram (0.6±0.5cm). However, LLD values obtained by
used. ANALYSIS: The datas were analized using SPSS for Windows the method Umbilicus/MM presented no significant difference
(0.6±0.5cm, p ≡ 0.577) in comparison with scanogram. Results
Release 11.5 packed program.Unrelated t-Test was used to compare
showed also that leg length data obtained by the four clinical methods
the parameters in the groups.The significance level was set at
presented a higher correlation to data obtained by scanogram (r from
p < 0.05. RESULTS: The mean pain level in rest was 1.5±0.84
0.93 to 0.96; p 0.001). CONCLUSIONS: Although the four clinical
cm for bilateral TKA and 2±0.85 cm for unilateral TKA.Their pain
methods presented a higher correlation to the radiologic method in
level in activity was 3.44±1.27 cm in bilateral TKA and 3.46±0.75
relation to leg length, only the method umbilicus/MM presented the
cm in unilateral TKA.Knee score was found 64.22±4.53 points
same value of LLD as presented by the radiologic method, indicating
and functional score was 57.22±7.22 points in the bilateral TKA be the most precise clinical method. IMPLICATIONS: We suggest
group while knee score was 64.25±2.35 points and functional score that therapists should use the distance from umbillicus to inferior
was 71.25±3.32 points.There was no significant difference in pain border of medial malleolus as the main tool during clinical practice
level in rest and in activity between the patients with bilateral TKA in order to obtain precise values of LLD. KEYWORDS: Leg Length
and unilateral TKA (t1=0.602p > 0.05,t2=0.862p > 0.05).Knee score Inequality; Anthropometry. FUNDING ACKNOWLEDGEMENTS: this
and functional level were similar in unilateral and bilateral TKA work was funded by FAPESP. Process number 1: 03/08165-7 (Carla
groups (t1=0.808p > 0.05,t2=0.111p > 0.05).Patient’s satisfaction in Sonsino Pereira under orientation of Isabel de Camargo Neves
rest was higher in bilateral TKA group than the unilateral TKA group Sacco, PhD, Professor of the Departament of Speech, Physical
(t=0.04p < 0.05) whereas there was no difference between the groups Therapy and Occupational Therapy, School of Medicine, University
in patient’s satisfaction in activity (t=0.11p > 0.05). Overall satisfaction of São Paulo). Process number 2: 04/10604-1 (Mariane Silva de
was also higher in bilateral TKA group than the unilateral TKA group Andrade under orientation of Isabel de Camargo Neves Sacco, PhD,
(t=0.04p < 0.05). CONCLUSIONS: It has revealed that there is no Professor of the Departament of Speech, Physical Therapy and
difference in pain and in functions between unilateral and bilateral Occupational Therapy, School of Medicine, University of São Paulo).
TKA.However patient’s satisfaction was higher in simultaneous CONTACT: [email protected]
bilateral TKA.In following those results, simultaneous bilateral TKA ETHICS COMMITTEE: Approved by the Education and Research
could be recommended for patients with bilateral degenerative Committee of the Hospital das Clinicas of the University of São Paulo,
arthritis of the knee. IMPLICATIONS: Simultaneous bilateral knee Brazil
arthroplasty could be a better treatment procedure using one
anesthetic and one postoperative rehabilitation period if the patients
properly selected. KEYWORDS: Bilateral TKA, Pain, Knee Func-
tions, Patient’s Satisfaction. FUNDING ACKNOWLEDGEMENTS:
None.
ETHICS COMMITTEE: Hacettepe University Ethics Committee
Research Report Poster Display neural compression and its degree in patients with non-specific
16-23 Monday 4 June 15:30 LBP. The neural compression was evaluated by Soleus (sol) and
VCEC Exhibit Hall B & C Vastus Medialis (VM) H-reflexes from affected and unaffected lower
EFFECTS OF DIFFERENT EXERCISE CONDITION IN extremities during loading and unloading postures RELEVANCE:
IMMOBILIZATION-INDUCED MUSCLE ATROPHY IN THE RAT Treatment would therefore be directed to the compromised structure
e.g. neural or musculo-ligamentous PARTICIPANTS: Patients (n=30)
Sakakima H1 , Yoshida Y2 , Matsuda F2 , Hiroshi K1 ; 1 Department
with non-specific LBP with no leg pain, numbness or weakness
of Physical Therapy, School of Health Sciences Faculty of Medicine,
were selected by convenient sampling and consented to the stud
Kyoto University; 2 Department of Physical Therapy, School of
METHODS: Patients were tested with electrophysiologic studies of
Health Sciences Faculty of Medicine, Kagoshima University
the Sol and VM H-reflexes during lying (unloading) and standing
PURPOSE: The purpose of this study was to investigate the effects (loading). The reflex amplitude was the dependent parameter. Both
of different condition of treadmill running on immobilization-induced legs were tested and the peak-to-peak amplitude of the right to
soleus and gastrocnemius muscle atrophy of rats by morphology left lower limb’s sol. and VM reflexes were compared to measure
and histochemistry. RELEVANCE: This study might provide a basic reflex symmetry/asymmetry. The difference in the reflex amplitude
evidence of rehabilitation medicine. PARTICIPANTS: Thirty-nine 8- between the right and left side was compared for the lying and
week old female Wistar rats weighing 188.2±10.6 g (mean ± standing postures (R/L lying, R/L standing, R lying/R standing, L
standard deviation) were used in this study. METHODS: The right lying/L standing). The compromised spinal side (right Vs left) and
ankle joint of rat was immobilized for two weeks. Thereafter, rats the spinal levels (soleus for S1/L5 & VM for L4) were identified.
were randomly assigned to 4 groups for 6 weeks of exercise under Sol. & VM H-reflexes were recorded using Sabbahi & Khalil (1990)
different conditions: free cage activity and free remobilization (FR), after electrical stimulation of the tibial nerve at the popliteal fossa
once-a-week treadmill running (low frequency running: LFR), three or the femoral nerve at the inguinal canal and recording the sol. or
time-a-week running (middle frequency running: MFR), and six VM reflex action potential with surface electrodes. Electromyography
time-a-week running (high frequency running: HFR) groups. The (EMG) unit was used for H-reflex testing. ANALYSIS: ANOVA was
program was progressive so that the running time increased from 10 used for statistical analysis with a value set at 0.05. RESULTS:
min/session in the first week to 40 min/session in the sixth week, showed reflex asymmetry with a smaller amplitude of sol. or
and running speed was increased from 12 m/min to 24 m/min, VM H-reflexes on one side (of more than 20%) that was more
with an inclination of 10º. ANALYSIS: One-way analysis of variance pronounced during standing postures. Such 20% reduced amplitude
(ANOVA) was used and when a significant F ratio was found, post- was significant (p < 0.05) when compared to our previous data on
hoc Fisher’s protected least significant differences (PLSD) test was normal subjects. Patients with compromised sol. H-reflex suffer LBP
performed on each variable. RESULTS: Two weeks of immobilization at the lower segment of lumbosacral region indicating S1 root
significantly reduced the muscle fiber cross-sectional area of soleus involvement. Patients with smaller VM H-reflexes suffer higher spinal
type I and type II fiber, gastrocnemius type I and type II fibers. segmental level (L4) of pain/tenderness CONCLUSIONS: These
It increased the ratio of type II to total fiber numbers in the results indicate possible neural compromise to the spinal nerve
soleus, and gastrocnemius, and induced pathological changes in roots in patients IMPLICATIONS: Treatment of non-specific LBP
muscle fibers. Some of these changes could not be corrected must be directed toward the nerve root compromise/impingement
by free remobilization; however, the LFR, MFR, and HFR groups and not the musculo-ligamentous dysfunction for speedy recovery.
clearly recovered toward normal levels with exercise frequency, the KEYWORDS: low back pain, H-reflex, electrophysiologic testing,
effect on muscle recovery being more beneficial in the MFR and nerve roots. FUNDING ACKNOWLEDGEMENTS: unfunded study.
HFR-groups. CONCLUSIONS: Our study provided evidence that CONTACT: [email protected]
immobilization-induced reduction in fiber size, accumulation of fibers
with pathological alteration, and changes in fiber type conversion
are in great part reversible phenomena. This study suggested that Research Report Poster Display
treadmill running three and six times a week was more beneficial 19-19 Monday 4 June 15:30
in recovery of muscle atrophy compared to no running or once-a- VCEC Exhibit Hall B & C
week running. Thus, middle frequency exercise is as beneficial as NECK MUSCLE STIFFNESS MEASUREMENT BY AN
high frequency exercise for recovery of atrophied muscle tissues, ULTRASOUND PALPATION SYSTEM
although low frequency exercise showed little effect. IMPLICATIONS:
Lee E1 , Moore A2 , Jones M3 , Leung S4 ; 1 Physiotherapy
This study may be helpful to determine the appropriative frequency
Department, Prince of Wales Hospital, Shatin, Hong Kong SAR;
of a rehabilitation program. KEYWORDS: muscle atrophy, exercise, 2 Clinical Research Centre for Health Professions, University
recovery. FUNDING ACKNOWLEDGEMENTS: Supported by the
of Brighton, United Kingdom; 3 School of Engineering, University
Ministry of Japan Culuture, Education and Science.
of Brighton, United Kingdom; 4 Department of Clinical Oncology,
ETHICS COMMITTEE: The following experimental protocol was
Chinese University of Hong Kong, Hong Kong SAR
approved by the ethical board of the Institute of Laboratory Animal
Sciences of Kagoshima University. PURPOSE: In clinical practice, an objective and quantifiable
assessment to detect the soft tissue stiffness as an outcome indicator
is lacking. This study aimed to assess the neck muscle stiffness
by a novel ultrasound palpation device to document the Young
18-07 Monday 4 June 15:30 Modulus (YM) which is a biomechanical property that characterises
VCEC Exhibit Hall B & C the deformability of the soft tissue. RELEVANCE: Manual palpation
IS NON-SPECIFIC LOW BACK PAIN ASSOCIATED WITH is a common clinical assessment method to reflect the soft tissue
NEURAL COMPRESSION? stiffness. The information obtained is subjective and can only be
categorized in ordinal form. Soft tissue stiffness can be measured
Sabbahi M; Texas Woman’s University, Houston, Texas, USA
by the YM. The development of an ultrasound palpation device
PURPOSE: Non specific low back pain (LBP) without radicular to measure YM has been addressed by one of the authors in
symptoms (pain, numbness or weakness) has always been evaluated previous studies. The concept was applied to quantify post-irradiation
and treated as musculo-ligamentous disorders. The lack of sensitivity fibrosis which is a very common late complication in patients
in clinical evaluation and lack of studies of standing MRI for those with nasopharyngeal carcinoma (NPC). PARTICIPANTS: Patients
patients resulted in missing the neural involvement in non-specific suffering from NPC with their cancer in remission and were attending
LBP. Purpose: The objective of this study was to evaluate the treatment in the physiotherapy department in a regional teaching
hospital were invited. Those reluctant to participate or had signs and objective screening for past or present injury to the neck,
of active metastases were excluded. All invited patients agreed and shoulder girdle or upper limb, inflammatory joint conditions, and
they were recruited for the one-off assessment (n=20). 15 healthy vascular or neurological disorders. METHODS: Whilst seated the
health-care workers volunteered for this neck muscle stiffness profile subjects’ arm was passively supported in a randomised series
assessment. METHODS: Intra- and inter-rater reliability studies were of 12 standardised arm positions incorporating varying degrees
first performed on a 50mm diameter x 9.5mm thick circular phantom of horizontal flexion/extension, abduction and external rotation.
silicone gel pad. Two raters were included for the inter-rater reliability Doppler ultrasound insonated subclavian artery D (mm) and PSV
calculation. Afterwards neck muscle stiffness was measured, the (cm/s) in each position. ANALYSIS: Data comparisons were made
subjects were seated and their necks were put in a neutral position. using ANOVAs with bonferroni adjustment for multiple comparisons.
An ultrasound probe was applied on a reference point 3cm inferior Alpha level was set at P = 0.01. RESULTS: The normative re-
to the lowermost point of the mastoid on each side of the neck sponse for most arm positions was consistent with no change in
and YM was calculated from the load-indentation response curve. subclavian artery D and PSV. However, at 180º abduction, and
ANALYSIS: Intra- and inter-rater reliabilities were calculated by 120º abduction with 30º horizontal extension and 90º external
Bland and Altman plot using MedCalc for Windows, version 8.2.0.3. rotation, a heterogeneous PSV response was evident. Specifically,
Independent t test using SPSS 13.0 were performed to compare complete occlusion was demonstrated by 6 subjects’ and 2 subjects’
YM values between normal subjects and patients. RESULTS: Very respectively. Further, significant decreases (P = 0.008) in PSV were
good intra- and inter-rater reliabilities were shown by the ultrasound recorded from 120º, 90º and 45º abduction (92±10, 89±11, 88±14
palpation device in YM measurements of the phantom silicone pad. cm/s, respectively) to 180º abduction (mean±95% CI: 52±16 cm/s).
Regarding the patient profiles, their average age was 46.5 (13 males, Similarly, post hoc comparisons revealed a significant decrease
7 females) versus 48.6 in the healthy normal subjects (9 males, (P = 0.008) in PSV from 120º abduction (94±14 cm/s) to 120º
6 females). Average post radiotherapy completion time was 13.2 abduction with 30º horizontal extension and 90º external rotation
months (range: 4-62). The YM values of patients were significantly (69±12 cm/s). CONCLUSIONS: Vascular parameters were largely
higher. The respective YM of the left neck muscle of patients and unaffected by arm movements in normal healthy adults. Only
normal subjects were 28.8+/−21.9 kPa and 17+/−4.6 kPa (mean +/− at the extremes of range of motion were significant alterations
SD) with p = 0.049 while that of the right side were 26.6+/−19.3 kPa recorded in PSV. These responses were notably heterogeneous.
and 16.8+/−4.7 kPa (mean +/− SD) with p = 0.044. CONCLUSIONS: IMPLICATIONS: Clinically, signs of vascular insufficiency occurring
YM values were obtained by the ultrasound palpation method which in the less extreme arm positions would better detect arterial
produced a quantified outcome parameter. The method also proved compromise than tests employing the extremes of range where
to differentiate between normal subjects and patients with irradiation a high risk of false positives exists. Clinical decisions based on
given to the neck, and post-radiotherapy gave rise to a stiffer neck. false positive outcomes have serious implications for mistreatment
IMPLICATIONS: A wide range of YM values were documented for such as inappropriate surgical intervention. The heterogeneous
the patient group which needs to be further divided into groups response of asymptomatic individuals with no past history of TOS
with and without fibrotic changes. Correlational studies with neck symptoms sheds uncertainty on the validity and reliability of positive
symptoms and neck ranges can be explored. KEYWORDS: neck, test responses from extreme arm positions. Further research is
stiffness, palpation. FUNDING ACKNOWLEDGEMENTS: The study required to ascertain the sensitivity of such manoeuvres and
was funded by Sir Robert Black Trust Fund Postgraduate Scholarship. discover means to improve the specificity. KEYWORDS: thoracic
CONTACT: [email protected] outlet syndrome. FUNDING ACKNOWLEDGEMENTS: unfunded.
ETHICS COMMITTEE: Joint the Chinese University of Hong Kong_ CONTACT: [email protected]
New Territories East Cluster Clinical Research Ethics Committee ETHICS COMMITTEE: Liverpool John Moores University Ethics
Committee
21-11 Monday 4 June 15:30 Research Report Poster Display
VCEC Exhibit Hall B & C 22-23 Monday 4 June 15:30
SONOGRAPHIC EVALUATION OF THE SUBCLAVIAN ARTERY VCEC Exhibit Hall B & C
DURING THORACIC OUTLET SYNDROME SHOULDER INFLUENCE OF KYPHOSIS ON WALKING IN PARKINSON’S
MANOEUVRES DISEASE PATIENTS
Stapleton C1 , Herrington L2 , George K1 ; 1 Research Institute for Sakurai Y, Nagasawa H, Uchida K, Fujita M; Kanagawa University
Sport and Exercise Sciences, Liverpool John Moores University, of Human Services, 1-10-1 heiseicho, Yokosuka, Kanagawa, Japan
Liverpool, UK; 2 Centre for Rehabilitation and Human Performance
PURPOSE: We performed this study to clarify the relationship
Research, University of Salford, Manchester, UK
between kyphosis and walking. RELEVANCE: Kyphosis is a major
PURPOSE: Clinical tests for vascular thoracic outlet syndrome symptom of Parkinson’s disease (PD). We may encounter PD
generally incorporate shoulder horizontal flexion/extension, gleno- patients whose kyphosis gradually advances with walking until they
humeral abduction and external rotation. It is assumed that these are unable to walk. However, there have been only a few reports
manoeuvres stress the vasculature to accurately reproduce the signs concerning the relationship between the degree of kyphosis and
(e.g. radial pulse disappearance) and symptoms (e.g. heaviness, walking in PD patients. PARTICIPANTS: The subjects were 12
paraesthesia) of vascular insufficiency. The effect of these clinical PD patients (mean age: 65 years, mean disease duration: 6.7
tests on blood flow characteristics and the most effective arm years, Hoehn-Yahr stage: 1-3, UPDRS: 26.9) and 10 healthy adults.
positions for detecting arterial compromise are, however, unknown. METHODS: Infrared-reflecting markers were applied to C7, L4, the
The aims of this study are to; establish normative vascular responses most protruded point of thoracic kyphosis (T), shoulder, hip joint, knee
(i.e. arterial diameter [D] and peak systolic blood flow velocity [PSV]) joint, lateral malleolus, and head of the 5th metatarsus, and measured
to various arm positions, and to identify the most effective using a 3-dimensional motion analysis instrument, VICON612 (Vicon
arm position(s) for differential diagnosis. RELEVANCE: Vascular Peak Co.). The lengths of a line, L, connecting C7 and L4, and
compromise has been reported in individuals performing repetitive a perpendicular line, D, drawn from T to L were measured, and
athletic and occupational overhead actions. Physiotherapists require the kyphosis index (KI)(D/L × 100) was calculated using the method
accurate clinical tests to differentiate vascular insufficiency from reported by Milne. The KI and lower extremities (L/E) joint angle
neuro-musculoskeletal injury. PARTICIPANTS: 10 male and 21 during walking were analyzed. ANALYSIS: Analysis of variance
female (mean age: 25 yr) healthy volunteers underwent subjective (ANOVA) was used for statistical analysis with a significance level
of 5% (SPSS, ver-13, Windows). RESULTS: The mean KI during seconds to 14 seconds while 9MWT increased from 265 meters
the gait cycle were 7.74 and 12.3 in the healthy and PD groups, to 280 meters. During the experimental treatment BBS increased
respectively. No regularity was noted in the changing pattern of the from 39 to 49, 10MWT decreased from 14 seconds to 12 seconds
KI in a gait cycle in the healthy group. When the KI increased in while 9MWT increased from 280 meters to 360 meters. At follow-
the early stance phase, the hip and knee flexion angles increased, up these values were retained. LEMS scores were similar in all
and when the index decreased in the mid stance phase (M.S), the study phases and resulted in 35/50 (14/25 left lower extremity,
knee joint extension angle increased. The PD group was classified 21/25 right lower extremity). CONCLUSIONS: During baseline period
into 3 groups: A, the KI was almost constant throughout a gait cycle; subject’s balance and walking abilities improved, although during
B, the KI was high at the time of landing the foot-flat and in the treadmill training those parameters improved further. In comparison
terminal-stance phase, while the index was low in M.S, showing a to conventional treadmill training with upper extremities support on
biphasic pattern; and C, variation was large among tests, showing no parallel bars, treadmill training with the dynamic support device,
regularity. The mean KI in M.S were 10.8, 13.3, and 17.41 in A, B, significantly improved studied balance and walking parameters, which
and C, respectively, showing that the index increased in the order of were retained at one month follow-up. IMPLICATIONS: These results
C, B, and A. The UPDRS score increased in the order of C, B, and A. indicate that the dynamic balance support device for walking on a
No significant difference was noted in the mean L/E joint angle in the treadmill might be useful addition to conventional treadmill training,
early stance phase, but the increase in variation (SD) with the number through its facilitation of balance control and more functional walking
of tests increased in the order of the PD-C, healthy, PD-A, and PD-B without use of upper extremities for support. KEYWORDS: SCI, gait,
groups, indicating that variation of L/E joint angle per step increased rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
in this order. CONCLUSIONS: Aggravation of kyphosis decreases supported by the research grant P2-0228 from the Research Agency
the variation of L/E alignment during walking, which may be a of the Republic of Slovenia. CONTACT: [email protected]
cause of decreased walking ability in PD patients. IMPLICATIONS: ETHICS COMMITTEE: Slovenian national etics commitee
Based on these findings, the healthy subjects changed the mutual
alignments of the trunk and L/E every step to deal with walking,
but the complementary relationship between the trunk and L/E Research Report Poster Display
was destroyed in the PD patients, and they walked by reproducing 23-07 Monday 4 June 15:30
individually fixed forms of the trunk and L/E. KEYWORDS: Parkinson, VCEC Exhibit Hall B & C
Kyphosis, Gait. FUNDING ACKNOWLEDGEMENTS: Aggravation of
kyphosis decreases the variation of L/E alignment during walking, MOVEMENT PATTERN AND ELECTROMYOGRAPHIC ANALYSIS
which may be a cause of decreased walking ability in PD patients. OF WHEELIE OVER DIFFERENT HEIGHTS IN SUBJECTS WITH
CONTACT: [email protected] SPINAL CORD INJURY
ETHICS COMMITTEE: This study was approved by the Ethical Lin K1 , Lu T2 , Chen H3 , Liing R1 ; 1 School and Graduate Institute of
Review Board of Kanagawa University of Human Services. Physical Therapy, College of Medicine, National Taiwan University,
Taipei, Taiwan; 2 Institute of Biomedical Engineering, National
Taiwan University, Taipei, Taiwan; 3 School of Occupational Therapy,
Research Report Poster Display College of Medicine, National Taiwan University, Taipei, Taiwan
VCEC Exhibit Hall B & C PURPOSE: The purpose of this study was to investigate the
movement pattern and muscular activation in the negotiation of the
EFFECTIVENESS OF DYNAMIC BALANCE SUPPORT DEVICE
curbs with high and low heights in patients with spinal cord injury
FOR WALKING ON A TREADMILL: A CASE STUDY
(SCI). RELEVANCE: The ability of wheelie is a required skill for the
Obreza P, Spoljar J, Skorjanc T, Savrin R, Matjacic Z; Institute negotiation of obstacles (such as: curb) which become fairly common
for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia in daily environment. The results of this study will provide the kinetic
PURPOSE: Regaining of walking ability is one of the main goals and kinematic information of wheelie during obstacle-negotiation. The
of rehabilitation following neurological disorder. An important aspect movement pattern and electromyographic activities (EMG) during
of bipedal locomotion is efficient control of balance. RELEVANCE: wheelie can also be used as the index of bimanual coordination.
A dynamic balance support device that would enable walking on a PARTICIPANTS: Eleven SCI (ASIA class A–D; age: 32.09 years old)
treadmill without upper extremities support on parallel bars, and at the who could perform wheelie independently participated in this study.
some time assure safety and facilitate balance control would enable METHODS: The subjects propelled the wheelchair on two force
more functional training. The aim of this case study was to evaluate plates (AMTI, USA), and performed the wheelie crossing over the
the effectiveness of walking on a treadmill with the dynamic balance curb with 5 cm-height or 10 cm-height. Totally, 54 reflective markers
support device in an incomplete spinal cord injury (SCI) patient. were attached on the anatomical landmarks of body surface and
PARTICIPANTS: A 32 years old male patient with an incomplete the frame of wheelchair for three-dimensional motion analysis (Vicon
SCI (level C5) and grade C on American Spinal Injury Association 250, UK). ANALYSIS: The data were analyzed by Matlab programs
Impairment Scale, 13 months after injury, participated in the study. and SPSS software. The t-test was used for the comparison between
METHODS: Following a six months baseline period in which the two-groups, and the Pearson correlation test was performed for the
subject practiced overground walking, the subject completed 16 relations between right and left upper extremities. RESULTS: The
sessions of treadmill training while using upper extremities holding pitch angle during wheelie was 19.73ºfor 5 cm-curb and was 22.48ºfor
on parallel bars for support (control treatment). Then the subject 10 cm-curb. The greatest acceleration occurred just before the
completed additional 16 sessions of treadmill training while being maximal tilted pitch angle that the acceleration was 317.9º/sec2 for 5
supported with the dynamic balance support device (experimental cm-curb and was 439.9º/sec2 for 10 cm-curb. However, the distance
treatment). Lower Extremities Motor Score (LEMS), Berg Balance between center of mass (COM) and center of pressure (COP) was
Scale (BBS), 10-m walking test (10MWT) and 9-minutes walking test not affected by the height of the curb. During wheelie, the angles of
(9MWT) were used as outcome measures. ANALYSIS: Descriptive shoulder elevation and wrist pronation became larger with increasing
statistics was used to compare the data between the baseline, the height of the curb. Furthermore, the correlation between right and
control, and experimental treatment periods and at one month left wrist extensor (r= 0.96–0.99) was higher than that of biceps and
follow up. RESULTS: During baseline period BBS increased from triceps. CONCLUSIONS: The movement pattern of wheelie over the
37 to 39, 10MWT decreased from 19 seconds to 17 seconds curb depends on the height of the curb. The interlimb coordination
while 9MWT increased from 240 meters to 265 meters. During the of shoulder and wrist joints was important for the control of wheelie
control treatment BBS did not change, 10MWT decreased from 17 at different heights. IMPLICATIONS: The training of wheelie over the
curb should emphasize the control of acceleration torque, shoulder- Ontario/Heart and Stroke Foundation of Ontario, Physiotherapy
wrist joint angles, and COM. KEYWORDS: Wheelie, Curb, Center Foundation of Canada, Toronto Rehabilitation Institute, Natural
of Mass, Center of Pressure. FUNDING ACKNOWLEDGEMENTS: Sciences and Engineering Research Council of Canada, and the
This study was granted by National Science Council, Taiwan (Grant Provincial Rehabilitation Research Program, Ontario Ministry of
# NSC94-2314-B-002-021). The authors thank Chia-Chieh Chang, Health and Long Term Care. CONTACT: [email protected]
Yang-Chieh Fu, Chia-Cheng Lin and Ying-Chen Chen for the ETHICS COMMITTEE: Toronto Rehabilitation Institute Research
assistance in data analysis. CONTACT: [email protected] Ethics Board, University of Toronto Ethics Review Board
ETHICS COMMITTEE: Department of Medical Research, National
Taiwan University Hospital, Taiwan.
24-11 Monday 4 June 15:30 KNEE EXTENSOR FORCE CONTROL ABILITIES IN
VCEC Exhibit Hall B & C POST-STROKE HEMIPARESIS
EARLY EXERCISE INTERVENTION AFTER STROKE Kiyama R, Tetsuo M, Kiyohiro F, Akihide U, Toshiki H, Yoichi Y;
Tang A1−3 , Sibley K2,3 , Thomas S4 , Bayley M3 , McIlroy W1−3 , Course of Physical Therapy, School of Health Sciences, Faculty
Brooks D1−3 ; 1 Department of Physical Therapy, University of of Medicine, Kagoshima University; Rehabilitation Center,
Toronto; 2 Institute of Medical Science, University of Toronto; Kajiki-Onsen Hospital
3 Toronto Rehabilitation Institute; 4 Faculty of Physical Education &
PURPOSE: Since maximal strength is scarcely recruited in activities
Health, University of Toronto
of daily living, sub-maximal force control may be a more meaningful
PURPOSE: To establish the feasibility of adding early aerobic training parameter. To estimate force control ability, a force-tracking task
to conventional stroke rehabilitation; and to determine its effects in which the patient applies a target force according to the
on aerobic and functional capacity and health-related quality of visual feedback is generally used.Evangelos found age effects on
life RELEVANCE: Demonstrated benefit would support the addition knee extensor force control during rapid discrete isometric task.
of aerobic training to conventional rehabilitation in the early post- Assessment of force control ability is expected to be useful for
stroke phase PARTICIPANTS: Thirty-six participants (mean age ± evaluation of lower extremity function in post-stroke hemiparesis.This
SE 65.4±2.0 years, 17±2.2 days post stroke) with moderate to mild study investigated the validity of sub-maximal isometric force
functional impairment from stroke recruited from an inpatient stroke control abilities of the knee extensors in post-stroke hemiparesis.
rehabilitation unit METHODS: Participants were allocated to Exercise RELEVANCE: Clinical evaluation of sub-maximal force control ability
or Control groups and were matched on age and sex. Outcome may contribute to the improvement of the physical therapy practice
measures were taken at baseline and completion and included in stroke hemiparesis. PARTICIPANTS: Twenty patients with post-
aerobic capacity, 6-Minute Walk Test (6MWT) and Stroke Impact stroke hemi-paresis (mean 61.1 (SD 16.1) years of age, mean 6.1
Scale (SIS). The Exercise group participated in individualized cycle (SD 4.8) years post-stroke) with the ability to walk volunteered for
ergometer training, in addition to conventional stroke rehabilitation this study. In 13 cases, the patient’s right side was hemiplegic.
therapy, 30 minutes, 3 days per week until discharge from the METHODS: For testing, subjects were seated in the chair with the
hospital. The Control group received conventional rehabilitation only. knee at a 90º angle. Strength data were measured using a hand-
ANALYSIS: Paired t-tests were used to compare Exercise and held dynamometer EG-230 (SAKAI Medical Corp., Tokyo, Japan).
Control groups. A two-factor repeated-measures analysis of variance Sub-maximal voluntary isometric knee extensor force was obtained
was used to determine interaction effects. RESULTS: The Exercise on the affected leg. The dynamometer was placed above the medial
group (n=18) completed 99% of scheduled sessions in 24.1±6.6 and lateral malleoli. The participant attempts to match the voluntary
days, without adverse effects. Both groups demonstrated improve- knee extensor strength with the target force represented by a bar
ment in aerobic capacity (VO2peak time effect p = 0.004, peak work chart for 60 seconds. The target force values during the trial period
rate p = 0.008, heart rate 0.002), 6MWT distance (p < 0.0001) and varied over two frequencies (0.3 Hz, 0.5 Hz), which ranged from
SIS Physical Domain scores (p < 0.0001) by discharge. While there 0% to 20% of the participant’s maximal isometric knee extensor
were no post-training differences between groups, there was a trend strength. The strength data were transmitted to a computer at
towards greater improvement in peak VO2 and work rate in the a sampling rate of 20Hz. The difference between the voluntary
Exercise group compared to the Controls (12.6 vs. 8.2%, and 23.4 knee extensor strength and the target force was considered an
vs. 15.5% respectively), but less change in peak heart rate (4.5 estimate of force control ability. Smaller values indicated a better
vs. 11.4%) suggesting improved cardiovascular efficiency at higher force control ability.We also assessed gait velocity with gait aids,
exercise intensities. CONCLUSIONS: Implementing a structured and Brunnstrom Recovery Stage. ANALYSIS: The Spearman’s rank
aerobic training program after stroke is feasible and safe, even in the correlation was used to determine correlations of force control
sub-acute phase. Further, a trend towards greater cardiorespiratory abilities and Brunnstrom Recovery Stage, gait velocity. RESULTS:
benefit was observed in those participating in the training program The correlation between the force control ability at frequencies of
compared to those receiving conventional therapy alone, despite the 0.3 Hz and 0.5 Hz, and Brunnstrom Recovery Stage were −0.09
small sample size and relatively short duration of training provided. (n.s.) and −0.45 (p < 0.05), respectively. Similarly, the correlation
Ongoing work is focused on providing longer training duration with a between force control ability at frequencies of 0.3 Hz and 0.5 Hz,
larger sample, and exploring novel training regimens to maximize and gait velocity were −0.36 (n.s.) and −0.57 (p < 0.05), respectively.
function in this important phase of recovery, and reduce the risk CONCLUSIONS: We found that knee force control ability at a
for further cardiovascular events. IMPLICATIONS: Results from this frequency of 0.5 Hz correlated with Brunnstrom Recovery Stage and
study contributes to our knowledge about the influence of structured gait velocity. It may be that the knee force control ability kept pace
physical activity after stroke. The current work has implications on qualitatively with motor recovery. The coordination of knee extensor
shaping physical therapy practice for professionals working with force is important to control the center of gravity during gait, therefore
stroke survivors by providing evidence for aerobic training early knee extensor force control ability is associated with gait velocity.
after stroke to minimize the decline in cardiorespiratory fitness Measuring knee extensor force control ability may be available as a
and functional implications of this. KEYWORDS: Stroke, exercise, method of qualitatively evaluating motor recovery following stroke.
rehabilitation. FUNDING ACKNOWLEDGEMENTS: Supported by IMPLICATIONS: Clinical evaluation of sub-maximal force control
the Canadian Institutes of Health Research (CIHR), Canada ability may contribute to the improvement of the physical therapy
Research Chair, CIHR New Investigator Award), Government of practice in stroke hemiparesis. KEYWORDS: force control ability,
hemiparesis, gait velocity. FUNDING ACKNOWLEDGEMENTS: This Research Report Poster Display
work was supported by Grants-in-Aid for Scientific Research 2004- 25-23 Monday 4 June 15:30
2005, Japanese Ministry of Education, Culture, Sports, Science and VCEC Exhibit Hall B & C
Technology. CONTACT: [email protected] PROGNOSTIC INDICATORS FOR RETURN TO WORK OF
ETHICS COMMITTEE: The Institutional Review Board at the PATIENTS WITH SUB-ACUTE OCCUPATIONAL NECK OR BACK
Kagoshima University approved the procedures used in this study. PAIN – SYSTEMATIC REVIEW
Heitz C1,5 , Bachmann L2 , Hilfiker R3,5 , Joronen H1 , Lorenz T4 ,
Research Report Poster Display Uebelhart D1 , Klipstein A1 ; 1 Department of Rheumatology and
24-19 Monday 4 June 15:30 Institute of Physical Medicine, University Hospital Zurich, 8091
VCEC Exhibit Hall B & C Zurich, Switzerland; 2 Horten Centre, Zurich University, 8091
Zurich, Switzerland; 3 Hochschule Wallis für Gesundheit und Soziale
RECOVERY FOLLOWING STROKE – A ONE YEAR
Arbeit, 3954 Leukerbad, Switzerland; 4 Rehazentrum Leukerbad,
PROSPECTIVE STUDY
3954 Leukerbad, Switzerland; 5 Physiotherapy Sciences Studies,
Horgan F1 , O’Regan M2 , Finn A3 ; 1 School of Physiotherapy, Department of Rheumatology and Institute of Physical Medicine,
Royal College of Surgeons in Ireland, Dublin, Ireland; 2 Department University Hospital Zurich, Switzerland and Faculty of Health
of Statistics, Trinity College Dublin, Ireland; 3 Department of Sciences, Maastricht University, the Netherlands
Physiotherapy, Trinity College Dublin, Ireland
PURPOSE: Indicators for return to work (RTW) in patients with
PURPOSE: The aim of this study was to document the course back or neck pain have been discussed controversial. A systematic
of recovery in a group of stroke patients over a one year period. literature review was performed to provide an evidence base
RELEVANCE: The course of recovery in the first three months for clinical decision-making. RELEVANCE: Back pain, stress and
after stroke has been well documented. However, the outcome of muscular pain and strain in the extremities are the most common
patients after this time is less well understood. PARTICIPANTS: All work health problems among the working population in Europe.
patients with stroke of moderate severity, defined by the Orpington Employees performing physically demanding work have a higher
Prognostic Score, admitted to two teaching hospitals over an eight- percentage of long-term disability than office workers. Prognostic
month period were included. METHODS: 23 stroke patients were indicators (determinants of prognosis) could help to detect those
assessed using measures of impairment, disability (Stroke Activity patients who would run the risk of developing long-term disabling
Scale), handicap (Frenchay Activity Index) and quality of life (General back problems and patients who would subsequently benefit most
Well Being Schedule) on 15 occasions during the first year after their from costly comprehensive treatment leading to improved prognosis.
stroke. ANALYSIS: Analysis was by repeated measures analysis PARTICIPANTS: We focused on publications reporting on patients
of variance. RESULTS: There were significant changes in recovery who performed physically demanding work and were on sick leave
throughout the one year period (F ratio 75.6 df 4 p 0.0001) (one to six month) due to non-specific sub-acute/chronic neck or back
including after six months (t 4.5 p 0.0001). The patients made pain. METHODS: We searched eight databases (Medline, Embase,
significant gains in function (FAI) between six (mean 7.3 sd 5.4) PsycINFO/PsycLIT, Cinahl, Central, PEDro, Psyndex, Sociofile)
and 12 months (mean 12.6 sd 9.8) after stroke (t 3.8 p 0.0021) without restrictions, checked reference lists of the publications
but they did not attain their pre stroke functional levels (mean 28.5 included and other relevant literature and contacted authors for
sd 8.1). Quality of life scores indicated levels of severe distress prospective studies on indicators predicting RTW. We screened
at six and 12 months and did not change significantly throughout articles retrieved in duplicate for inclusion criteria, assessed quality
this period (t −0.391 p 0.7001).There were significant changes and extracted salient features of all studies included. ANALYSIS:
in motor scores for the upper and lower hemiplegic limbs (Q Due to lack of comparability of prognostic indicators of the studies
statistic 15.8-46.6 all p 0.01) during this period. CONCLUSIONS: included, odds ratios (ORs) of the different predictive factors could
In this prospective study, recovery following stroke at all levels not be statistically pooled and therefore studies were only described
was detected throughout a 12 month period. Despite this recovery in the light of their methodological rigor. RESULTS: Nine publications
patients appeared to have a poor quality of life which did not of moderate quality reporting in four different study publications and
improve. IMPLICATIONS: An increased understanding of the course patients with sub-acute low back pain were included. 85 medical,
of recovery following stroke could provide a basis for evaluating ergonomic, psychological and socio-demographical variables were
the varied aspects of therapeutic intervention and the physical and analyzed. Numerous weak, two conflicting and several not relevant
psychological aspects of recovery. KEYWORDS: Stroke, recovery, indicators (described in at least two different study populations as not
quality of life. FUNDING ACKNOWLEDGEMENTS: Foundation relevant) resulted. Five authors developed models to predict patients’
Fellowship University of Dublin, Trinity College Dublin and the future ability to work. All models (range of overall correct classification
National Rehabilitation Board Ireland. CONTACT: [email protected] 67.9-87.4%; range of ORs 5.41-25.5) included several indicators out
ETHICS COMMITTEE: Federated Dublin Voluntary Hospitals of different biopsychosocial fields. CONCLUSIONS: The evidence
Research Ethics Committee found on prognostic indicators in detecting patients at risk for long-
term absenteeism from work was weak. To date, long-term disability
cannot be predicted definitely. The likelihood of RTW may depend on
a number of, or combination of variables from the biopsychosocial
model. Further effort should be directed in detecting, defining and
standardizing relevant prognostic indicators and directed to the target
population of rehabilitation, especially patients with neck problems.
IMPLICATIONS: Making decisions concerning patients should not be
currently based on prognostic indicators alone. KEYWORDS: non-
specific neck or back pain, prognostic indicators, systematic review.
FUNDING ACKNOWLEDGEMENTS: The authors would like to thank
Dr. Pius Estermann, information specialist and librarian for performing
the literature searches, Leokadia Zurek, librarian for ordering and
preparing full-text articles, Leanne Pobjoy for her help in preparing the
manuscript, and all the experts acting as members of our focus group
inquiry. This review was supported by grants of the Swiss National
Science Foundation. CONTACT: [email protected]
Research Report Poster Display occupational health. FUNDING ACKNOWLEDGEMENTS: None.
26-03 Monday 4 June 15:30 CONTACT: [email protected]
VCEC Exhibit Hall B & C ETHICS COMMITTEE: Ethics Committee North at Karolinska
ERGONOMICS AND AESTHETICS AT WORKPLACE – Institutet, Sweden
CORRELATIONS TO OCCUPATIONAL AND INDIVIDUAL HEALTH
FACTORS IN A “PUBLIC SERVICE” BROADCASTING COMPANY
Schell E1 , Theorell T2 , Saraste H1 ; 1 Karolinska Institutet,
Department of Molecular Medicine and Surgery, Stockholm, Sweden; Research Report Poster Display
2 Karolinska Institutet, National Institute for Psychosocial Factors 26-07 Monday 4 June 15:30
and Health, and Center for Health Sciences, Stockholm, Sweden VCEC Exhibit Hall B & C
QUALITY OF LIFE IN PATIENTS WITH SUBACUTE
PURPOSE: Pain and stress disorders are costly and have been WORK-RELATED LOW BACK PAIN
increasing the last decade. The aim was to study needs for
ergonomic and aesthetic improvement respectively in relation to Mngoma N1,2 , Stevenson J1 , Symes A2 , Hopman W3 ; 1 Queen’s
occupational and individual health factors. RELEVANCE: Efforts to University, Kingston, Ontario, Canada; 2 Providence Continuing Care
achieve early prevention implementations towards deteriorated work Centre, Kingston, Ontario, Canada; 3 Kingston General Hospital,
health, need development, beyond traditional methods. A broad view, Ontario, Canada
also with aesthetic aspects might increase efficacy in occupational PURPOSE: The main objectives of this study were to compare
health work within ergonomics/physiotherapy and other professionals quality of life (SF-36) scores before and after program participation,
work. PARTICIPANTS: All employees in different occupations at a and to compare the SF-36 scores to the Canadian norms. A
Broadcasting Company for Television and a Symphony Orchestra secondary objective was to determine associations with return-to-
at a Radio Company were offered to participate in a mail distributed work. RELEVANCE: Low back pain is one of the leading causes of
prevalidated questionnaire. Persons on leave & sick-leave>6 months, disability in the working age population, particularly in industrialized
were excluded. Informed consent was included. METHODS: The countries. It is important for clinicians to understand the burden
needs for ergonomic and aesthetic improvements were correlated of illness imposed by low back pain in order to gain greater
to socio-economic factors, work stress, musculoskeletal pain (MSP), appreciation of the impact on patients’ lives. One of the main goals
stress/depression, sleep, sick leave, treatment, occupation, educa- of physiotherapy is to improve quality of life of our patients, therefore
tion, work environment and life-style. ANALYSIS: Chi-square test if factors associated with quality of life were known, efforts could
for trend comparisons was performed. Student’s t-test and One- be directed at improving these in order to improve quality of life.
way Anova. were used. Multivariate analyses were preformed with PARTICIPANTS: Seventy-one patients with subacute low back pain
linear logistic regression. RESULTS: The participation rate was participated in the study. All patients received treatment for low
74% (n=1961). Non -participants did not differ significantly from back pain in an outpatient, clinic-based return-to-work rehabilitation
participants in age, gender and occupational level. Males were 57%, program. METHODS: A pretest-posttest design was used in this
female 43%, mean age 48 yrs (21-67 yrs), 53% had no sick-day. program evaluation project. In addition to demographic, work-related,
Definite/high ergonomic and aesthetic needs were reported by 35% and clinical data, health-related quality of life (HRQOL) was assessed
and 40% respectively. No need at all was reported by 17% and 18%, on admission to (pre) and discharge from (post) the program
respectively. High executives and IT-staff were those who had the using the Medical Outcomes Study 36-item short form (SF-36).
lowest needs. Definite/high – ergonomic needs correlated directly Pre- and post-program scores were compared to the Canadian
(p 0.001) to all pain and stress parameters including treatment norms. ANALYSIS: t-tests, at level of significance p < 0.05, were
and sick-leave, work stress, worry about own health, sleeping used to detect pretest-posttest differences as well as differences
disturbances, disturbing noise, psychologically strenuous work, poor between those who had returned to work versus those who had
influence on work, problems and dissatisfaction with work conditions not. RESULTS: There were significant (p < 0.05)improvements in
and with life conditions in general. Definite/high – aesthetic needs quality of life after program participation. However, quality of life
correlated directly (p < 0.001-.040) to pain-parameters including scores at discharge were still considerably lower than the Canadian
treatment, sick-leave due to pain, work stress, problems and population norms, particularly in the physical domains. Patients who
dissatisfaction at work, disturbing noise, psychologically strenuous had returned to work at program completion reported significantly
work. The aesthetic needs did not relate directly to treatment and better quality of life compared to those still off work. These differences
sick-leave due to stress, low influence on work, worry about own were found in six of the eight SF-36 domains: physical functioning,
health, sleeping disturbances and sick-leave due to any reason. pain index, general health perceptions, social functioning, role
Definite/high need for both ergonomic and aesthetic improvements emotional, mental health, as well as the two component scores.
correlated (p < 0.001) to younger age. Neither of them correlated CONCLUSIONS: Quality of life improved significantly during the
to alcohol intake, education level or gender. CONCLUSIONS: The course of rehabilitation. However, when compared with Canadian
results confirm ergonomic needs’ direct relation to occupational population norms, the discharge quality of life scores were still
health and well being. Relation was found for aesthetic factors too. markedly low. Moreover, those off work at program completion,
Younger persons showed higher needs for both ergonomic and generally reported significantly poorer quality of life compared to
aesthetic improvements than older ones (p < 0.001). No differences those who were working. IMPLICATIONS: Low back pain is a
in genders or education levels were found. The results indicate complex problem that has a huge impact on society and the lives
that not only ergonomic, but also aesthetic design might contribute of the individuals affected. Measuring quality allows for a more
in prevention of neck, shoulder and back pain, sick leave and comprehensive understanding of the burden of illness. Work is an
negative work conditions IMPLICATIONS: Physiotherapists meet important part of adult life; therefore it is not surprising that poor
persons with different health problems, as MSPs and stress- quality of life is reported where disruptions in the ability to work
related work environment related symptoms. Subjective pain and have occurred. The therapeutic value of work has been suggested
stress may be aggravated by unergonomic and ugly occupational in the work disability literature. These results seem to support this
environment. Implementation of ergonomic improvements in pre- notion. The facilitation of safe and timely return to work needs to
vention and rehabilitation has earlier shown efficacy. To add an be a key goal of rehabilitation of injured workers with low back pain.
aesthetic perspective on work place design may contribute to KEYWORDS: low back pain, quality of life, return-to-work. FUNDING
better occupational health. KEYWORDS: Ergonomics, aesthetics, ACKNOWLEDGEMENTS: This study was made possible by the
support provided by Providence Continuing Care Centre, Kingston, Marie-Anne Lavallée. The authors thank M. Beaudry and M. Labadie
Ontario. CONTACT: [email protected] for their technical support. CONTACT: [email protected]
ETHICS COMMITTEE: Queen’s University and Affiliated Hospitals ETHICS COMMITTEE: CSSS Bordeaux-Cartierville-St-Laurent
Research Ethics Board ethics’ committee

THE EFFECTS OF SHORT-TERM INTERVENTION ON FALLS
INTER-TRIAL AND TEST-RETEST RELIABILITIES OF TIMED
SELF-EFFICACY AND THE RELATIONSHIP BETWEEN
BRIDGE TESTS AMONG FRAIL OLDER ADULTS
CHANGES IN PHYSICAL FUNCTIONS AND FALLS
Pilon M1,2 , Nadeau S2,3 , Piotte F2 ; 1 CSSS Bordeaux-Cartierville- SELF-EFFICACY
St-Laurent, Montréal, Québec, Canada; 2 École de réadaptation,
Arai T1,2 , Obuchi S2 , Inaba Y1 , Nagasawa H3 , Shiba Y4 ,
Université de Montréal, Québec, Canada; 3 Institut de réadaptation
Watanabe S5 , Kimura K6 , Kojima M2 ; 1 Graduate School of
de Montréal, Centre de recherche Interdisciplinaire en Réadaptation
Medical Science, Kitasato University; 2 Department for Prevention
(CRIR), Montréal, Québec, Canada
of Dependence on Long-term Care, Tokyo Metropolitan Institute
PURPOSE: To assess the reliability of three versions of the Timed of Gerontology; 3 Faculty of Health and Social Work, School
Bridge Test (TB Test) in frail older adults. RELEVANCE: Bridging of Rehabilitation, Kanagawa University of Human Services;
4 Department of Allied Health Science, Kitasato University;
activities in bed are often performed by the geriatric population, which
5 Department of Gerontology, Graduate School of International
often has a reduced mobility. Physical therapists also use this activity
to assess the hip muscle strength and lower-limb motor control in Studies, Obirin University; 6 Department of Humanities and Social
various populations such as individuals with hemiparesis following Sciences. Tokyo Denki University
a stroke. However, the psychometric characteristics of bridging PURPOSE: It is important to determine how to maximize the
have never been studied in a geriatric rehabilitation population. effectiveness of short-term exercise intervention for elderly people.
PARTICIPANTS: A convenience sample of 30 frail older adults The purposes of our study were to evaluate the effects of short-
(17 females, 13 males), aged from 65 to 94 years (mean age term exercise intervention on falls self-efficacy and to evaluate the
±SD: 80.4 ±7.2), participated in the study. They were recruited relationships between baseline falls self-efficacy and changes in
from the functional intensive rehabilitation centre (63%), the geriatric physical functions in older people. RELEVANCE: Health promotion
evaluation unit (14%) and the geriatric day hospital program (23%) of community-dwelling older people is now becoming a major field
of a Montreal health center. All gave their written consent prior to in which physical therapy will play an important role. In particular,
the assessment. METHODS: The subjects performed three different preventing falls and slowing declines in physical function are
TB Tests: 1) a hold test(TB-Static), 2) a 5-repetitions dynamic important areas for physical therapists. The results of this study are
test (TB-5rep) and 3) a 60 seconds dynamic test (TB-60s). The aimed at providing information on how to maximize the effect of short-
tests were repeated twice on two occasions separated by a 48-h term exercise intervention. PARTICIPANTS: The participants were
interval. For all trials, a physical therapist recorded the height of the 171 community-dwelling older people aged 65 and older. METHODS:
bridge with a pelvialtimeter, the time of execution (TB-Static and TB- This study was a randomized controlled trial. The methodology of
5rep) or the number of repetitions (TB-60s). ANALYSIS: Descriptive this study was approved by the ethics committee. The subjects were
statistics were calculated to establish the subjects’ characteristics and randomly assigned into an exercise intervention group or a health
performance in the TB Tests. The coefficients of dependability (÷) education group. The subjects in the exercise intervention group
and standard errors of measurement (SEMs) derived from the performed an exercise program that included strength and balance
generalizability theory were used to assess the test reliability. training. The duration of the exercise program was 3 months, with
RESULTS: For the three tests, the mean (±SD) height of the bridge classes conducted for 1.5 hours, twice a week. The subjects in
was 7.5 cm (±2.7) with values ranging from 2.8 to 13.5 cm. The the health education group, which functioned as a control group,
mean time to execute the test was 32.4 s (±24.1) and 16.4 s (±6.7) received 1.5 hours of lectures on health promotion for older people
for the TB-Static and TB-5rep, respectively, and the mean number of twice a month for three months. Falls self-efficacy was measured
repetitions for the TB-60s was 29.7 (±14.9). The inter-trial reliability using the Falls Efficacy Scale (FES). The measurements of physical
was almost perfect for heights of the bridge with coefficients (÷) higher functions included static and dynamic balance, walking velocity,
than 0.96 and SEMs all under 1 cm. A good inter-trial reliability was flexibility, and strength. ANALYSIS: After the randomization, we
also found (0.83 < ÷ < 0.94; SEMs 11.1 s, 2.3s and 4.2 rep) for the evaluated the differences in each set of measurements between
duration (TB-Static and the TB-5rep) and the number of repetitions the two groups using an unpaired t-test. The improvement of
(TB-60s). For the test-retest reliability, the height of the bridging test measurements was evaluated by the Wilcoxon rank test. To evaluate
showed ÷ indices varying from 0.87 to 0.91 (SEMs lower than 2 cm). the relationships between the baseline FES score and the change in
For the time or repetition parameters, the reliability was good for these measurements after the intervention, we used the Spearman
the TB-60s dynamic test (÷ = 0.87; SEM=5.6 reps) and moderate rank-correlation coefficient. RESULTS: About half of the subjects
for TB-Static (÷ = 0.73; SEM=13.7 s) and for the TB-5rep (÷ = 0.70; had perfect scores on the FES at the first investigation. There
SEM=3.6 s). CONCLUSIONS: The TB Tests were simple to execute was no difference between the exercise intervention group and the
and showed good clinical applicability in a geriatric population. All control group in terms of FES score either before or after the
parameters assessed showed acceptable to very good inter-trial and intervention period. Also, there was no significant improvement of
test-retest reliability with several values higher than 0.80. Future FES in either group. But there were significant negative correlations
studies will now need to determine the factors associated with between the baseline FES score and the change in maximum
the execution of these bridging activities. IMPLICATIONS: Physical walking velocity (r = −0.29, p < 0.018) and knee extensor strength
therapists often use bridging activities during rehabilitation. This study (r = −0.25, p < −0.040) in the exercise group. CONCLUSIONS: The
showed that the performance of different standardized bridge tests results suggest that a short-term exercise intervention had no effect,
is reliable and might be part of the tests used to assess geriatric possibly due to the high baseline FES scores of the participants, on
patients. KEYWORDS: Elderly, reliability, assessment. FUNDING the confidence of community-dwelling older persons. However, the
ACKNOWLEDGEMENTS: This project was supported by the Ordre negative association between baseline FES score and increases in
professionnel de la Physiothérapie du Québec and the Fonds de some measures of function suggest that short-term exercise may be
beneficial to a subset of older persons with lower FES scores. The Research Report Poster Display
results of our research might help in the planning of effective strate- 28-23 Monday 4 June 15:30
gies to improve the physical functions of community-dwelling older VCEC Exhibit Hall B & C
people. IMPLICATIONS: For physical therapy practice. KEYWORDS: FALLS PREVENTION IN THE ELDERLY. PARTICIPATORY
falls self-efficacy, physical function, short-term exercise intervention. ACTION RESEARCH AS A FRAMEWORK TO IMPLEMENT
FUNDING ACKNOWLEDGEMENTS: This work was not funded by EVIDENCE-BASED KNOWLEDGE IN CLINICAL PRACTICE
any foundation or company. Granbo R1 , Vaskinn A2 , Hansen A3 , Iversen S4 , Helbostad J5 ;
ETHICS COMMITTEE: This study was approved by the ethics 1 Sør-Trøndelag University College, Norway; 2 Department of
committees of the Tokyo Metropolitan Institution of Gerontology. Physiotherapy, Trondheim, Norway; 3 Department of Physiotherapy,
Trondheim, Norway; 4 Dept. of Neuroscience, Faculty of Medisine,
Noewegian University og Science and Technology; 5 University
Research Report Poster Display of Bergen, Norway
27-19 Monday 4 June 15:30 PURPOSE: The base of knowledge is ever developing and there
VCEC Exhibit Hall B & C is a challenge in implementing new evidence-based knowledge
RANDOMIZED CONTROLLED TRIAL OF SENSORY-SPECIFIC in clinical practice. To develop evidence-based practice, Physical
BALANCE TRAINING IN OLDER ADULTS: EFFECT ON Therapists need to be able to search for relevant literature, as well
POSITION, MOVEMENT, AND VELOCITY SENSE AT THE ANKLE as interpret results and their relevance for current practice. The
present study aimed to investigate how recent, relevant knowledge
Westlake K, Wu Y, Culham E; Queen’s University, School of about fall prevention in elderly can be implemented as a part of
Rehabilitation Therapy, Kingston, Canada the daily clinical practice for Physical Therapists working in the
PURPOSE: The purpose of this randomized controlled trial was primary health care. RELEVANCE: To implement evidence-based
to investigate the effects of balance exercises on proprioception. knowledge in the Physical Therapists practice. PARTICIPANTS:
RELEVANCE: Age-related changes in proprioception contribute to All Physical Therapists (n=46) working in the primary health care
impairments in postural control and increased fall risk in older in the municipality of Trondheim, Norway participated. METHODS:
adults. Few studies have examined the possibility of enhancing this Action research was used as methodological framework. Methods
sensation through specific training interventions in this population. used were literature studies, case studies, dialogue seminars and
PARTICIPANTS: Thirty-six healthy older volunteers and 24 healthy focus-groups. ANALYSIS: The study has been a process through
which the researchers together with the Physical Therapists have
younger volunteers. METHODS: Older participants were randomly
identified needs for knowledge development, collected and analysed
assigned to a balance exercise group (n=17) or a falls prevention
information and acted upon these findings. Discussions and inter-
education group (n=19), each led by a physical therapist. Baseline
views were taped, transcribed and analysed through open coding.
and post-intervention measurements of three proprioceptive mea-
In this way data collection, analyses and evaluation have been
sures (threshold to perception of passive movement, TPM; passive
parallel processes. RESULTS: The physiotherapists report increased
joint position sense, P-JPS; threshold to velocity discrimination, TVD)
consciousness about their professional role and increased capacity
were obtained at the ankle in exercise and education groups. Follow-
in questioning and reflecting on their own and their colleges’ clinical
up measurements of TPM, P-JPS, TVD were also taken in the
reasoning process. The therapists show a more homogeneous
exercise group 8-weeks post intervention. For comparative purposes,
approach to older people with risk of falling than previous to the study.
24 healthy younger participants underwent a one-time assessment
There has been an agreement within the community of Physical
of TPM, P-JPS, and TVD. ANALYSIS: Analysis of variance
Therapists about how to identify people at risk of falling and how to
(ANOVA) was used to investigate the effects of the interventions on assess them. A model has been developed that illustrates the various
proprioceptive outcomes and differences between younger and older phases which must be present in order to make changes toward
groups. Interaction effects were followed with Bonferroni adjusted a more evidence-based practice. CONCLUSIONS: Implementation
post-hoc tests. RESULTS: Improvements in TVD between baseline of results from research into practice requires active work with the
and post-intervention in the exercise group, p = 0.014, and differences interpretation of the research results as well as a research community
between exercise and education groups post-intervention, p = 0.019, based on confidence and support. The Physical Therapists’ own
were found. These improvements were not maintained 8-weeks clinical work experiences seemed to be good starting points for
post exercise intervention. Comparisons with the younger group discussing the relevance of research results. IMPLICATIONS: This
revealed differences in TVD in both the exercise and education group methodological framework seems to bee an appropriate way to
at baseline, p < 0.001, education group post-intervention, p < 0.001, implement evidence-based knowledge and make changes towards
and exercise group at 8-weeks follow-up, p = 0.018. Differences a more evidence based practice among Physical Therapists working
between TVD of the younger group and exercise group were no with elderly in primary health care. We hope that our model
longer present by post-intervention. TPM and P-JPS showed no can be useful in other working fields for Physical Therapists,
change as a function of the exercise intervention. CONCLUSIONS: and also within other professionals. KEYWORDS: FallS prevention.
Results support short-term improvements in velocity sense following Participatory Action Research. Evidence-Based Practice. FUNDING
a sensory-specific exercise program. Improvements in movement and ACKNOWLEDGEMENTS: The present study has been financially
position sense were not supported. Further research is required to supported by The Norwegian Fund for Post-Graduate Training in
determine the contributing physiological mechanisms and to confirm Physiotherapy, Sør-Trøndelag University College, Norway and the
the functional relevancy of this discovery. IMPLICATIONS: Given Municipality of Trondheim, Norway. CONTACT: [email protected]
that previous research has shown velocity input to be crucial and ETHICS COMMITTEE: Recommended by the Regional Committee
more accurate than position and acceleration information for postural for Research Ethics in Norway. Approved by The Norwegian Social
corrections, the possibility to reverse age-related changes in velocity Science Data Services.
sense is encouraging and may lead to more effective balance
exercise programs. KEYWORDS: Proprioception, Balance, Aging.
FUNDING ACKNOWLEDGEMENTS: Kelly Westlake was supported
by a Canadian Institutes of Health Research Fellowship. CONTACT:
[email protected]
ETHICS COMMITTEE: Queen’s University Health Sciences and
Affiliated Teaching Hospitals Research Ethics Board.
Research Report Poster Display were ambulatory for less than one year. Children who were not
29-03 Monday 4 June 15:30 able to participate actively in a therapy program, or who had
VCEC Exhibit Hall B & C orthopaedic surgery within the past year were excluded from this
FALLS AND COGNITIVE FUNCTION IN OCOTOGENARIAN study. METHODS: Ethics approval was obtained from the University
COMMUNITY-DWELLING ELDERLY of Ottawa Research Ethics Board. Subjects were assessed for a
total of four sessions: prior to injection, 1-month following, 3-months
Leonardi A1 , Teixeira D1 , Galceran N1 , Okuma L1 , Meidiros P1 ,
following and 6-months following injection of Btx-A. At the initial
Uhler C1 , Lemos P1 , Driusso P2 , Perracini M2 ; 1 Physical Therapy
pre-injection assessment, the process for Goal Attainment Scaling
undergraduate students, City of São Paulo University, São Paulo,
(GAS)was used to determine three goals of treatment. The subjects’
Brazil; 2 Professor Department of Physical Therapy, Master of
current functional ability with respect to the three functional goals
Science Program, City of São Paulo University, São Paulo, Brazil
was assessed. Additional assessments included range of motion
PURPOSE: To verify the association between history of falls in (ROM) and Gross Motor Function Measure (GMFM). Based on the
the previous year and cognitive level in octogenarian community- goals of treatment and current functional ability a treatment program
dwelling elderly. RELEVANCE: Cognitive decline has been pointed was provided for families. Items were reassessed at one, three
out as one of the major risk factors for falls and recurrent falls in the and six months post Btx-A injection. ANALYSIS: Scores from ROM
elderly, especially in frail subjects. But its association is poorly studied and GAS data were compared between pre-injection and the three
among a very old community-dwelling population. PARTICIPANTS: post-injection data points. Scores from GMFM data were compared
A cohort of 377 octogenarian subjects living in an urban area in São between pre-injection and 6-months post-injection. ROM and GMFM
Paulo, Brazil which is referred to an outpatient ambulatory preventive data were compared using paired t-tests. T-scores were used to
follow-up. This study is based on a sample of 61 subjects, mean analyze changes in GAS scores for each subject. RESULTS: While
age 84.25±2.98 both genders. METHODS: They were evaluated all five subjects had clinically significant differences in ROM scores
through a standard multidimensional questionnaire containing socio- from pre-injection assessment to post-injection assessments at 1-
demographic, clinical, functional, psycho-cognitive and health-related month and 3-months follow-up, none of the ROM changes were found
quality of life data which accomplishes MMSE, GDS, Brazilian OARS to be statistically significant (p values from 0.06–0.78). GMFM scores
Multidimensional Functional Assessment Questionnaire – BOMFAQ, from pre-injection assessment to 6-months post-assessment did not
WHOOQL, Timed up and Go Test. ANALYSIS: Simple and inferential change significantly (ranged between 0.6 and 5%). Five subjects
descriptive statistics were performed using Chi-Squared test and the were evaluated on three goals of treatment each, using the process
correlation between quantitative variables were verified by Pearson’s for GAS (n-15 goals). From pre-injection to 1-month post, there was
Correlation test and Mann-Whitney non-parametric test. The level of improvement noted in 14 goals. From pre-injection to 3-months post,
significance adopted was p < 0.05. RESULTS: It was verified that improvement was noted in all 15 goals. From pre-injection to 6-
23% had presented cognitive decline and that 57% of them had months post-injection, there was improvement noted for 14 goals.
suffered falls in the last year, however it was not found a significant The outcome for each goal was expressed as a T-score; a T-score
statistical association (p = 0.62). Considering the TUG performance, of 50 represents the level of attainment expected after intervention.
there was a significant correlation to MMSE score (p = 0.005) and At the 6-month post-injection assessment, 5 of the goals obtained a
its dimensions: orientation (p = 0.0001), attention (p = 0.01) and T-score of less than 50, for 6 goals the T-score was 50, and for 4
language (p = 0.005). CONCLUSIONS: The results suggest that cog- goals, the T-score was greater than 50. CONCLUSIONS: Injection
nition and falls are not independently related in octogenarians despite with Btx-A combined with a physical therapy treatment program can
the fact that mobility measured through TUG could be influenced by result in functional changes for children with cerebral palsy who
cognitive decline. There must be other independent variables that are not independently ambulatory. These functional changes can
are confounding its relation and more extensive statistical analysis remain following the effectiveness period of Btx-A. IMPLICATIONS:
should be conducted. IMPLICATIONS: Balance and mobility are a Functional skills that are not captured by the GMFM can be measured
typical concern among geriatric physical therapists and its relation using GAS. KEYWORDS: Functional assessment, botulinum toxin
to cognitive decline should be carefully evaluated when considering type-A, cerebral palsy. FUNDING ACKNOWLEDGEMENTS: The
its implication to falls in very old subjects, since other factors have generous support of the Physiotherapy Foundation of Canada is
to be accomplished. A multidimensional assessment can provide gratefully acknowledged. CONTACT: [email protected]
essential key indicators. KEYWORDS: falls, cognitive function, octo- ETHICS COMMITTEE: University of Ottawa Research Ethics Board
genarian. FUNDING ACKNOWLEDGEMENTS: UNICID. CONTACT:
[email protected]
ETHICS COMMITTEE: University protocol number: 13185589
IS PAIN ASSOCIATED WITH DEMOGRAPHIC, PHYSICAL AND
30-11 Monday 4 June 15:30 LIFESTYLE FACTORS IN ADULTS WITH CEREBRAL PALSY?
Dumas F1,2 , Maltais D1,2 , Boucher N1,2 , Corriveau D3 ,
FUNCTIONAL EVALUATION OF THE EFFECTS OF BOTULINUM Beauregard L1 , Pelletier M3 , Pichard L3 , Robitaille N1,2 ,
TOXIN TYPE-A INJECTION IN NON-AMBULATORY CHILDREN Roy K1 , Richards C1,2 ; 1 Centre for Interdisciplinary Research in
WITH CEREBRAL PALSY Rehabilitation and Social Integration, Quebec City, Canada; 2 Laval
Megens A1 , Kealey L1 , McCormick A1 , Sveistrup H2 ; 1 Ottawa University, Quebec City, Canada; 3 Quebec Rehabilitation Centre,
Children’s Treatment Centre; 2 University of Ottawa Quebec City, Canada
PURPOSE: The purpose of this prospective pilot study was to PURPOSE: To determine, for adults with cerebral palsy (CP), if
investigate whether there are functional changes for non-ambulatory pain is associated with selected demographic, physical, and lifestyle
children with cerebral palsy (CP) following injection with Botulinum factors. RELEVANCE: Although pain is known to interfere with
Toxin Type-A (Btx-A) to the lower extremity. RELEVANCE: Very activities of daily living in adults with CP, very little is known about
few studies have investigated functional skills in children with CP factors associated with pain. A better understanding of the relevant
who are not independently ambulatory following injection with Btx- demographic, physical or lifestyle factors could guide future physical
A to the lower extremity. PARTICIPANTS: Subjects included five therapy research and interventions designed to address pain in these
children with cerebral palsy who had Btx-A injection planned for clients. PARTICIPANTS: Men (n=71) and women (n=69) aged 28
the lower extremity who were not independently ambulatory, or yr ±5.6 participated in the study. All were diagnosed with CP and
were previous clients of the local pediatric rehabilitation centre. The challenged, Sapporo, Japan. All parents provided their informed
frequency distribution (%) across Gross Motor Function Classification consent and the ethics commission of our university approved the
Levels (GMFCS) was: Level I=30.7; Level II=8.6; Level 3=15.7; study. METHODS: Rohrer index (RI) and body-mass index (BMI)
Level IV=31.4; Level V=13.6. There was no significant difference was used as body characteristics criteria. Height and weight indices
in the distribution of age across the GMFCS levels. METHODS: were calculated. The subjects’ percentage body fat were measured
A questionnaire regarding health and lifestyle was administered to using a percentage body fat meter (Poke-NAVI II DF215 Yamato-
the participants during either a telephone or face-to-face interview, scale co., Ltd.). Three trials of percentage body fat were taken
or as a form sent to the participant by mail. The questionnaire for each subject, then the mean value for each subject was used.
was based on that used in a province-wide (Quebec) survey of Subjects were classified into five groups according to the Gross Motor
lifestyle and health (1998). ANALYSIS: Descriptive statistics were Function Classification System (GMFCS), and into three groups
used to summarize the demographic data. The relationships between according to their feeding ability (independent, partial assisted,
pain and the various factors of interest were analyzed using the assisted). ANALYSIS: A Pearson’s correlation coefficient was used
Chi-square test with significance set at p = 0.05. RESULTS: The to examine the relationship between their body characteristics and
participants as a total group, whether men or women, had an equal the percentage body fat. A Spearman’s correlation coefficient was
chance of having or not having pain (n=38 men, 40 women with used to examine the relationship between their GMFCS levels and
pain; n=33 men, 29 women with no pain, ns). Pain and whether their percentage body fat, and between their feeding ability. A p
walking ability deteriorated or not over the last three years was also value of less than 0.01 was accepted for significance. All statistical
assessed (n=86). Of the 33 individuals in this group who reported analyses were performed using SPSS for Windows. RESULTS: The
a deterioration in walking, a significantly greater number of them body fat percentage could not be measured in 6 children because
reported pain (n=28 pain; n=5 no pain, p < 0.001). With respect to of operating errors. For the remaining subjects, the mean value
the participants’ level of physical activity (less active group = 20- of the percentage body fat was 18.4% [SD9.3]. Two children were
30 minute bouts of activity less than twice weekly, more active judged obese children using the BMI. Subjects were classified into
group = 20-30 minute bouts of activity two or more times weekly), level I (n=3), level III (n=20), level IV (n=6) and level V (n=5)
the number who reported pain (n=78) was similar in the two activity categories depending on the GMFCS. There was a significant
groups (n=43 less active; n=35 more active, ns). Of those who were positive correlation between the body characteristics and the
pain free (n=62), however, there were significantly more participants percentage body fat (RI; r =0.89, BMI; r =0.77), and the feeding ability
in the active than in the less active group (n=42 active; 20 less and the percentage body fat (r = 0.65). There was significant negative
active, p = 0.004). Moreover, of those in the less active group (n=63), correlation between the GMFCS levels and the percentage body fat
significantly more participants reported having pain (n=43 pain; (r = 0.47). CONCLUSIONS: The percentage body fat tended to rise in
n=20 no pain, p = 0.004). CONCLUSIONS: Individuals with cerebral children who had high GMFCS levels. This result may have occurred
palsy have an equal chance of having and not having pain. Pain, because the high GMFCS level children had a better feeding ability,
however, may be related to walking ability and the level of physical they are able to feed themselves, while the low level children had
activity. IMPLICATIONS: Although those with CP do not necessarily limited feeding ability. This finding is important for guiding children
report pain, for those who do, interventions which focus on walking with CP in managing their weight. It is possible to guide exercise
ability (for those who are able) or on physical activity, may be of for children with CP by understanding physical characteristics of
benefit to address pain. Further research is needed to test these each child with CP. The correlation suggests an appropriate fitness
hypotheses and to clarify whether pain is the cause or effect of conditioning in their school life. IMPLICATIONS: This report gives
decreased walking or physical activity. KEYWORDS: cerebral palsy, the future plan for children with CP in a school from the perspective
pain, personal factors. FUNDING ACKNOWLEDGEMENTS: This of their health management. KEYWORDS: Cerebral palsy, health
study was supported by the Centre for Interdisciplinary Research management, GMFCS. FUNDING ACKNOWLEDGEMENTS: We
in Rehabilitation and Social Integration, the Laval University Chair thank the parents and school for helping with this study. CONTACT:
in Cerebral Palsy Research, and the Cerebral Palsy Consortium. [email protected]
CONTACT: [email protected] ETHICS COMMITTEE: the ethics commission of Sapporo Medical
ETHICS COMMITTEE: Institutional Review Board of Quebec university
Rehabilitation Centre, Quebec City, Canada

VCEC Exhibit Hall B & C DELAYED PAIN REACTIONS DUE TO STRESS IN PATIENTS
EXERCISE GUIDANCE FOR CHILDREN WITH CEREBRAL PALSY WITH COMPLEX REGIONAL PAIN SYNDROME
IN A SCHOOL FOR PHYSICALLY CHALLENGED CHILDREN Allen R, Hulten J, Roelofson M, Martin T, McCormack S; University
Osuda Y1 , Kozuka N2 , Sato Y3 , Takakura C1 , Kayukawa C4 , of Puget Sound, Tacoma, WA, USA
Kashiki M4 , Furukawa A4 ; 1 Graduate School of Health Sciences,
PURPOSE: This study’s purpose was to determine the effect
Sapporo Medical University. Sapporo. Japan; 2 School of Health
of perceived stress on pain intensity, timing of episodic pain
Sciences, Sapporo Medical University. Sapporo. Japan; 3 Division
increases, and related functional changes in patients with complex
of Rehabilitation, Tokeidai Memorial Hospital. Sapporo. Japan;
4 Hokkaido Makomanai School for the physical challenged, Sapporo regional pain syndrome (CRPS). RELEVANCE: Intensity of pain
associated with CRPS varies over time and may be exacerbated
Unit. Sapporo. Japan
by activity, temperature, stress, etc. Episodes of severe pain
PURPOSE: The purpose of this study was to investigate the intensity are often inexplicable, hard to predict, and markedly impact
relationship between percentage body fat and physical characteristics therapy and function. Latent endocrine changes associated with
of children with cerebral palsy (CP) in a school for physical challenged psychogenic stress can increase peripheral nerve excitability long
children. RELEVANCE: It is important to know the relation between after the initiating event, possibly explaining delayed increases
body characteristics and gross motor function for children with CP in neuropathic pain intensity. PARTICIPANTS: This was a case
in school. Additionally, it may be possible to improve their fitness study design involving two functionally stable, male volunteers with
conditioning with the view of managing their weight. PARTICIPANTS: sympathetically mediated Type I CRPS. Patient 1 was an unemployed
Forty students (male: 23, female: 17, mean age 14.2Y, [SD 2.7], 49 year-old, with a six-year CRPS history affecting the right lower
range 10Y-18Y) in Hokkaido Makomanai school for the physically extremity. Patient 2 was an employed 31 year-old with an eight-year
history of CRPS affecting the left upper extremity. METHODS: To This study demonstrated the effectiveness of low-frequency visiting
track temporal fluctuations in perceived pain, stress, and function, physical therapy for supporting home-cared disabled people in rehab-
participants completed a visual analog pain and stress scales, the deprived regions. PARTICIPANTS: The subjects were 84 home-
Daily Stress Index, and the RAND 36-Item Health Survey daily for cared disabled people in 5 towns or villages of rehab-deprived
ten weeks. ANALYSIS: Daily values for all scales were graphed regions in Aomori Prefecture, Japan. The subjects were selected
across the ten-week tracking epoch for each participant. Episodic with cooperation by the local governments. They were divided into
peaks were manifested on days when ratings exceeded 1.5 and 2.5 an intervention group (57 subjects; mean age 69.5±10.7 years)
standard deviations above the participant’s ten-week means for pain and a control group (27 subjects; mean age 70.5±8.5 years).
and stress, respectively. To analyze temporal relationships between METHODS: Visiting physical therapy was conducted by a team
stress and delayed pain flares, serial lag correlations were performed consisting of a physical therapist and a health care specialist such
using 0-14 day lags. The same statistical comparisons were made as a public health nurse once every 1-3 months. ADL were evaluated
between stress and function. RESULTS: No clear relationship was using a modification of the Barthel Index (BI) by Granger et al.,
evident between ratings stress levels and perceived pain intensity and the family relationships were evaluated using the Evaluation
occurring on the same day (r = +0.04 & +0.14). However, serial Scale for Family Relationships of the Home-Cared Disabled (family
lag correlations revealed strong concordance between days of peak relationship scale) of Ito et al., at 2 points, i.e., the point of
stress and high pain intensity experienced ten days later for both initial evaluation during the intervention period (initial) and the
participants (r = +0.49 & +0.52). For each participant, every criterion point 6-24 months after the initial evaluation (second). ANALYSIS:
peak stress day was followed ten days later by a sharp pain The c2 -test, residual analysis, Cramer’s measure of association,
intensity increase. Notable reductions in measured function were structural equation modeling (mean structure models), logit loglinear
also reported ten days following each peak stress day. These analysis, and Wilcoxon signed-ranks test were used for statistical
findings are consistent with timing of the thyroxine axis in the stress analyses. RESULTS: The mean BI was significantly higher at the
response. Once released, thyroxine is bound by serum proteins, second measurement (68.3±34.1) than at the initial measurement
whose timed dissociation results in peak effects ten days later. (63.2±33.0) in the intervention group (Z=-3.781, P = 0.000), but no
Thyroxine’s relevant effect is increased peripheral nerve excitability, significant difference was noted in the control group. Whether the
thereby possibly heightening perceived neuropathic pain severity. subjects received visiting rehabilitation or not was moderately related
CONCLUSIONS: Based on findings from two participants measured to changes in ADL (c2 (2) = 8.347, P = 0.015) (Cramer’s V=0.315,
over ten weeks, these individuals with CRPS experienced delayed P = 0.015), and improvements in ADL were observed more frequently
increases in pain magnitude and decreased function occurring ten in the intervention group. ADL of the intervention group improved
days following stressful episodes. IMPLICATIONS: Patients and even after adjustment of unevenness in subject assignment for the
therapists are frequently unable to explain debilitating CRPS pain SEM, and the improvement rate was 3.89 times higher than in the
flares. Knowing that stressful episodes may lead to pain flares, and control group. The score of family relationship scale was significantly
related functional attenuation ten days later, patients could predict higher at the second measurement than at the initial measurement
the onset of particularly painful days, and better time and plan in the intervention group, but this improvement was not ascribed to
activity. This may placate some patient fear and anxiety related visiting physical therapy (c2 (2) = 0.645, P = 0.725). CONCLUSIONS:
to latent pain increases. Therapists can use this information to Visiting physical therapy by physical therapists was suggested to
time treatment components and distinguish stress-related pain flares improve the independence level of ADL even when it is performed
from those induced by activity or treatment intensity. KEYWORDS: at a frequency of once every 1-3 months in a rehab-deprived region.
Complex Regional Pain Syndrome, Stress, Delayed Pain. FUNDING Therefore, low-frequency visiting physical therapy is considered to be
ACKNOWLEDGEMENTS: This study was supported by a Student necessary in order to support home-cared disabled people. However,
Research Award grant from the University Enrichment Committee the improvements in the family relationships may have been caused
of the University of Puget Sound, Tacoma, WA, USA. CONTACT: by factors other than visiting physical therapy. IMPLICATIONS: non.
[email protected] KEYWORDS: Visiting physical therapy, activities of daily living, family
ETHICS COMMITTEE: Institutional Review Board, University of relationships. FUNDING ACKNOWLEDGEMENTS: This study was
Puget Sound, Tacoma, WA, USA supported by a grant for Health Science special study at Aomori
University of Health and Welfare in 2001.
ETHICS COMMITTEE: The ethical consideration for this study was
approved by the Ethics Committee of Aomori University of Health and
32-07 Monday 4 June 15:30 Welfare.
EFFECTS OF LOW-FREQUENCY VISITING PHYSICAL THERAPY
ON ACTIVITIES OF DAILY LIVING AND FAMILY RELATIONSHIPS
OF SUBJECTS IN REHABILITATION-DEPRIVED REGIONS 35-03 Monday 4 June 15:30
Morita H1 ,ItoH2 , Sakuragi Y1 ,Lee S1 ,
Kanbayashi H1 ,
Saito K3 ,
Kanazawa Y4 ; 1 Department of Physical Therapy, Aomori University ATTITUDES TOWARDS THE PHYSICALLY CHALLENGED
of Health and Welfare, Aomori, Japan; 2 Formerly, Aomori (ATPC): RELIABILITY AND VALIDITY OF A JAPANESE VERSION
University of Health and Welfare, Akita, Japan; 3 Department of OF ATPC-FORM O
Physical Therapy, Kibi International University, Okayama, Japan; Yoneyama M1,2 , Ogiwara S2 ; 1 Department of Medical Rehabilitation
4 Department of Physical Therapy, Mejiro University, Saitama, Japan Services, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan;
2 Division of Rehabilitation Science, Department of Health Sciences,
PURPOSE: In Japanese regions deprived of home or facility
Graduate School for Health Studies, The University of Kanazawa,
rehabilitation resources (rehab-deprived regions), visiting physical
Kanazawa, Ishikawa, Japan
therapy is difficult to implement despite the presence of subjects
needing it. Visiting physical therapy has been reported to be effective PURPOSE: Studies on attitudes towards the physically challenged
even at a frequency of 1-2 times a week, but its frequency is often (ATPC) have involved the use of a variety of measuring instruments.
below this level in rehab-deprived regions. This study was designed to Out of ATPC-Forms A, B, and C developed by Yuker et al., the latter
prospectively evaluate the effects of low-frequency visiting physical has the highest validity amongst the three. The Japanese version
therapy continued over a period on activities of daily living (ADL) of ATPC-Form O (Form O) has been available since 1999, and
of home-cared disabled people in rehab-deprived regions and their an attempt was made to test it and verify its use. RELEVANCE:
relationships with caregivers (family relationships). RELEVANCE: Attitudes are conceptualised as feelings, knowledge, and readiness
to act, all of which are amenable to change. These concepts are or practitioners. PARTICIPANTS: 186 first and second year students
considered important when applied to professional practice and (94 PTA and 92 business students) at two community colleges
in the education of physiotherapists. Psychometric measures must in the Midwest United States participated. This was a sample of
possess high reliability and validity to enable evidence-based study of convenience. Thirteen returned surveys were incomplete resulting
ATPC. Verification of Form O would therefore be conducive to future in a final response rate of 93% (n=173). The mean age of the
research on the physically challenged in Japan. PARTICIPANTS: participants was 24; 60% were female; and 81% possessed a high
A convenience sample of 154 out of 350 physiotherapists in Fukui school diploma or GED as their highest earned degree. METHODS:
Prefecture, Japan participated in this mailed survey. METHODS: We Form A of the Attitude Toward Disabled Persons scale (ATDP-A) and
used Form O that measured the affective attitude component of the a brief demographic survey were distributed to the participants by
views towards the physically challenged and contained 20 Likert- one of the investigators. The ATDP-A is a reliable and valid tool
type statements to be responded to in a six-point range. ANALYSIS: that includes 30 items designed to provide an objective measure
The reliability of Form O was assessed as homogeneity using the of participants’ attitudes toward persons with physical disabilities.
Spearman’s rank correlation coefficient, followed by the calculation of Scores can range from 0 to 180 with lower scores indicating
the Cronbach’s alpha reliability estimates. As for construct validity, the more negative attitudes. ANALYSIS: Descriptive statistics were used
responses to the statements were submitted to a principal component to compile demographic information about the participants. Group
factor analysis with varimax rotation. The number of factors was differences based on gender and major were examined with t-
determined by using the factor scree plot, followed by a second- tests and the relationship between age and ATDP-A score was
order factor analysis using the factors from the first-order factor assessed with a Pearson correlation coefficient. A one-way ANOVA
analysis and then by calculation of the alpha reliability coefficients with Tukey post-hoc testing was used to investigate differences
in order to verify the internal consistency of each of the factors. In based on amount of contact with persons with disabilities. RESULTS:
order to address convergent validity the authors used the multiple There was a significant positive relationship between age and total
regression analysis on the respondents’ background information as ATDP-A score. While there were no differences in ATDP-A scores
independent variables and Form O as the dependent variable. This based on gender, academic major was a significant factor. PTA
was accompanied by the use of the two-tailed Mann-Whitney U students (mean ATDP-A score = 125.11) held significantly more
test. RESULTS: The rate of return was 47.5%, and all but 1 of the positive attitudes than the business students (mean ATDP-A score
20 items were found to have significant item-to-total correlations. = 115.10). In addition, students with 10 or more contacts per week
The alpha reliability estimate for Form O was 0.76 with some with persons with disabilities had significantly more positive attitudes
evidence for construct validity, which explained 30.9% of the variance. as measured on the ATDP-A than did students who reported no
The obtained factors were labelled as ‘prejudice,’ ‘differing view,’ contact per week with persons with disabilities. CONCLUSIONS:
and ‘self-concept’, with the rate of contribution (Cronbach’s alpha) Student attitudes toward persons with disabilities appear to be
being 20.27% (.73), 6.41% (.66), and 4.25% (.69), respectively. influenced by age, academic major, and the amount of contact that
Evidence for construct validity was demonstrated in Form O’s ability an individual has with persons with disabilities. Further research
to differentiate between genders and also between physiotherapists is needed to examine the influence of the type of contact that
who preferred treating clients with conditions or diseases that would takes place between students and persons with disabilities as
lead to a permanent disability and those who preferred treating well as the potential role of the curriculum in shaping student
clients with conditions or diseases that would lead to a full recovery. attitudes. IMPLICATIONS: A better understanding of the factors
Convergent validity, as a form of construct validity, was also supported that influence student attitudes toward persons with disabilities
for Form O. CONCLUSIONS: The Japanese version of ATPC-Form can lead to improved academic curricula as well as enhanced
O can be considered a reliable and valid measure of documenting patient and societal outcomes. KEYWORDS: Attitudes, Persons
trends of importance in regards to the physically challenged. with Disabilities, Social Values. FUNDING ACKNOWLEDGEMENTS:
IMPLICATIONS: ATPC-Form O is a means of measurement Unfunded. CONTACT: dutton@findlay.edu
of ATPC before and/or after ATPC modification, which can be ETHICS COMMITTEE: Institutional Research Review Board, The
used for both cross-sectional and longitudinal studies of ATPC. University of Findlay, Findlay, OH, USA
KEYWORDS: Attitudes towards the physically challenged (ATPC)-
Form O, Reliability, Validity. FUNDING ACKNOWLEDGEMENTS:
This work was unfunded, and ethics approval was not required. Research Report Poster Display
CONTACT: [email protected] 36-11 Monday 4 June 15:30
CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE
Research Report Poster Display FES-I AND CONFBAL QUESTIONNAIRES: GREEK VERSIONS
Billis E, Sakellari V, Kapreli E, Strimpakos N, Trigkas P, Gioftsos G;
Department of Physiotherapy, School of Health and Caring
PHYSICAL THERAPIST ASSISTANT AND BUSINESS STUDENTS’ Professions, Technological Educational Institute (T.E.I) of Lamia,
ATTITUDES TOWARD PERSONS WITH DISABILITIES Greece
Liles A, Schlachter R, Seymour J, Spencer K, Dutton L; The
PURPOSE: The purpose of this study was the cross-cultural
University of Findlay, Findlay, OH, USA
adaptation and validation of two falls-efficacy measures, the
PURPOSE: The primary purpose of this study was to examine Falls Efficacy Scale-International (FES-I) and the Confidence in
the influence of factors such as age, gender, academic major and Maintaining Balance Scale (CONFbal) in a community dwelling
contact with persons with disabilities on physical therapist assistant elderly sample in Greece. RELEVANCE: Fear of falling has recently
and business students’ attitudes toward persons with disabilities. been identified as one of risk factors for recurrent falling and
RELEVANCE: The attitudes of health care professionals can one of the compromising factors of physical function and quality
positively or negatively influence the patient-therapist relationship and of life amongst the elderly. One of the most important falls-
significantly impact goal setting and the outcomes of rehabilitation. related outcomes is the self-efficacy and confidence measures.
In addition, these attitudes affect physical therapy practitioners’ PARTICIPANTS: A sample of 89 community dwelling elderly (50
approach to broader patient advocacy and social policy issues. males, 39 females) aged 60-90 years old (Mean: 72.87, SD: 6.045)
There is limited research examining attitudes toward persons with was included in the study. METHODS: Subjects were requested
disabilities in physical therapy and no studies to date that have to complete 4 questionnaires; the 2 falls-related ones (FES-I &
addressed the attitudes of physical therapist assistant (PTA) students CONFbal) as developed in their final Greek version, and 2 generic
ones already adapted into Greek, the SF-36v2 and the General agreement method described by Bland and Altman with indirect
Health Questionnaire. Questionnaires were personally administered calorimetry (IC) serving as the criterion measure RESULTS: EE
and completed via structured interviews by two physiotherapists. In estimated by the RT3 is in agreement with the IC estimation for
addition, 3 functional mobility and balance tests were performed sedentary activities; watching TV (Bias 0.11, LOA −0.43 to 0.65
to compare against the specific instruments; Functional Reach, Kcal.min−1 95% CI +/−0.21) and internet browsing (Bias 0.12, LOA
Timed Get up and Go and TURN180 tests. An average of 3 −0.27 to 0.5 Kcal.min−1 95% CI +/−0.15). During level walking and
repeated performances for each test following a practice trial was jogging the RT3 overestimated EE and the measurement error
considered in the analysis. The above procedure was repeated 7- increase with augmenting workloads; 3km (Bias −0.65, LOA −2.05
10 days following initial testing to explore the repeatability of the to 0.75 Kcal.min−1 95% CI +/−0.54), 6Km (Bias −1.77, LOA −3.86
measures. For the cross-cultural adaptation, the back-translation to 0.32 Kcal.min−1 95% CI +/−0.8) and 9km (Bias −2.29, LOA
procedure was utilised, comprising forward and backward translations −7.24 to 2.67 Kcal.min−1 95% CI +/−1.97). During uphill walking
by 4 bi-lingual translators. ANALYSIS: Pearson’s correlations and t- data from 9 participants were excluded from analysis as they
tests were used. RESULTS: Content validity of the Greek versions exceeded anaerobic threshold. Resonant of previous work, the RT3
of the FES-I and CONFbal questionnaires was achieved as all underestimated EE during walking at this gradient (Bias 3.67, LOA
participants (including the ones in the pilot) found the questionnaires 0.19 to 7.14 Kcal.min−1 , 95% CI +/−1.35). CONCLUSIONS: The
appropriate and comprehensible. Concurrent validity of FES-I and results of this study confound the findings of similar works in that
CONFbal demonstrated an almost strong correlation (r = 0, 694, IC and RT3 estimates of EE during periods of activity cannot be
p < 0.01). Test-retest reliability of both questionnaires was excellent used interchangeably. The RT3 exceeds the IC measure of EE during
(Pearson’s r = 0.950 & 0.928, t-test p = 0.421 & 1.00 for FES-I and level walking and the degree of difference increases with activities
CONFbal, respectively). Responsiveness across fallers and non- of increasing intensity. Although an inaccurate measure of EE at
fallers yielded a medium effect size value for the CONFbal (0.66) and higher workloads, the RT3 can identify periods of acute activity and
a large one for the FES-I (0.95). Both questionnaires demonstrated differentiate between activities of variable intensities. That said, this
moderate to strong correlations (r ranging between 0.402-0.740) may only be applicable to walking/jogging on level ground as the RT3
with two of the SF-36 physical scales (Physical Function and Role underestimates EE and activity counts during walking at an incline.
Physical). CONFbal yielded moderate to strong correlations with all 3 Additional research is needed to clarify its validity during other forms
functional tests (r ranging between 0.520-0.622), whereas the FES-I of free-living and structured activity. IMPLICATIONS: The RT3 can
correlated only with the Get Up and Go test (r = 0.553). These scores be used clinically to monitor activity levels but it should not be used
appear somewhat comparable with findings across other countries. as a measure of actual EE. It consistently underestimates EE during
CONCLUSIONS: The Greek versions of the FES-I and CONFbal level walking/jogging and the discrepancies are increasingly variable
questionnaires have proven to be valid, reliable, comprehensible as the workloads increase. The device, capable of quantifying
and acceptable for the Greek community-dwelling sample tested. activity duration and relative level of activity on a minute by
IMPLICATIONS: The FES-I and CONFbal questionnaires can be minute basis, is useful as a measure of activity for those with
used in future trials and in cross-cultural comparisons when practicing an habitually sedentary lifestyle KEYWORDS: Energy Expenditure,
physical therapy assessment. KEYWORDS: Questionnaires, Falls, Physical Activity. FUNDING ACKNOWLEDGEMENTS: N.A.
Elderly. FUNDING ACKNOWLEDGEMENTS: This research is part of
the research project «Archimedes II» and has been funded by grants
from the EC and the Ministry of National Education and Religious
Affairs of Greece. 36-19 Monday 4 June 15:30
ETHICS COMMITTEE: The Ethical commitee of the Technological VCEC Exhibit Hall B & C
Educational Institute of Lamia. An official ethics system does not GERMAN TRANSLATION AND RELIABILITY OF THE WOLF
exist in Greece. MOTOR FUNCTION TEST (WMFT) FOR ASSESSING UPPER
EXTREMITY FUNCTION AFTER STROKE
Research Report Poster Display Mey S1 , Kool J2 , Jann B1 , Rutz L1 , Guertler L3 ; 1 Rheinburg-Klinik,
Walzenhausen, Switzerland; 2 Klinik Valens, Valens, Switzerland;
36-15 Monday 4 June 15:30 3 MIS Trend, Lausanne, Switzerland
VALIDITY OF THE RT3 ACCELEROMETER IN THE ASSESSMENT PURPOSE: The Wolf Motor Function Test (WMFT) is known
OF ENERGY EXPENDITURE DURING EXERCISE as an assessment used in clinical and research evaluation of
Constraint-Induced Movement Therapy (CIMT). Our intention was
O’Dwyer J, Langford S, Hussey J; Discipline of Physiotherapy,
School of Medicine, Trinity College Dublin to make a German version of the WMFT available for rehabilitation
specialists in German speaking countries. RELEVANCE: The goal
PURPOSE: To investigate the validity of the RT3 accelerometer as of interdisciplinary rehabilitation is to have patients return home
a measure of energy expenditure in adults during treadmill walking as independent as possible. Therefore reliable instruments are
and jogging. RELEVANCE: In validating the RT3 previous authors needed to assess change. The Wolf Motor Function Test (WMFT)
have often used inappropriate assessments of agreement between is an instrument which takes into account speed and actual
the RT3 and a reference measure which may hinder accurate performance of an activity. PARTICIPANTS: 16 post-stroke subjects
interpretation of results. With a design similar to previous studies in were recruited from the patient population of the Rheinburg-Klinik,
this field, this investigation utilizes an analysis approach advocated to Switzerland. All participants met the inclusion criteria and gave
detect agreement between measurement tools. PARTICIPANTS: A written informed consent to participate in the study. METHODS: We
sample of convenience comprising 20 healthy adults (Age = 26.2 used forward-backwards translation to develop the German version.
+/− 3.7yr, BMI = 23.7 +/− 3.45 kg.m−2 ) were recruited for this The WMFT contains 17 items and is hierarchically structured. One
study METHODS: Participants completed six activities (watching TV, therapist administered the WMFT’s which were videotaped. Three
browsing the internet, treadmill walking at 3kmph, 6kmph, 6kmph at random raters rated videotapes twice within a two week time
a 10% incline and treadmill jogging at 9kmph) each for a duration span. ANALYSIS: Statistical analysis using SPSS was performed
of 5 minutes with seated rest periods in between. Simultaneous to analyse the inter-and intrarater reliability (ICC) and internal
estimates of energy expenditure (EE) were made by the RT3 worn consistency (Cronbach’s Alpha) of the WMFT for performance time
on the waistband and indirect calorimetry (Oxycon Mobile) recorded and funtional ability. RESULTS: Interrater reliability was 0.93 for
continuously through out the protocol. ANALYSIS: The agreement functional ability and 0.99 for performance time for the first rating
between measurement modalities was assessed using the limits of and 0.89 respectively 0.99 for the second rating. Intrarater reliability
was 0.95 for functional ability scores and 1 for performance time. climbing ability (36.6%). A small number reported that there is a
Internal consistency for functional ability was 0.68 and 0.82 for decrease in their physical function. The average overall satisfaction
performance time for rating 1 and 0.69 respectively 0.82 for rating 2. score was 7.9 ±1.8. Some suggestions for improvement in the
CONCLUSIONS: The German version of the WMFT is a valuable program included increasing the frequency of PT, providing more
additional tool to assess motor function of the upper extremity variety of exercises and securing an exercise room for patients’ use.
in post-stroke patients during rehabilitation. IMPLICATIONS: It is CONCLUSIONS: Results of the survey indicated that outpatients
important to make reliable and valid assessments available in participating in the PT exercises program were overall satisfied
physical therapy. This may provide evidence for the efficacy of and they believed that the program was beneficial in improving
therapy concepts as well as document progress. It may also enhance or maintaining their physical function. Needs assessments should
communication between therapists, interdisciplinary personal and be done to determine if their suggestions for improvement are
other involved institutions. KEYWORDS: Wolf Motor Function Test, feasible for the program. IMPLICATIONS: It is worthwhile expanding
cerebro vascular accident, rehabilitation, reliability of results, motor the PT exercise program during hemodialysis. Future proposals
activity. FUNDING ACKNOWLEDGEMENTS: The work was not should include increasing staff and equipment to allow more
funded. support was given by the Rheinburg-Klinik. CONTACT: patients to participate more frequently in this exercise program.
[email protected] KEYWORDS: Physical therapy; Hemodialysis; Exercise Program.
ETHICS COMMITTEE: Ethics committee of Kanton Appenzell FUNDING ACKNOWLEDGEMENTS: No funding was received for
Aussenrhoden, Switzerland this quality assurance initiative. CONTACT: [email protected]
ETHICS COMMITTEE: Research Ethics Board, University Health
Network
VCEC Exhibit Hall B & C Research Report Poster Display
OUTPATIENT HEMODIALYSIS PHYSICAL THERAPY PATIENT 38-03 Monday 4 June 15:30
SATISFACTION SURVEY ADMINISTERED AT THE TORONTO VCEC Exhibit Hall B & C
GENERAL HOSPITAL DAILY HOME CANALITH REPOSITIONING PROCEDURE DOES
Hoy F1 , Carol H2 ; 1 University Health Network, Toronto Canada; NOT REDUCE RECURRENCE OF BENIGN PAROXYSMAL
2 University Health Network, Toronto Canada POSITIONAL VERTIGO
Helminski J1,4 , Janssen I2 , Hain T3,4 ; 1 Midwestern University,
PURPOSE: The purpose in administering an Outpatient Hemodi-
Downers Grove USA; 2 Rush University Medical Center, Chicago
alylsis Physical Therapy (PT) Patient Satisfaction Survey was to:
USA; 3 Northwestern University Medical Center, Chicago USA;
1) evaluate patients’ satisfaction with their exercise program during 4 Chicago Dizziness and Balance, Chicago USA
hemodialysis 2) determine the patients’ perception of whether the
program was effective in maintaining or improving their functional PURPOSE: To determine if daily performance of the home canalith
mobility and 3) solicit suggestions to improve the current PT repositioning procedure increases the time to recurrence and reduces
exercise program. RELEVANCE: Studies have increasingly shown the rate of recurrence of benign paroxysmal positional vertigo
the benefits of exercise during hemodialysis. These benefits range involving the posterior semicircular canal (BPPV-PC). RELEVANCE:
from improving overall physical performance and enhancing toxin BPPV is the most common cause of dizziness. BPPV-PC is treated
clearance. The Toronto General Hospital has one of the largest effectively with particle repositioning maneuvers such as the canalith
outpatient hemodialysis programs in North America. To date, patients’ repositioning procedure (Epley,1992). The average success rate of
satisfaction with physical therapy exercise programs, consisting a single treatment session is 76% (Harvey, Hain, & Adamic, 1994).
of bicycle ergometry and strengthening, that were implemented Of patients treated successfully, 44% redevelop BPPV within 2 years
approximately three years ago as a part of physical therapy care have (Hain, Helminski, Reis, & Uddin, 2000). Whether or not daily particle
not been evaluated. PARTICIPANTS: Thirty hemodialysis outpatients repositioning maneuvers can prevent recurrence of BPPV-PC is not
received the satisfaction survey in June 2006. To be included, know. Although widely used, the Brandt-Daroff exercise is minimally
participants had to be English speaking, on PT exercise program effective in the treatment of BPPV-PC with a 23% success rate at 1
and attending first or second shift hemodialysis. The exclusion week (Radtke, von Brevern, Tiel-Wilck, Mainz-Perchalla, Neuhauser,
criteria included diminished cognitive status, non-English speaking, Lempert, 1999) and does not prevent recurrence of BPPV-PC
PT following for issues other than exercise program, and attending (Helminski, Janssen, Kotaspouikis, Kovacs, Sheldon, McQueen, &
third shift hemodialysis. Consent was obtained from all eligible Hain, 2005). The home canalith repositioning procedure is effective
participants prior to completing the survey. METHODS: The physical in the treatment of BPPV-PC with a success rate of 95% at one week
therapist recruited eligible participants from the current caseload. A (Radtke, von Brevern, Tiel-Wilck, Mainz-Perchalla, Neuhauser, &
survey consisting of nine questions was distributed to the sample Lempert, 2004) but it is not know if it is effective in preventing
over a two-week time frame by two University Health Network recurrence of BPPV-PC. PARTICIPANTS: 39 subjects with BPPV-
volunteers. The survey collected information on demographics, type PC successfully treated with the canalith repositioning procedure.
and duration of program, patients’ perceptions on impact of program METHODS: Patients were assigned to the treatment group based on
on ambulation ability, ambulation distance, and stair climbing ability. willingness to perform daily exercises. Patients in the treatment group
Patients rated their overall satisfaction with the program using a (n = 17) performed daily the home canalith repositioning procedure
10-point Likert scale. In addition, patients were also asked to while patients in the no-treatment group (n = 22) performed no
provide any suggestions for improvement of the program. ANALYSIS: exercises. Patients were followed for as long as 2 years. Every
Descriptive statistics were used for data management purposes 2 months patients were mailed a questionnaire. If BPPV had
using an Excel. RESULTS: Thirty outpatients (sixteen males) were recurred, patients contacted the principal investigator within 24 hours.
included in the survey. Majority of the participants were age 60 Within 1 to 2 weeks of recurrence, patients were evaluated in the
or older (63.3%), had been on hemodialysis for 4.2 ±2.5 years, clinic with the Dix-Hallpike maneuver. ANALYSIS: The demographic
and were on the strengthening program (56.6%) for between one characteristics of the groups were compared. The difference in
to six months (46%). The majority of the participants reported frequency of recurrence was calculated (Pearson c2 ). To determine
improvement in their ambulation ability (60.0%), ambulation distance whether the time to recurrence differed between the treatment and
(53.3%), and stair climbing ability (43.3%). A moderate number of no-treatment groups and to account for patients entering the study
participants reported no change in their functional performance, at different times, the Kaplan-Meier product-limit method was used
ambulation ability (30.0%), ambulation distance (33.3%), and stair to estimate the survival function and the log rank test was used to
determine if there was a significant difference. RESULTS: There was Research Report Poster Display
no significant difference in age, sex, duration of symptoms prior to 39-11 Monday 4 June 15:30
treatment, or history of recurrence of BPPV between the groups. VCEC Exhibit Hall B & C
Symptoms recurred in 16 (41%) of the 39 subjects, 6 (35%) of CONTINENCE STATUS FIVE YEARS AFTER CESSATION OF
the 17 in the treatment group and 10 (46%) of the 22 in the no- ORGANIZED PELVIC FLOOR MUSCLE TRAINING
treatment group. There was no significant difference in the frequency
of recurrence (Pearson c2 , P = 0.522) or the time to recurrence Mørkved S1,2 , Fjørtoft T1 , Lindland M1 , Bø K3 ; 1 Clinical service, St.
(survival analysis, log-rank test, P = 0.242). CONCLUSIONS: Results Olavs Hospital, Trondheim University Hospital; 2 Dept. of Community
suggest that daily home canalith repositioning procedure does not Medicine and General Practice, Norwegian University of Science
increase the time to recurrence or decrease the rate of recurrence and Technology, Trondheim, Norway; 3 Norwegian School of Sport
of BPPV. IMPLICATIONS: Daily particle repositioning maneuvers do Sciences, Department of Sports Medicine, Oslo, Norway
not prevent recurrence of BPPV. KEYWORDS: Benign Paroxysmal
PURPOSE: The purpose of the study was to assess the continence
Positional Vertigo, Vertigo. FUNDING ACKNOWLEDGEMENTS:
Supported by National Institute of Health, National Institute on Aging, status in a group of women five years after cessation of 6 months
1 R15 AG17567-01A1. CONTACT: [email protected] organised pelvic floor muscle training. RELEVANCE: The present
ETHICS COMMITTEE: Midwestern University Internal Review Board study was a five years follow up study of a single blind, randomised
controlled trial assessing the effect of pelvic floor muscle training
with and without biofeedback in women with urodynamic stress
Research Report Poster Display incontinence (1). PARTICIPANTS: All women who had participated
38-07 Monday 4 June 15:30 in the randomised controlled trial and a previous one year follow up
VCEC Exhibit Hall B & C study (2) were invited to take part in the five year follow up study.
NORMATIVE DATA FOR THE GAZE STABILIZATION TEST (GST) Across the time of the study, several physical and social constraints
PROTOCOLS ON THE INVISION® FOR HIGH PERFORMANCE resulted in some women being unable to meet for the follow up
ATHLETES assessment. Five years after cessation of the training program 80
Tyner T, Robbins D, Trueblood P, Sailor S, Cleary B; California of 94 women (85%) in the original study returned the questionnairs.
State University, Fresno Mean age (range) at five year follow up was 53 (35-75) years, and
mean (range) duration of symptoms at inclusion in the original study
PURPOSE: This study was conducted to establish normative data,
was 10 (1-25) years. No specific characteristics of the group of
mean scores (degrees/second) of maximal head velocity for gaze
stabilization for high performance athletes. Normative data exists withdrawals were found. METHODS: The primary outcome measure
for the general population, but not for athletes. RELEVANCE: Gaze at five years follow up was self report of urinary incontinence. Women
stabilization maintains gaze direction of the eyes and visual acuity reporting urinary leakage once weekly or more were classified as
on an object during activities involving head and body movements. incontinent. The training program of the original study consisted
The vestibular system is responsible for gaze stability by sensing of six months of pelvic floor muscle training comprising three
motion of the head, maintaining stability of images on the fovea of sets of 10 contractions three times per day. All participants met
the retina, and controlling posture during motion. Gaze stabilization a physiotherapist for individual training sessions, motivation and
at velocities greater than 60 degrees per second is maintained by monitoring of pelvic floor muscle strength, once per week during
the vestibulo-ocular reflex (VOR). When functioning normally, the the first month, and every second week during the next 4 months.
VOR provides accurate information for balance control. This stability ANALYSIS: The statistical software program used for analyses was
is critical for safe, efficient and coordinated movements required SPSS (version 13.0). Results are given as mean values and range
for high performance sports. PARTICIPANTS: 47 NCAA Division and persentages (%). RESULTS: At the five-year follow up 45% of
I athletes from the Fresno State Athletic Department representing the women were classified as continent. Thirteen women had in the
several sports. METHODS: NCAA Division I athletes were recruited meantime had surgery due to their incontinence problem, and seven
and tested using the inVision, manufactured by NeuroCom Inc., women conservative treatment. Pelvic floor muscle exercises was still
in all three head motions; horizontal, vertical, and roll. Data was conducted weekly or more by 49% of the women. Sixty-one percent
collected and then analysed. ANALYSIS: Quantitative anaylsis was reported that the problems related to their urinary incontinence
completed. RESULTS: Mean scores for all sports were found to was lower at the five year follow up than before treatment, 25%
be: 139 deg/sec with a SD of 33 for horizontal, 113 deg/sec with
that the problems was unchanged, and 14% that the problems
a SD of 30 for vertical, and 100 deg/sec with a SD of 26 for
was worse. CONCLUSIONS: Five years after cessation of the six
roll. CONCLUSIONS: High performance athletes have higher mean
months pelvic floor muscle training program nearly half of the women
scores compared to non-athletes at motions ranging between 80
were still continent, and 61% reported improvement compared to
to 100 deg/sec. IMPLICATIONS: If high performance athletes with
higher visual and balance demands require a higher maximum before the training period. However, the percentage of continent
head velocity for gaze stabilization to meet the demands of their women at the five year follow up was slightly reduced compared
sport. Data from this study could provide an effective tool in to immediately after cessation of the pelvic floor muscle training
determining when an athlete could safely return to play folwing a mild program. IMPLICATIONS: The effects of pelvic floor muscle training
brain injury. KEYWORDS: Athletes, Gaze stabilization, Vestibulo- in the treatment of urinary incontinence is still present five years after
Ocular Reflex (VOR). FUNDING ACKNOWLEDGEMENTS: None. cessation of the training program. References: 1. Effect of adding
CONTACT: [email protected] biofeedback to pelvic floor muscle training to treat urodynamic stress
ETHICS COMMITTEE: California State University, Fresno – Protec- incontinence. Obstet Gynecol 2002;100:730-9. 2. Continence status
tion of Human Subjects one year after cessation of organised pelvic floor muscle training.
International Continence Society 33rd Annual Meeting. Florence 5/9
October 2003, Italy. KEYWORDS: pelvic floor muscle training, urinary
incontinence, long term effect. FUNDING ACKNOWLEDGEMENTS:
The Liaison Committee for Central Norway Regional Health Authority
(RHA) and the Norwegian University of Science and Technology.
ETHICS COMMITTEE: The Regional Committee for Research Ethics
in Sør-Trøndelag, Norway
Platform Presentations, Tuesday 5 June S299
39-15 Monday 4 June 15:30 Platform Presentations, Tuesday 5 June
WOMEN WITH PELVIC AND LOW-BACK PAIN DURING Research Report Platform Presentation
PREGNANCY – AN INTERVIEW STUDY 614 Tuesday 5 June 08:30
Nilsson-Wikmar L1 , Franke C1,2 , Biguet G1 ; 1 Department of PP Crystal Pavilion B & C
Neurobiology, Care Sciences and Society, Division of Physiotherapy, WAIT TIMES FOR PEDIATRIC REHABILITATION
Karolinska Institutet, Stockholm, Sweden; 2 Söderkliniken, Stockholm
Grilli L1−3 , Ehrmann Feldman D1−4 , Swaine B1,2 , Gosselin J1,5 ,
PURPOSE: Pelvic and low back pain is common during pregnancy. Champagne F4 , Pineault R4 ; 1 Université de Montréal, École
Half of all women are on sick leave during pregnancy and more de réadaptation; 2 Centre de recherche interdisciplinaire en
women than normal rate their quality of life as lower. Different réadaptation (CRIR); 3 McGill University Health Center: Montreal
treatments and measurements have been developed and evaluated, Children’s Hospital; 4 Université de Montréal, Groupe de recherche
however, little is known about the experiences expressed by the interdisciplinaire en santé (GRIS); 5 Centre de recherche Hôpital
women themselves. Thus the purpose of this study was to explore Sainte-Justine
and describe the experiences of women with pelvic and low back
pain during pregnancy. RELEVANCE: It could be useful in the PURPOSE: To describe waiting time to receive physical therapy (PT)
clinician’s work, to understand what the women’s experiences and and occupational therapy (OT) services at pediatric rehabilitation
needs are, and a help in the development of more effective healthcare centers for prechool-aged children with physical disabilities. To
programs. PARTICIPANTS: Fourteen pregnant women with pelvic examine factors associated with these waiting times. RELEVANCE:
and low back pain were interviewed. The women were recruited Early therapy intervention for children with disabilities may improve
strategically from a specialist physical therapy outpatient clinic. functional outcomes. Access to pediatric rehabilitation services
METHODS: A qualitative multiple case study design was chosen can sometimes be difficult. PARTICIPANTS: Our study population
and data collection was performed by semi-structured interviews. included parents of 206 children with physical disabilities, aged
ANALYSIS: A qualitative analysis was conducted using the cross- 6-72 months, referred in 2002-2004 from the Montreal Children’s
case method, which implies that the contents of all the interviews Hospital and Sainte-Justine Hospital to pediatric rehabilitation
are compared with each other in order to identify patterns of centers. METHODS: A prospective cohort study. Data on date of
regularity. RESULTS: Four categories emerged from the data. The referral, age, gender, and diagnosis were obtained from the hospital
main category was the experience of interrupted normal activities computer databases. Data on date of first PT or OT appointments
due to physical limitation, which resulted in feelings of insufficiency,
at the rehabilitation center, family socio-demographics, and diasbility
anxiety and lack of control, as well as the need for, acceptance.
severity (Functional Independence Measure for Children) were
The other three categories were each individual’s relation to time,
obtained during parental interviews. ANALYSIS: Descriptive statistics
to self and to significant others. These contribute to and influence
to summarize the characteristics of the cohort were calculated.
the overall experiences of the main category in both positive and
negative ways. CONCLUSIONS: Pregnant women with pelvic and Cox proportional hazard regression (survival) analysis was used to
low back pain are affected by the interruption of their normal activities determine the association between earliest time to rehabilitation (i.e.
due to physical limitation, which has an impact on their relation to waiting times for PT or OT) and the various factors. RESULTS:
time, to their self and their significant others. Health professionals, Half of the sample waited more than 7 and 11 months for PT
including physical therapists, should take this into account when and OT services, respectively. Shorter waiting time was significantly
choosing treatment or considering sick leave. The results could also associated with younger child’s age (adjusted HR = 0.5; 95% CI
be looked upon as a theoretical framework, which offers possibilities = 0.37-0.82) and referral to one particular rehabilitation center
to facilitate more adequate and suitable strategies on how to cope (adjusted HR = 2.8; 95% CI = 1.7-4.4). Maternal education or
in a new situation. IMPLICATIONS: There are several areas in severity of a child’s functional disability did not appear to influence
a pregnant woman with pain that are affected. It is not only the waiting times. CONCLUSIONS: Children with physical disabilities
quality of life that gets lower, many other aspects have to be taken experience long waiting times before receiving appointments for
into account. Sick leave is a common used strategy to handle PT and OT rehabilitation services. Despite provincial governmental
the situation. The result in the present study indicates that there recommendations for implementation and assurance of coordinated
are other strategies that can be considered when dealing with programs in the early 1990’s, our findings suggest that in the past
pain during pregnancy. KEYWORDS: Experiences, phenomenology, several years there has been an increase rather than a decrease
womens’ health. FUNDING ACKNOWLEDGEMENTS: The work was in waiting times for delivery of PT and OT services in rehabilitation
unfunded. CONTACT: [email protected] centers. IMPLICATIONS: The findings may support the need to
ETHICS COMMITTEE: The ethical approval was obtained from augment PT and OT resources in pediatric rehabilitation centers.
the Research Ethics Committee at Huddinge University Hospital in There may be a need for the development of alternative models
Sweden.
of care delivery for children with disabilities in order to provide
timely rehabilitation to maximize the children’s functional abilities and
well-being. Emphasis on implementation of new policies in order
to improve accessibility of services to physically disabled children
is extremely important as this may prevent repercussions later
during the school years. KEYWORDS: pediatric rehabilitation, wait
times, preschool-aged children with physical disabilities. FUNDING
ACKNOWLEDGEMENTS: Fonds de la Recherche en Santé du
Québec (FRSQ) and the Canadian Institutes of Health Research
(CIHR). A studentship was awarded to Lisa Grilli by Quebec
provincial professional order of physical therapists (OPPQ) and
la Faculté des Études Supérieures de l’Université de Montréal.
ETHICS COMMITTEE: Montreal Children’s Hospital and Hôpital
Sainte-Justine Ethic Committees.
VCEC Meeting Rooms 8&15 VCEC Meeting Room 16
THE ACCESS TRIAL: RANDOMISED CONTROLLED TRIAL OF THE BERG BALANCE SCALE: INTRA-RATER RELIABILITY
PUBLIC HOSPITAL-BASED VERSUS PRIVATE COMMUNITY- IN OLDER PEOPLE DEPENDENT IN ADL AND LIVING IN
BASED PHYSIOTHERAPY FOR LOW BACK PAIN:INTERIM RESIDENTIAL CARE FACILITIES
RESULTS Conradsson M1 , Lundin-Olsson L1 , Lindelöf N1,2 , Littbrand H1 ,
Casserley-Feeney S1 ,
Bury G2 ,
Daly L3 ,
Hurley D1 ; 1 School
of Malmqvist L1 , Gustafson Y1 , Rosendahl E1,2 ; 1 Umeå University,
Physiotherapy & Performance Science; 2 School of Medicine & Department of Community Medicine and Rehabilitation, Geriatric
Medical Science; 3 School of Public Health & Population Science, Medicine and Physiotherapy, Umeå, Sweden; 2 Luleå University
University College Dublin, Ireland of Technology, Department of Health Sciences, Physiotherapy
Unit, Luleå, Sweden
PURPOSE: This pragmatic randomised controlled trial aimed to PURPOSE: To investigate the absolute and the relative intra-rater
investigate any differences in the clinical outcomes of patients with reliability of the Berg Balance Scale (BBS) among older people
low back pain (LBP) receiving physiotherapy in (i) the current publicly- who are dependent in activities of daily living (ADL) and living
funded hospital-based secondary healthcare model (H) versus (ii) a in residential care facilities. RELEVANCE: The BBS is frequently
private community-based primary healthcare model (P). Patient costs used to measure balance and to evaluate treatment effects in older
will also be investigated. RELEVANCE: The current two-tier health people. It is crucial for the clinician to know whether a change in
care service in the Republic of Ireland results in high waiting times for score is due to a real change of balance function or due to a
patients receiving physiotherapy in publicly-funded hospital settings measurement error. PARTICIPANTS: 45 older people, 36 females
compared to privately-funded community settings, and the outcomes and 9 men, dependent in ADL and living in three residential care
and cost effectiveness of these different physiotherapy settings have facilities. Their mean age ± SD was 82.3±6.6 (range 68-96) and
not been previously established for LBP in any jurisdiction. Public mean score ± SD of the Mini Mental State Examination score was
17.5±6.3 (range 4-30). METHODS: The BBS was assessed twice
community-based physiotherapy for LBP is not widely available
by the same assessor, at approximately the same time of day,
due to the delayed implementation of Ireland’s Health Strategy
and with 1-3 days in between. ANALYSIS: The absolute reliability
(2001). PARTICIPANTS: Between March 2005 and May 2006, 160
for the difference in score between the two test occasions was
consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83)], calculated with the Bland and Altman analysis of variance with 95%
referred by general practitioners (GPs) for physiotherapy for non- confidence level. The relative reliability was calculated with Intraclass
specific LBP were recruited across three clinical centres within Correlation Coefficient (ICC). RESULTS: The mean score ± SD of
Ireland. METHODS: Subjects completed a baseline interview and the first test of the BBS was 30.1±15.9 (range 3-53) and of the
baseline outcome measures (Roland Morris Disability Questionnaire retest 30.6±15.6 (range 4-54). The absolute difference between the
(RMDQ), SF-36 V2, Fear Avoidance Beliefs Questionnaire, Back two test occasions was in mean ± SD 2.8±2.7 (range 0-11). The
Beliefs Questionnaire), were stratified (acute: <3/12; chronic: >3/12), absolute intra-rater reliability was 7.7 points and the ICC value was
and randomised to one of the two groups (i.e. H: n=80; P: 0.97. CONCLUSIONS: Despite a high ICC value, the result of the
n=80). Patients were treated as necessary by the participating absolute reliability shows that a change of 8 BBS points is required
physiotherapists based on assessment findings and followed up to reveal a genuine change of balance function among older people
by post at 3, 6 and 12 months post randomisation. ANALYSIS: who are dependent in ADL and living in residential care facilities.
Data were coded and questionnaires scored, then analysed using IMPLICATIONS: In older people living in residential care facilities, it
the Statistical Package for the Social Sciences (SPSS, Version seems important for clinicians to be careful when using the BBS
11). An intention-to-treat analysis was conducted. RESULTS: Both to draw conclusion of an individual’s change in balance function
over time. KEYWORDS: Geriatric assessment, Observer variation,
groups were comparable for all baseline demographic variables
The Berg Balance Scale. FUNDING ACKNOWLEDGEMENTS: This
and questionnaire scores. Response rates are 82% (n= 131/160)
work was supported by grants from the Swedish Research Council
and 76% (n= 84/110) for 3 and 6-month follow ups respectively. K2005-27VX-15357-01A, Erik and Anne-Marie Detlof’s Foundation,
Current descriptive analysis of mean change scores (SD), from and the European Union (Interreg Kvarken-MittSkandia). CONTACT:
baseline to 3-months: RMDQ: [H = 4.68 (−1.27); P = 4.74 (−0.91)] [email protected]
and SF-36 Bodily pain: [H = −7.51 (−3.81); P= −9.58 (−3.03)] ETHICS COMMITTEE: The study was approved by the Ethics
and from baseline to 6-months: RMDQ: [H = 5.87 (−0.27); P = Committee of the Medical Faculty of Umeå University (§439/03).
6.52 (0.06)] and SF-36 Bodily pain: [H = −8.44 (−4.57); P = −8.5
(−4.27)] show clinically meaningful improvements in both groups
overtime with no differences between groups. Current treatment
record data (n=126/160) show a significant difference in waiting 737 Tuesday 5 June 08:30
time days (SD) between groups [H = 48.87 (49.43); P = 12.64 VCEC Meeting Room 17
(15.77); p < 0.001]. Despite this, the number of treatments (H = THE EFFECT OF PATTERN OF REPETITIVE EXERCISE ON
4.93; P = 5.83), and the treatment packages being delivered were CORTICAL EXCITABILITY IN NORMAL SUBJECTS
comparable, comprising patient education, manual therapy, exercise- Sorinola I1 , Oliver K; 1 Division of Applied Biomedical Research,
therapy and home exercises. The 12-month follow-up is underway School of Biomedical & Health Science, King’s College London
and will also be presented at the conference. CONCLUSIONS: and
PURPOSE: This study was designed to determine whether different
IMPLICATIONS: The findings may influence future health policy
parameters of repetitive movement affect motor cortical excitability as
regarding the funding and provision of physiotherapy services in measured by motor evoked potentials (MEPs) elicited by transcranial
Ireland. KEYWORDS: Randomised Controlled Trial, Physiother- magnetic stimulation (TMS). The purpose was to identify optimal
apy, Low Back Pain. FUNDING ACKNOWLEDGEMENTS: Health repetitive exercise parameters for rehabilitation of central paresis e.g.
Research Board, Ireland for Research Project Grant. CONTACT: stroke. RELEVANCE: Previous studies have shown that repetitive
[email protected] exercise is crucial for motor learning and recovery from stroke
ETHICS COMMITTEE: Ethics Committee, Mater Misericordiae (Bütefisch et al 1995, Hummelsheim et al 1996, 1997) and there
Hospital, Eccles Street, Dublin 7 are suggestions that the type, frequency and intensity of repetitive
exercise may determine its therapeutic impact (Hauptmann et al ANALYSIS: All collected data were checked for completeness and
1996, 1997, Samii et al 1996). However the optimal characteristics normality. Analysis was undertaken on an intention-to-treat basis. We
of repetitive exercise for rehabilitation are unknown. PARTICIPANTS: created a dichotomous variable for existence of a PPC, which was
Eleven healthy normal subjects were recruited from students and compared between the intervention and control group with the Odds
staff of Kings College London. METHODS: The mean amplitude Ratio. Differences in continuous variables between the intervention
of 5 motor evoked potentials in the extensor carpi radialis muscle and the control group were tested with the Pearson c2 test. Length of
elicited by TMS at 1.2 times motor threshold (Mills & Nithi 1997) was postoperative hospital stay was compared between the two groups
used as an index of cortical excitability. This was measured before with the Mann-Whitney test. Statistical tests were two-sided, and a P
and immediately after 9 different exercise interventions and after 3 value 0.05 was considered statistically significant. RESULTS: Both
and 5 min recovery. The interventions were isometric contractions groups had a similar preoperative cardiac and pulmonary history. The
of the wrist extensions of different durations (2, 6 & 8 mins), duration of surgery, number of coronary vessels affected by disease,
frequencies (10, 20 & 30 min.-1) and loads (10, 20 & 30% of and cardiopulmonary bypass time were not significantly different
maximum voluntary isometric contraction (MVC) force. ANALYSIS: in the two groups. Patients in the intervention group exercised
Peak to peak amplitudes of MEPs at each time point were averaged. preoperative without any report of adverse events during and after
Pre and post values were compared using repeated measures training-sessions in their diaries. Primary Outcome: The incidence
ANOVA to determine significant differences (a = 0.05). Bonferonni of pneumonia was 6.5% (9 of 139 patients) in the IMT group and
corrections were applied for post hoc t-test analysis. RESULTS: 16.1% (22 patients of 137) in the usual care group (OR= 0.40;
Increased excitability occurred only after 8 minutes exercise duration 95% CI 0.19 to 0.84). Secondary Outcome: The median duration
(72.3 + 22.1%, P = 0.025) and contractions with 10% MVC load of postoperative hospitalization was 7 days, range 5 to 41 days, in
(161.3 + 100.1%, P = 0.013) throughout the 5 minutes recovery the IMT group and 8 days, range 6 to 70 days, in the usual care
period. Decreased excitability was observed after contractions with group, which was significantly different (Mann-Whitney U; Z = −2.42;
30% MVC load (32.1 + 8.40%, P= 0.03) but, frequency had no p = 0.015). CONCLUSIONS: Preoperative physical therapy reduces
effect. CONCLUSIONS: This study indicates that both duration and the incidence of PPCs (e.g. pneumonia) in patients at high risk of
force of repetitive exercise influence cortical excitability. Repetitive developing a PPC undergoing CABG. IMPLICATIONS: Postoperative
exercise of longer durations and low force was most effective in pulmonary dysfunction after CABG may cause a longer duration of
facilitating cortical excitability. IMPLICATIONS: These data suggest mechanical ventilation, difficulty weaning the patient, and prolonged
that the addition of low force repetitive exercise for approximately hospitalization, and may be associated with a higher mortality. We
8 min may be effective additions to the rehabilitation programmes found that preventive physical therapy with IMT given to patients at
of patients with central paresis. KEYWORDS: motor evoked high risk of PPCs before CABG, decreased the incidence of PPCs
potentials, transcranial magnetic stimulation, motor cortex, repetitive and shortened the duration of mechanical ventilation and hospital-
exercise, cortical excitability. FUNDING ACKNOWLEDGEMENTS: ization. KEYWORDS: Preoperative Physical Therapy, Postoperative
None. CONTACT: [email protected] Pulmonay complications, Coronary Artery Bypass Graft Surgery,
ETHICS COMMITTEE: King’s College London Ethics Committee Randomized Clinical Trial. FUNDING ACKNOWLEDGEMENTS: This
study was funded [1] through a project grant from the Netherlands
Organization for Health Research and Development (ZonMw; grant
no: 1310.0004), [2] the Rudolf Magnus Institute of Neuroscience
545 Tuesday 5 June 08:30 of the University Medical Center Utrecht, the Netherlands, [3]
VCEC Meeting Room 18 AGIS Health Insurance House, Amersfoort, [4] the Royal Dutch
PREVENTION OF PULMONARY COMPLICATIONS IN HIGH RISK Association of Physical Therapy supported the IMT training and [5]
PATIENTS UNDERGOING CABG SURGERY BY PREOPERATIVE PT-medical supported the Threshold Loading Devices. CONTACT:
INSPIRATORY MUSCLE TRAINING: A RANDOMIZED CLINICAL [email protected]
TRIAL ETHICS COMMITTEE: The protocol was approved by the institu-
Hulzebos E1,2 , Helders P2 , Favie N1 , de Bie R3 , Brutel de la tional Review Board and Ethics Committee of the University Medical
Riviere A4 , van Meeteren N1,5 ; 1 Department of Neurology and Center Utrecht, the Netherlands.
Neurosurgery, Rudolf Magnus Institute of Neuroscience, University
Medical Center Utrecht, the Netherlands; 2 Department of Pediatric Research Report Platform Presentation
Physical Therapy and Exercise Physiology, University Medical Center
and Children’s Hospital Utrecht, the Netherlands; 3 Department of
Epidemiology, Maastricht University, the Netherlands; 4 Department
of Cardiopulmonary Surgery, Onze Lieve Vrouwe Gasthuis, RELATION OF MUSCLE STRENGTH AND FUNCTIONAL
Amsterdam, the Netherlands; 5 Department of Physical Therapy- WALKING CAPACITY AMONG STROKE PERSONS
Research, Academy of Health Sciences Utrecht, the Netherlands Moriello C, Mayo N; School of Physical and Occupational Therapy,
McGill University, Montreal, Quebec Canada
PURPOSE: To study the prophylactic efficacy of preoperative
physical therapy on the incidence of postoperative pulmonary PURPOSE: To estimate the extent to which muscle strength is
complications (PPCs) in patients at high risk of developing PPCs independently associated with functional walking capacity among
who underwent CABG surgery. RELEVANCE: The rate of PPCs stroke patients. RELEVANCE: Muscle strength is an important
has remained stable, possibly because CABG is now performed construct to understand in the stroke population because it is required
in more fragile (high risk) patients at greater risk of PPCs as a in performing activities, including walking and basic activities of
consequence of their comorbid conditions. Physical therapy was daily living. PARTICIPANTS: Sixty three patients with stroke onset
usually given after the operation, whereas the preferred strategy is between 3 to 12 months. METHODS: Muscle strength of six lower
to identify, on the basis of known risk factors, and treat patients who extremity muscles (hip flexors, hip extensors, knee flexors, knee
might benefit the most before surgery. PARTICIPANTS: Two hundred extensors, ankle plantarflexors: gastrocnemius and soleus) were
sixty-zeven high risk patients awaiting elective, primary CABG were assessed using hand held dynamometry. They were tested bilaterally
eligible for inclusion and were randomly assigned to the two study in various gravity related positions. Functional walking capacity
groups. METHODS: Included patients were closely monitored during was assessed using the 6 Minute Walk Test (6MWT). ANALYSIS:
their entire hospital stay until discharged. The intervention group (n= Principal component analysis (PCA) was used to create a global
139) received preoperatively individualized, tailored exercises and the index of muscle strength. The relationship between walking and
control group (n= 137) received care as usual the day before surgery. muscle strength was determined using multiple linear regression.
RESULTS: A principal components analysis (PCA) resulted in a through discussion and clearer programme documentation. They
global index of lower extremity position-specific muscle strength. The acknowledged interns’ familiarity with the workplace as beneficial.
results showed that a global index of muscle strength, balance, tone Managers valued improved relationships with the university and
and comorbids explain 70% of the variability of the 6MWT. Moreover, involvement in the student selection process. Assurance of continued
the muscle strength of the affected side in gravity related positions, funding remained a foremost concern. They viewed SLP as
as an index, explain most of the variability (37%), in comparison enhancing graduates’ fitness for practice, but questioned whether
to the other positions. In addition, the hip flexor in an alternate ideals of greater diversity had been fully realised. SLP strengthened
against gravity position, as an individual muscle, explains the most university and hospital relationships. The importance of the SLP
variability of walking capacity. CONCLUSIONS: The observation programme leader as a central source of communication and support
that global strength was strongly associated with distance walked was widely acknowledged and valued. Challenges centred around
supports strength training in functional tasks in addition to specific overlap between placement availability with traditional students, and
training programs for individual muscles. IMPLICATIONS: Clinically, assurance of continued funding. CONCLUSIONS: Feedback from all
this study can help optimize the treatment and time of the stakeholders was positive and recommended continuation of SLP.
therapists and the patients. During an assessment, a therapist Original ideals were becoming realised, and SLP was comparable
now has the option of assessing only the gravity related muscles, with the traditional programme. SLP was aided by a dedicated
or at a minimum, the hip flexors in an alternate against gravity lead within the university and at each clinical site to develop the
position. KEYWORDS: muscle strength, walking, stroke. FUNDING programme together. IMPLICATIONS: Assuming commitment from
ACKNOWLEDGEMENTS: Canadian Stroke Network. academic and clinical stakeholders, SLP is a successful model which
ETHICS COMMITTEE: Faculty of medicine McGill University is widely applicable to undergraduate education in Physiotherapy.
Institutional Review Board KEYWORDS: Situated learning;Work based learning;Clinical ed-
ucation. FUNDING ACKNOWLEDGEMENTS: South East London
Workforce Development Confederation.
ETHICS COMMITTEE: The University of East London Research
1188 Tuesday 5 June 08:50 Ethics Committee
SITUATED LEARNING: AN EVALUATION OF STAKEHOLDER
PERSPECTIVES AND ACADEMIC ACHIEVEMENT OF THE FIRST Research Report Platform Presentation
PHYSIOTHERAPY GRADUATES FROM THE PROGRAMME 880 Tuesday 5 June 08:50
Baldry Currens J1 , King R1,2 ; 1 University of East London, London,
UK; 2 Homerton University Hospital NHS Foundation Trust, London, A SYSTEMATIC REVIEW ON THE EFFECTS OF EXERCISE
UK PROGRAMS DESIGNED TO IMPROVE STRENGTH FOR PEOPLE
WITH DOWN SYNDROME
PURPOSE: In the Situated Learning Programme (SLP), students
Shields N, Dodd K; School of Physiotherapy, La Trobe University,
attend university two days per week and work as ‘interns’ three
Melbourne, Australia
days. Established in 2003 as an alternative to traditional under-
graduate physiotherapy programmes, original ideals focussed on PURPOSE: To determine if participation in programs designed to
enhancing university and hospital partnerships, student diversity improve muscle strength are safe and beneficial for people with
and theory-practice integration. Evaluation was undertaken as the Down syndrome. RELEVANCE: Muscle weakness can contribute to
first student cohort graduated. The prime research aim was to disability in people with Down syndrome and can also impact on
explore stakeholders’ perceptions regarding value, effectiveness, and their ability to work, perform activities of daily living, or participate
operational aspects of implementation. Secondary aims considered in recreational activities. As their work-place activities typically
whether original development ideals had been fulfilled, and compared emphasise physical rather than cognitive skills, decreased strength
intern achievement with traditional students. RELEVANCE: Whilst can also negatively impact on the vocational development of adults
situated learning (Lave and Wenger,1991) is relevant to many with Down syndrome. It is possible that participation in programs
professions, there has been no previous evaluation of its application designed to improve strength could lead to detrimental outcomes for
to physiotherapy education. SLP represents a unique and innovative people with Down syndrome as hypotonia and ligamentous laxity
model. PARTICIPANTS: Study participants were 5 graduating commonly associated with Down syndrome might increase their
students, 3 physiotherapy managers, 3 trust-based coordinators and risk of soft-tissue injury. This systematic review therefore aimed
6 clinical educators as key informants. METHODS: Qualitative, semi- to determine the benefits and risks of such programs for people
structured interviews were conducted by an independent interviewer. with Down syndrome. PARTICIPANTS: Not applicable METHODS:
Key interview topics addressed: stakeholder perceptions; programme Eleven electronic databases were searched from inception to July
strengths and needs; implementation challenges; partnership issues; 2006 using the following key words: Down syndrome, Trisomy
intern employability; placement availability; human resource issues; 21 or mental retardation in combination with exercise, exercise
funding arrangements. All interviews were audio-taped, transcribed therapy, therapeutic exercise, resistance, strength, rehabilitation,
and summarised within each topic area. ANALYSIS: Transcriptions physical training, motor intervention and physical therapy. Additional
were sent to participants for respondent validation of accuracy articles were identified through manual searching and citation
and interpretation. Key issues were identified and coded by two tracking. Two reviewers independently assessed the full text articles
researchers, cross-checked with the original interviewer and each identified for the following inclusion criteria: (1) participants with
other. Data were analysed through thematic content analysis of Down syndrome, (2) an intervention program designed to improve
issues arising, and considered against original programme ideals. strength and (3) assessed changes in muscle strength, activity
Module assessment marks were compared between traditional and limitation or societal participation. Trials of low methodologic quality
SLP programmes. RESULTS: Students recognised SLP was inten- (Pedro <3) including case studies were excluded. Of the 1564
sive and required organisational skills but appreciated greater clinical articles initially identified, five trials examining programs designed
experience. They recognised their confidence in the workplace to improve strength met the inclusion criteria. ANALYSIS: Data
and their transferable skills. Trust-based coordinators recognised from included trials relating to body structure and function, activity
the importance of their role in supporting programme delivery and limitation, societal participation and contextual factors were extracted
valued the experience of close working with university colleagues independently by two reviewers on a standardized form. Trial
to ‘demystify the academic world’. Clinical educators recognised quality was rated using the Pedro scale. Effect sizes and 95%
initial uncertainty regarding their role in relation to interns, resolved confidence intervals were calculated for all trials. RESULTS: Four
trials reported increases in strength after progressive resistance The team judged their successful patients,those who achieved
strength training (d=3.08, 95% CI 2.16-4.00 to d=7.52, 95% CI 6.46- positive clinical outcomes, as entering into interactions typified by
8.58), circuit strength training (d=1.94, 95% CI 1.02-2.86 to d=5.06, assertiveness, negotiation and critical reflection. These patients
95% CI 4.14-5.98), combined strength and cardiovascular fitness responded to the team’s adoption of an interpretive and critical
training (d=1.16, 95% CI 0.61-1.81 to d=1.21, 95% CI 0.57-1.75) and paradigm in which they, with their individual experience, informed
a 25-week treadmill walking program (d=2.68, 95% CI 1.62-3.73 to the decision making process in the former and reframed their
d=11.20, 95% CI 10.48-11.92). No improvement was reported in one perspectives with new understanding in the latter. However,even
trial for peak torque in the quadriceps muscles (d=0.47, 95% CI the most able team will not be able to inspire and create a
−0.34-1.28) and the hamstring muscles (d=0.68, 95% CI −0.14- collaborative framework unless their patients are willing to grasp the
1.50) after a combined strength and dynamic balance program. Two opportunity offered to them and they judged their least successful
trials reported improvements in activity outcomes including walking patients as adopting passive and unrealistic interactions which had
(d=2.95, 95% CI 2.42-3.48 to d= 4.67, 95% CI 4.14-5.20). No trials consequences in clinical outcome. CONCLUSIONS: Themes of
investigated the effects of programs on participation restrictions. dependence and interdependence were identified. Resistance by
No adverse effects from training were reported. CONCLUSIONS: the patients or an inability to carry over problem solving skills
Programs designed to improve strength appear to be safe and into their lives, led to an intense form of dependence, which had
beneficial for adults with Down syndrome, however, these results negative clinical consequences for them and a stunting of the team’s
should be interpreted with caution as only three of the five included potential. Alternatively, interdependent positions between patients
trials reported control group data. IMPLICATIONS: High quality and the team showed positive clinical outcomes. IMPLICATIONS:
randomized controlled trials should be completed in the future to A model of practice that enables therapists and their patients to
determine the effect of programs designed to improve strength on question their actions and thoughts, collaboratively, will construct a
activity limitations and societal participation, particularly in females knowledge of practice in which they can move forward, together, in
with Down syndrome. KEYWORDS: Down syndrome, systematic an innovative manner drawn from their own ideas and experiences.
review, strength. FUNDING ACKNOWLEDGEMENTS: This work Further research needs to explore the perceptions of patients judged
was unfunded. CONTACT: [email protected] to be resistant to this model. KEYWORDS: Ethnography, professional
practice, patient/therapist interactions, clinical outcomes. FUNDING
ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
[email protected]
611 Tuesday 5 June 08:50 ETHICS COMMITTEE: Royal National Orthopaedic Hospital Stan-
VCEC Meeting Rooms 11-12 more Middlesex HA7 4LQ
AN ETHNOGRAPHIC STUDY OF THE INTERACTIONS BETWEEN
PHYSIOTHERAPISTS AND THEIR PATIENTS ON A PAIN
MANAGEMENT UNIT IN A N.H.S. HOSPITAL
Thomson D1 , Richardson B2 ,
Steward B3 ; 1 Academic
Department VCEC Meeting Room 16
of Physiotherapy, School of Biomedical Sciences Kings College,
London SE1 1UL, UK; 2 School of Allied Health Professions, MEASUREMENT ERROR IN THE BERG BALANCE SCALE –
University of East Anglia, Norwich NR4 7TJ, UK; 3 Sheffield Hallam WHAT CHANGE IS REAL CHANGE?
University, Sheffield S1 1WB, UK Gilhooley L1 , Griffin E2 , Jennings A3 , Lyons M4 , Ni Mhaille E5 ,
O’Neill S6 , O’Sullivan M7 , Walsh L3 , Ward S7 , Stokes E8 ; 1 Naas
PURPOSE: Changes in healthcare brought about by the increased
Hospital, Kildare, Ireland; 2 Royal Hospital Donnybrook, Dublin,
incidence of chronic conditions and changing views of disability
Ireland; 3 Sacred Heart Hosdpital, Castlebar, Ireland; 4 Connolly
have resulted in an increased focus on patient self-directed
Hospital, Dublin, Ireland; 5 Loughlinstown Hospital, Dublin, Ireland;
care. This study explores how certain types of therapist/patient 6 St. Vincent’s University Hospital, Dublin, Ireland; 7 St. James’s
interactions influence success or contribute to meeting patients’
Hospital, Dublin, Ireland; 8 Sacred Heart Hosdpital, Castlebar,
self-selected goals and therefore a positive clinical outcome, on
Ireland; 9 St. James’s Hospital, Dublin, Ireland; 10 Department of
a pain management unit. RELEVANCE: In contrast to previous
Physiotherapy, School of Medicine, Trinity College Dublin, Ireland
studies this research sought to link the therapists’ perspectives of
their patient interactions with clinical outcomes. PARTICIPANTS: PURPOSE: The purpose of this study was to calculate the Minimal
A team of physiotherapists of different levels of seniority working Detectable Change (MDC) for the Berg Balance Scale in a group
on an in-patient pain management programme in a U.K. teaching of older people, with balance problems, undergoing physiotherapy
hospital. METHODS: An ethnographic approach was chosen with its rehabilitation. RELEVANCE: Reliability can be reported in two ways –
emphasis on observing and understanding people’s everyday social relative reliability (inter & intra reliability) and absolute reliability.
interactions. The team members were observed individually, with The standard error of measurement (SEM), returns a value for
their patients, and collectively over a period of eight months. Their measurement error in the same units as the measurement itself i.e. it
interactions were audiotaped and fieldnotes were recorded alongside is an indication of absolute reliability. SEM also allows us to calculate
the researcher’s memos. Interviews were carried out following the the minimal detectable change (MDC) i.e. the amount a patient’s
observations to gain the therapists’ perspectives in an open critical score needs to change, to be sure the change is greater than simply
exploration of assumptions and ideas. ANALYSIS: Triangulation of measurement error. The calculation of the MDC is important for day-
data was provided by the transcriptions of the interactions, the to-day clinical decision-making. The Berg Balance Scale (BBS) is
follow-up interviews and the relevant sections of the field notes. The a tool designed to measure balance that has demonstrated relative
analysis was iterative. Features in that reflected certain types of reliability. The MDC has only been reported in the BBS for older
patient/therapist interactions were looked for and cross referenced people with stroke and not for the general population of older people.
to the fieldnotes and interviews. Codes were assigned to segments PARTICIPANTS: People aged greater than 65 years and attending
of sentences that summarized their content and emerging patterns for physiotherapy rehabilitation were eligible for inclusion in the study.
in the interactions were noted. These were grouped into categories. People who were recently post hip replacement or who were unable
The final stage of the analysis identified themes representing the to give informed consent were excluded. 61 older people participated
relationship between the categories. The researcher assumed a (35% female). METHODS: Ethical approval was obtained from the
reflexive stance throughout. RESULTS: Patient goals, reviewed at relevant committees. The balance performance of each participant
three months and a year, post programme, were the benchmarks by was measured using the BBS at time 1 (T1) and again a second
which a successful clinical outcome of the programme was judged. time (T2) within 48 hours and their scores calculated. At T2, the
researcher was blind to the T1 score on the BBS. ANALYSIS: The patients during hemiparetic extremity (HPE) performance in the first
SEM Was calculated using the formula: SEM = s• (1 − r), where s = and third week, and up to 3 months in the patients with stroke
the standard deviation for the test, r = the reliability coefficient for in the right hemisphere (p 0.05). Cortex activation was changed
the test i.e. Pearson’s correlation co-efficient between T1 & T2. The (p 0.05) also during performance with the nonhemiparetic extremity
MDC95 (95% confidence interval) was calculated using the formula: (NHPE). The differences between hemispheres gradually normalized
MDC95 = SEM × • 2 × 1.96 (as per Stratford, 2004). RESULTS: The with time, however the activation remained different from healthy
mean age of the participants was 80 years (sd 6.5, range 65-95 subjects (p 0.05). Concomitantly the motor characteristics of both
years). The MDC for people who were able to walk unassisted was upper extremities improved. Recovery of HPE correlated well with
3 and for people who required assistance i.e. physical or an aid was the intensity and/or area of M1 activation in the ipsilesional or
5 CONCLUSIONS: This preliminary report suggests that in older contralesional hemisphere (r = 0.6-0.9; p 0.05). More correlations
people, who are having rehabilitation and who require no assistance were observed with dexterity than with muscle strength, and were
of an aid or physical help to mobilise, require a change of at least increasing with time. CONCLUSIONS: In stroke patients with partially
3/56 points on the BBS for the change to be ‘true’ change and impaired upper extremity function, the normalization of brain cortex
not measurement error. It also suggests that in older people who activation in both hemispheres during tasks performed with either
are having rehabilitation and who require assistance of an aid or HPE or NHPE, occurred gradually during first 3 months after
physical help to mobilise a change of at least 5 points on the BBS is stroke. The recovery of M1 cortex, predominantly in the contralateral
required for the change to be ‘true’ change and not measurement hemisphere, correlated well with the recovery of upper extremity
error. IMPLICATIONS: Changes in scores in outcome measures function. IMPLICATIONS: Changes in activation of both brain
should be reported to indicate true change in performance and not hemispheres during first three months after stroke indicate the
measurement error. The results of this study will enhance clinical importance of functional training and use of HPE in promoting the
decision making for older people when their performance is measured process of cortex reorganization. For future research, comparison of
using the BBS. KEYWORDS: Berg Balance Score; Older people; different therapeutic techniques is suggested. KEYWORDS: stroke,
Outcome measurement. FUNDING ACKNOWLEDGEMENTS: None. acute stage, motor recovery. FUNDING ACKNOWLEDGEMENTS:
CONTACT: [email protected] The current work was supported by the postgraduate fellowship from
ETHICS COMMITTEE: Local ethics commitees in each of the centres Ministry of Higher Education and Science, and by the research grant
involved P3-0019 from the Research Agency of the Republic of Slovenia.
ETHICS COMMITTEE: National Etics Committee of the Republic of
Slovenia
RECOVERY OF MOTOR CORTEX AND UPPER EXTREMITY
MOVEMENT DURING ACUTE STAGE AFTER STROKE 796 Tuesday 5 June 08:50
Puh U1 ,Suput D2 ; 1 University
of Ljubljana, University College
for Health Studies, Ljubljana, Slovenia; 2 University of Ljubljana, PHYSIOTHERAPY SUPERVISED WALKING PROGRAM IMMEDI-
Medical Faculty, Ljubljana, Slovenia ATELY FOLLOWING CABG RESULTS IN EARLIER RETURN OF
FUNCTIONAL CAPACITY. A RANDOMIZED CONTROLLED TRIAL
PURPOSE: The purpose of the current study was to investigate
Hirschhorn A1,3 , Richards D2 , Mungovan S1 , Morris N3 , Adams L3 ;
the brain cortex activation characteristics 1 week, 3 weeks and 1 Westmead Private Physiotherapy Services, Westmead Private
3 months after stroke and to establish the relationship between
Hospital, Sydney, Australia; 2 Westmead Private Cardiology,
the recovery of primary motor cortex (M1) and motor functions
Westmead Private Hospital, Sydney, Australia; 3 School of
of the upper extremity. RELEVANCE: Following stroke, recovery
Physiotherapy and Exercise Science, Griffith University, Gold Coast,
of upper extremity control is generally poor. Although there is
Australia
evidence for cerebral cortex reorganization on animal models, the
mechanisms of motor recovery after stroke in humans are not PURPOSE: We aimed to investigate whether a moderate intensity
clear. Understanding of the neurophysiological process underlaying walking exercise program, performed under direct physiotherapy
cerebral cortex reorganization will increase the effectiveness of supervision, would improve functional outcomes such as sub-
therapeutic techniques and improve the outcome of rehabilitation of maximal exercise capacity and self-reported health, and/or vital
patients following stroke. PARTICIPANTS: 12 patients, aged 65 years capacity, at discharge from hospital following coronary artery
(SD 15), 2-8 days after stroke, where included in the study. All had bypass graft surgery (CABG). We also sought to investigate
partially impaired function of the right (8) or left (4) upper extremity whether supplementary respiratory and musculoskeletal exercises
and were right-handed prior the stroke. From the first to the third week might further benefit patient outcomes. RELEVANCE: Research
after stroke, they were included in a functional training program. 13 investigating physiotherapy following CABG has focused largely on
healthy subjects, aged 41.5 years (SD 11) participated as a control respiratory measures of outcome, such as pulmonary complication
group. METHODS: A 1.5 T scanner was used to collect functional rates. We hypothesized that the achievement of positive outcomes,
magnetic resonance imaging (fMRI) data during upper extremity such as improved ability to walk and self-reported health, is more
functional tasks. Healthy subjects were evaluated only in one fMRI relevant following CABG than measures of respiratory morbidity
session. In patients, motor characteristics of upper extremity were (which is presently minimized with routine peri-operative care).
evaluated by hand-held dynamometry, hand and pinch grip strength There is no research available to date investigating the effect of
measurements, Nine Hole Peg Test, timed ARAT and AMPS. Patients physiotherapy and/or exercise prescription on functional outcomes
with a stroke were evaluated in the first, and third week, and 3 months acutely after CABG. PARTICIPANTS: Patients awaiting first-time
after stroke. ANALYSIS: Intensity and area of cortex activation CABG at Westmead Private Hospital were invited to participate in
were calculated for brain regions using AFNI software. Wilcoxon, the study. Exclusion criteria included planned concomitant surgery,
Friedman and Mann-Whitney U tests were conducted to compare significant musculoskeletal or neurological impairment, non-English
cortex activation between the brain hemispheres, measurement speaking background and emergency surgery. 92 patients (80 men,
sessions and groups of subjects. Spearman correlation with upper 12 women), mean age 63±9 years were enrolled having given
extremity functions was calculated. RESULTS: In comparison to written, informed consent. METHODS: The study was a prospec-
healthy subjects, an attenuated activation of some brain regions tive, single-blinded, randomized controlled trial with 3 treatment
in the ipsilesional or contralesional hemisphere was observed in arms. Patients were allocated prior to pre-operative physiotherapy
assessment to one of: a) a ‘minimal’ intervention group, receiving in patients after stroke. This category includes any mechanical or
gentle post-operative mobilization (n=31); b) a ‘walking’ group, computerised device, or both, designed to improve walking function.
receiving a physiotherapy-supervised, moderate intensity walking However, trials testing the effectiveness of treadmill training or
program (n=31); or c) an ‘exercise’ group, receiving the same other approaches such as repetitive task training in physiotherapy
walking program, musculoskeletal and respiratory exercises (n=30). or electrical stimulation were not included in this review. We
Primary outcomes were 6-minute walking assessment distance searched the Cochrane Stroke Group Trials Register, CENTRAL,
(6MWA), self-rated health and recovery (using SF-36v2, EQ-5D and MEDLINE, EMBASE, CINAHL, AMED, SPORTDiscus, PEDro and
QoR-40 questionnaires) and vital capacity. These outcomes were COMPENDEX and INSPEC. Additionally, we handsearched po-
measured pre-operatively, at hospital discharge and at 4 weeks tentially relevant conference proceedings, screened reference lists
following discharge. ANALYSIS: Linear mixed effects models were and searched ongoing trials and research registers. Furthermore,
fitted to outcome variables. In these models, patient identifier was we contacted trialists and researchers in our field of study to
considered as a random effect, and time and intervention group identify published, unpublished and ongoing trials not available in the
as fixed effects. For those outcome measures where the p-value major databases. ANALYSIS: We included randomised, controlled
for interaction between time and intervention group approached trials and randomised controlled cross-over trials in this review.
significance, the effect of intervention group was analysed separately For all statistical analyses we used The Cochrane Collaboration’s
at discharge and at follow-up. Two-tailed tests with a 5% signifi- Review Manager software (RevMan 4.2). RESULTS: Seven trials
cance level were used throughout. RESULTS: 6MWA distance at with a total of 332 patients were included in the review. The
discharge from hospital for both walking (452±70m) and exercise reported data suggested that electromechanical-assisted walking
(431±98m) groups were significantly better than that of the minimal training after stroke might improve walking ability of non-ambulatory
(377±90m) intervention group (p = 0.005, p = 0.022 respectively). patients after stroke. However, the number of patients is too small
These differences were not sustained at 4 week follow-up. There to be certain whether electromechanical-assisted walking training
were no differences in self-reported health or vital capacity between is effective for treatment after stroke. Results from much larger
minimal, walking and exercise groups at discharge or at 4 week randomised trials are needed to assess accurately the benefits and
follow-up. CONCLUSIONS: A physiotherapy-supervised, moderate harms of electromechanical-assisted walking after stroke. At least a
intensity walking program in the inpatient setting following first-time more detailed review will be published and updated in the Cochrane
CABG improves sub-maximal exercise capacity at discharge from Database of Systematic Reviews. CONCLUSIONS: There was
hospital. Additional respiratory and musculoskeletal exercises confer some evidence that electromechanical-assisted walking training may
no further benefits to the assessed outcomes. Further investigation improve walking of non-ambulatory patients after stroke. Larger trials
is required to determine the optimal level or dosage of physiotherapy are needed evaluating the effectiveness of electromechanical devices
intervention and aerobic exercise following CABG. IMPLICATIONS: for patients who cannot walk after stroke. IMPLICATIONS: For non-
The role of physiotherapy following CABG is evolving from one of ambulatory patients after stroke, there is some evidence for the use
prophylaxis against respiratory complications to one of fostering of electromechanical-assisted devices to improve walking function,
early return to exercise and functional activity. KEYWORDS: but further research is needed. KEYWORDS: Walking – Stroke –
Exercise, cardiac surgery. FUNDING ACKNOWLEDGEMENTS: Nil. Training. FUNDING ACKNOWLEDGEMENTS: None declared.
ETHICS COMMITTEE: Sydney West Area Health Service Human
FEEDBACK IN PHYSIOTHERAPY CLINICAL EDUCATION:
1075 Tuesday 5 June 08:50 IMPLICATIONS OF A MONOLOGIC PROCESS
Molloy E1 , Webb G2 , Remedios L, Clarke D; 1 Monash University,
ELECTROMECHANICAL-ASSISTED TRAINING FOR WALKING Melbourne, Australia; 2 The University of Melbourne, Melbourne,
AFTER STROKE: A SYSTEMATIC REVIEW FOR THE Australia
COCHRANE COLLABORATION
PURPOSE: Formal feedback in physiotherapy clinical education
Mehrholz J1,3 , Werner C2 , Kugler J3 , Pohl M1 ; 1 Department of Early
is an important process in shaping students’ learning and pro-
Rehabilitation, Klinik Bavaria, Kreischa, Germany; 2 Department
fessional identity. Despite the health education literture’s claim
of Neurological Rehabilitation, Klinik Berlin, Germany; 3 Department
for the importance of feedback in learning, no empirical studies
of Public Health, Technical University, Dresden, Germany
have investigated the feedback sessions in situ. This research
PURPOSE: The purpose of the present study was to review aimed to fill these gaps in understanding. What do the feedback
the available literature systematically to assess effectiveness and sessions look like? What are the rights and duties of the student
acceptability of these electromechanical devices. RELEVANCE: and the clinical educator as enacted through the conversation?
Stroke is a leading of serious, long-term disability in adults. How much agency do students have in shaping their learning
Restoration of walking ability and gait rehabilitation is therefore highly experience in feedback sessions and what are the implications of
relevant for patients who are unable to walk independently after the feedback style for students’ immediate learning and long-term
stroke, as well as for their relatives. In recent years automated professional development? RELEVANCE: The feedback process
electromechanical gait machines were developed, consisting either of is valued highly in the education and health education literature.
a robot-driven exoskeleton orthosis or an electromechanical solution Such skills are important for maximising the student’s learning, for
with two driven footplates simulating the phases of gait. Until now maxismising the clinician’s lifelong professional learning, and to aid
scientific evidence for the benefits of these technologies, which the therapeutic patient-clinician interaction. Prior to this research,
could justify their relative high cost, is lacking. PARTICIPANTS: We the recommendations on ‘best-practice’ feedback were largely
included studies with participants of any gender over 18 years of age speculative, rather than empirically- based claims. PARTICIPANTS:
after stroke. METHODS: We included all trials that evaluate robotic- In Phase One, 102 clinical educators affiliated with the School
assisted or automated electromechanical gait training devices, or of Physiotherapy, The University of Melbourne participated in a
both, for regaining and improving walking after stroke. Automated questionnaire (RR=88%). Nine students and 12 clinical educators
electromechanical devices were defined as any device with an across three hospital institutions and three practice domains were
electromechanical solution designed to assist (by supporting body ‘purposively selected’ to participate in the qualitative Phase Two
weight and automating the walking therapy process) stepping cycles of the project. METHODS: The project consituted two phases. In
Phase One, clincial educators were asked to respond to an 18-item goal setting for professional development. ANALYSIS: Descriptive
questionnaire designed to elicit their understanding of current and analysis revealed frequency of responses to questions about whether
‘effective’ feedback practice. Phase Two involved the videotaping goals had been met. Open ended questions about factors that
of formal, student-clinical educator feedback sessions at the half- contributed to goals not being met were grouped into common
way and completion point of the clinical placement. Seperate, semi- themes. Interviews were transcribed and analyzed for themes using
structured interviews were conducted with participants following Ethnograph v. 2.0. RESULTS: One year following graduation, there
the feedback sessions. ANALYSIS: The questionnaire, videotape were 11 survey responses, for a response rate of 34%. Three
and interview data were analysed for themes using a Grounded years following graduation, 19 of 32 responded for a rate of 59.3%.
Theory Methodology. Such analysis lead to a structured charac- One year following graduation, 72.7% had met employment goals,
terisation of formal feedback practice, and highlighted perceived 63.6% met education goals, and 36.4% met goals for community
constraints to effective practice. RESULTS: Despite both students’ service. Three years after graduation, 47.4% had met goals for
and clinical educators’ support of the importance of a two-way employment, 42.7% had met educational goals, and 36.3% had met
feedback exchange, the feedback sessions were monologic in service goals. Reasons for not meeting goals stated most often
practice. The clinical educators assumed the position as ‘expert were: change of job or preference for patient population, lack of
diagnostician’ and did not provide sufficient opportunities for students monetary resources for education, or other priorities, such as family,
to self-evaluate their learning and performance. Of note was that interfering with goal accomplishment. CONCLUSIONS: The results
students conspired with clinical educators to generate this one- suggest that goals for professional development set by students are
way feedback exchange. Attempts to elicit student self-evaluation met more often for one year following graduation than for three years.
were viewed as ‘tokenistic invitations’ by both parties in the Interviews suggest that students close to graduation do not recognize
educational relationship. CONCLUSIONS: The formal feedback the many factors that may interfere with goal accomplishment.
sessions observed in physiotherapy clinical education were educator- Interviews indicate that the interests for newly practicing therapists
driven, one-way encounters, despite the participants’ intentions change between graduation and three years later. In spite of
to engage in conversation. Both students and clinical educators these changes, graduates found the exercise of explicitly developing
were responsible in generating this monologic feedback culture. measurable goals for their professional development to be useful.
IMPLICATIONS: This pattern, whereby educators assumed the IMPLICATIONS: Educators and new employers can expect that
position as ‘expert diagnostician’ did not privilege the students’ self- new graduates are likely to have specific goals for employment,
evaluative and self-reflective skills which are central to professional education, and service. However, as their views of the profession and
development in a continually changing health care climate. The lack personal goals change over time, goals for professional development
of development of students’ self-evaluative skills has implications may be delayed or change. KEYWORDS: Professional development,
in both the educational and clinical practice setting. KEYWORDS: education. FUNDING ACKNOWLEDGEMENTS: Nazareth College
Feedback; Learning; Self-evaluation; Clinical education; Professional supported this study with a summer research grant. CONTACT:
Development. FUNDING ACKNOWLEDGEMENTS: The authors [email protected]
would like to acknowledge the help of the Australian Postgraduate ETHICS COMMITTEE: Nazareth College Human Subjects Review
Award(APA) and the Australian and New Zealand Association for Committee
medical education (ANZAME)in funding this project. CONTACT:
[email protected]
ETHICS COMMITTEE: HREC University of Melbourne, August 2003
INTER-RATER RELIABILITY EVALUATION OF PHYSIOTHERAPY
2159 Tuesday 5 June 09:10 PRIORITY INTERVENTION CRITERIA IN ACUTE HOSPITALS: A
VCEC Ballroom A MULTI-CENTRE EVALUATION
STUDENT PROFESSIONAL DEVELOPMENT PLANS: A
Brolin S1 , Francis T2 ; 1 Fraser Health, Royal Columbian Hospital;
LONGITUDINAL STUDY 2 Fraser Health, Surrey Memorial Hospital
Collins J; Nazareth College, Rochester, New York, USA

PURPOSE: This study is aimed at evaluating inter-rater reliability
PURPOSE: The purpose of this study was to determine whether of physiotherapist priority value assignments for patients in acute
graduates of a physical therapist program met goals for professional hospital settings, using a standard tool – Physiotherapy Priority In-
development one and three years following graduation. It described tervention Criteria (PPIC). RELEVANCE: Physiotherapy services are
changes in goals over the three years, and events that contributed in high demand in acute hospitals. With increasing patient numbers
to not meeting or changing goals. RELEVANCE: APTA emphasizes and complexity it is important for physiotherapists to reliably prioritize
the professional values and behaviors necessary for a doctoring patients for service. In this way, targeting physiotherapy services
profession. Lifelong learning and professional development are toward patients in the greatest need may serve to maximize patient
essential behaviors. This study helps educators to understand if flow through the health care system, thereby maximizing efficiency
goals for professional development set as students are realized by of service. PARTICIPANTS: Twenty-one physiotherapists took part
graduates one and three years later, and if not, what factors interfere in the inter-rater reliability evaluation, randomly selected from three
with goals. PARTICIPANTS: Thirty two students in one entry- acute hospitals in the Vancouver area. METHODS: Approximately
level, MSPT program participated in an activity to set professional 25% of all patients on active physiotherapy caseload, in each hospital,
development goals before graduation. These 32 students were were randomly selected. Two therapists independently assigned a
surveyed one and three years after graduation. METHODS: Following priority value, according to the PPIC to selected patients. ANALYSIS:
class sessions discussing the importance of setting goals for Inter-rater reliability was evaluated by analysis of percent agreement
professionl development in the areas of employment, education, and measurement of kappa statistic. RESULTS: Percent agreement
and community/professional service, the participants were asked of priority assignment was determined to be 82.2% agreement for
to set goals for one and three years following graduation. At one all cases involved in the study (n=90). All three hospitals were
and three year timeframes, students were surveyed to ascertain if relatively similar in priority assignment reliability (80.0%-agreement
goals had been met. If not, students were asked an open ended [n=19 cases], 81.2%-agreement [n=32 cases] and 84.6%-agreement
question about what factors contributed to the goal not being met. [n=39 cases]). Kappa statistic measurement revealed a value of
In depth, follow up interviews were completed with five students to 0.737 for all cases, across all three hospitals. CONCLUSIONS:
better understand reasons for not meeting goals and the value of Physiotherapists in acute settings demonstrate an excellent ability
to reliably prioritize patients for assessment and treatment using addition, the possible negative consequences of using patients’ family
the PPIC. IMPLICATIONS: The current study demonstrates that the members as interpreters should be discussed. KEYWORDS: Limited
PPIC is an effective tool that ensures that scarce physiotherapy English Proficiency. FUNDING ACKNOWLEDGEMENTS: This work
resources can be directed to patients that need it the most in the was unfunded. CONTACT: [email protected]
acute care setting. KEYWORDS: prioritization, reliability, criteria. ETHICS COMMITTEE: California State University, Sacramento
FUNDING ACKNOWLEDGEMENTS: This study was supported by Committee for the Protection of Human Subjects
in-kind department funding from each of Royal Columbian and Surrey
Memorial Hospitals in the Fraser Health Authority and by Lion’s
Gate Hospital in the Vancouver Coastal Health Authority. CONTACT:
[email protected] 2481 Tuesday 5 June 09:10
ETHICS COMMITTEE: Fraser Health Research Ethics Board VCEC Meeting Room 16
THE ICELANDIC VERSION OF THE ACTIVITIES-SPECIFIC
BALANCE CONFIDENCE SCALE: PSYCHOMETRIC
PROPERTIES EVALUATED BY RASCH ANALYSIS
VCEC Meeting Rooms 11-12 Arnadottir S1 , Gunnarsdottir E2 , Fisher A3 ; 1 University of Akureyri,
Iceland, Faculty of Health Sciences; 2 University of Akureyri, Iceland,
A STUDY OF LIMITED ENGLISH PROFICIENCY (LEP) IN Faculty of Law and Social Sciences; 3 Umeå University, Sweden,
PATIENTS SERVED BY PHYSICAL THERAPY PRACTICES IN Department of Community Medicine and Rehabilitation, Division
NORTHERN CALIFORNIA of Occupational Therapy
McGinty S, Avalos L, Bhim M, Lopez T, Osborne R; California
State University Sacramento, Sacramento, California, USA PURPOSE: The Activities-Specific Balance Confidence (ABC) scale
is widely used to evaluate how confident people are in moving
PURPOSE: This study was conducted to determine the extent of around in the environment. The aim of this study was to use
multiple languages being encountered in patients seeking services in the analytical features of Rasch modeling to investigate if the
Physical Therapy practices in Northern California and to determine Icelandic version of the ABC rating scale (ABC-IS) demonstrates
the means of communication being utilized to serve patients with acceptable psychometric properties. RELEVANCE: Low balance
Limited English Proficiency (LEP). RELEVANCE: Language barriers confidence or fear of falling is one of the remediable barriers to older
can interfere with all processes involved with the provision of health persons’ mobility and participation in various activities. Quantifying
care. Effective cross cultural communication and cultural competency balance confidence or fear of falling is therefore necessary for
is impossible without understanding and addressing the importance physical therapists to be able to measure the impact of this health
of language in culture. PARTICIPANTS: Participating clinics were problem and effectiveness of interventions aimed at reducing it.
randomly selected from a list of 493 clinics compiled from online Although psychometric evidence for the ABC scale is promising,
phone directories in 28 counties in Northern California. METHODS: further evaluation is warranted to answer questions that have been
A survey instrument was developed to determine whether or not raised about the suitability of the 11-point rating scale and the
clinicians were encountering patients with LEP and if so, which appropriateness of adding up the ordinal scores of the scale to
languages were most often heard. The survey sought information obtain a summary score. Additionally, each time the test is used
about whether or not clinicians, or their staff, were bilingual, and in a new context the validity and reliability needs to be examined.
what methods were utilized to communicate with patients with LEP. PARTICIPANTS: 183 community-living individuals, aged 65 to 88
The top 25 languages from the 137 languages spoken in California years (mean+/−SD=73.8+/−6.2 years) and 47.5% were females. They
were selected from the 2000 United States of America census data. were randomly selected from the national registry from one urban
A stratified, random sample of 216 clinics was selected from the and two adjacent rural areas in Northern Iceland. METHODS: An
493 clinics identified. A minimum of 1 clinic was selected from interview format of the ABC-IS was administered by trained field
each of the 28 counties in Northern California with the exception technicians. ANALYSIS: Winsteps computer program was used to
of Colusa, Sierra, Alpine, and Trinity for which no clinics were implement Rasch rating scale analysis in order to transform the
listed. ANALYSIS: SPSS version 13.0 was utilized for analysis ordinal ABC-IS to an interval measure and to evaluate internal
of quantitative data. Qualitative analysis of written responses was validity and reliability of the scale. RESULTS: Participants were not
completed to identify common themes. RESULTS: 33 of 216 surveys able to differentiate reliably between the 11 rating scale categories
were returned to sender. 111 of the remaining 183 were returned of the ABC-IS scale. Additionally, three items on ABC-IS failed to
and usable for a 60.7% return rate. 85% of all Northern California show acceptable levels of goodness-of-fit to the ABC-IS rating scale
counties were represented. 85% of clinics reported encountering model. However, by collapsing categories and creating a new 5-point
patients with LEP. 89.9% of those patients speak Spanish, followed scale, only one item failed to demonstrate acceptable goodness-of-fit.
by Vietnamese, Hindi, Chinese, Russian and Tagalog. 40% of Removing the misfitting item of “balance confidence when bending
clinicians report they are bilingual; 34% speak Spanish. 45% of over to pick up a slipper from the front of a closet floor” resulted in a
non-licensed staff are bilingual; 37% speak Spanish. 46% of clinics modified version of ABC-IS with five rating scale categories. Both
state they provide patient education in another language and 49% item goodness-of-fit statistics and principal components analysis
state they provide written information. Many clinics report they supported the unidimensionality of the ABC-IS items. Items reliably
commonly use patients’ family members (including children) to serve separated the sample of older people into at least three statistically
as interpreters, some utilize contracted interpreter services, and distinct strata of balance confidence. The hierarchical order of item
some rely on English/other language dictionaries, pictures, and difficulties was consistent with theoretical expectations. Finally, the
demonstration to instruct patients. CONCLUSIONS: Although 85% items on the modified test were well targeted towards the balance
of participating clinics report treating patients with LEP, less than confidence of the persons tested although ceiling effects were
half provide instruction in another language (written or oral). Only present (26 persons received a maximum score). CONCLUSIONS:
46% of clinics offer instruction in Spanish despite the fact that almost The findings provide preliminary evidence that the modified ABC-
90% of patients with LEP speak Spanish. Bilingual clinicians and IS, with five rating scale categories, demonstrates internal scale
staff skills often do not match the languages encountered in the validity and good separation reliability. These findings indicate that
clinics. IMPLICATIONS: Clinicians may not be aware of ethical and the modified scale is suitable to measure balance confidence of
legal requirements to provide instruction to patients in their primary community-living older Icelanders in research and clinical settings.
languages. Education about patients’ rights to be provided services in IMPLICATIONS: Improving the psychometric properties of the ABC-
their primary language should be included in entry-level education. In IS scale and transforming it to a linear measure potentially affects the
quality of physical therapists’ evaluations of balance confidence and and effective intervention to improve exercise capacity of patients
subsequent interventions. The measurement properties of the ABC in in the early post-stroke period. Gains in aerobic capacity were
other cultural contexts may be improved through modifications based maintained at 6-month follow-up. Effects of BWSTT on gait, activity-
on Rasch analyses. KEYWORDS: aging, balance, measurement. level attributes, and health-related quality of life will be reported
FUNDING ACKNOWLEDGEMENTS: University of Akureyri, KEA separately. IMPLICATIONS: Patients undergoing stroke rehabilitation
University Founding and RANNIS. CONTACT: [email protected] are woefully deconditioned. The findings of this study demonstrate
ETHICS COMMITTEE: The Icelandic National Bioethics Commit- that BWSTT is an effective method of safely increasing exercise
tee(§ 04-037-V2) and the Icelandic Data Protection Authorities capacity during the period in which physical rehabilitation is typically
(§ S1948). offered. KEYWORDS: stroke, exercise, aerobic training. FUNDING
ACKNOWLEDGEMENTS: Heart and Stroke Foundation, Canadian
Stroke Network. CONTACT: [email protected]
ETHICS COMMITTEE: Research Ethics Board, Capital District
1306 Tuesday 5 June 09:10 Health Authority, Halifax, Nova Scotia
EFFECT OF BODY WEIGHT-SUPPORTED TREADMILL
TRAINING ON CARDIOVASCULAR ENDURANCE EARLY AFTER
STROKE: A RANDOMIZED CONTROLLED TRIAL 1030 Tuesday 5 June 09:10
MacKay-Lyons M1 ,McDonald A2 ,
Matheson J2 ,
Howlett J3 ; 1 School
RANDOMISED CONTROLLED PILOT STUDY COMPARING
of Physiotherapy, Dalhousie University, Halifax, Nova Scotia,
PHYSIOTHERAPY TECHNIQUES OF BREATHING AND MOBILITY
Canada; 2 Nova Scotia Rehabilitation Centre, QEII Health Sciences
AFTER OPEN ABDOMINAL SURGERY ON HIGH RISK PATIENTS
Centre, Halifax, Nova Scotia, Canada; 3 Department of Cardiology,
QEII Health Sciences Centre, Halifax, Nova Scotia, Canada Silva Y, Li F; Concord Hospital, Sydney, Australia
PURPOSE: To examine the effects of body weight-supported PURPOSE: Breathing and secretion clearance techniques have been
treadmill training (BWSTT) on cardiovascular endurance of people shown to minimise incidence of post pulmonary complications (PPC)
early after stroke. RELEVANCE: Aerobic training has been shown after open abdominal surgery. Physiotherapists use mobility as a
to improve exercise capacity of individuals in the chronic post- treatment but it has not been compared with other physiotherapy
stroke period (i.e. >6 months after stroke). What has not been treatment techniques in line with clinical practice. This study aimed
investigated, but clearly warrants attention, is the effectiveness to determine if the addition of deep breathing and coughing to
of such training earlier post-stroke, when physical rehabilitation a physiotherapy directed mobility programme altered PPC and
typically takes place and when the potential for functional recovery restoration of mobility in high risk patients after open abdominal
is maximized. PARTICIPANTS: 46 patients (60.6±11.3 years of age; surgery. RELEVANCE: Results from this study may provide evidence
26 males, 20 females) with a post-stroke interval of <1 month were which can be applied to post operative physiotherapy practice.
assigned, by block randomization according to ambulatory ability, PARTICIPANTS: Forty four subjects undergoing open abdominal
to 1 of 2 treatment groups (BWSTT, usual care). METHODS: All surgery, at high risk of developing PPC were recruited. All patients
subjects received 12 weeks of physiotherapy – 6 weeks as in- gave written informed consent. METHODS: Subjects were randomly
patients for 60 min/day, 5 days/wk, and 6 weeks as out-patients for assigned to three groups prior to surgery. Group A only received
60 min/day, 3 days/wk. Control subjects (C) participated in usual care physiotherapy directed early mobility. Group B in addition to early
therapy; sessions were audited periodically to ensure adherence to a mobility received deep breathing and coughing. Group C received
standard protocol. Physiotherapy sessions for experimental subjects deep breathing and coughing but were only mobilised by the
(E) incorporated 20-30 minutes of BWSTT, initiated using 40% body physiotherapist on day three. The breathing exercises and the
weight support. Exercise training guidelines (e.g., use of individual intensity of mobility were quantified to all three groups. The
target heart rate (HR) and on-going monitoring of HR, blood pressure, patients were blinded to the treatment. Documentation of a PPC
perceived exertion, and levels of hydration) were strictly followed. and restoration of independent mobility were recorded. ANALYSIS:
Independent evaluators, blinded to group assignment, conducted Results were analysed using intension to treat. Statistical analysis
maximal, symptom-limited treadmill exercise tests at baseline, post- was performed using a SPSS package. RESULTS: Groups A, B and
training, and 6-month follow-up. Prior to exercise testing, HR (HRrest) C had similar mean age (71, 75 and 72 years), body mass index
and systolic and diastolic blood pressure (SBPrest, DBPrest) (29.6, 28.7 and 28.8), American Society of Anaesthesiologists (ASA)
were measured. At peak exercise intensity oxygen consumption score (2.55, 2.64 and 2.3) and length of anaesthesia (3.9, 4.6 and
(VO2 peak), heart rate (HRpeak), and rating of perceived exertion 5.3 hours). There were more patients with pulmonary disease and
(RPEpeak) were recorded. ANALYSIS: Intention to treat analysis was reduced lung function in group B compared to the other groups with
conducted using repeated measures analysis of variance with one a significant level p = 0.019. Subjects in group C had no pulmonary
within-subject factor (time: baseline, post-test, 6-month followup) and disease. The PPC rates were 25%, 42% and 10% and the day
one between-subject factor (group: E, C) to determine effects of the restoration of independent mobility were 5.6, 11.6 and 9.11 for groups
intervention on dependent variables. Bonferroni post hoc testing was A, B and C. The rate of PPC was correlated to the ASA score
applied to detect statistically significant differences in the dependent (p = 0.02). CONCLUSIONS: The pilot study showed the addition of
variables. The significance level was set at p < 0.05. Normality of deep breathing to an early mobility programme or mobilising on day
distribution of the data was verified using the Kurtosis and Skewness three does not significantly alter the incidence of PPC. However
tests. RESULTS: No adverse events occurred during the testing this resulted from a relatively small sample size. Also there were
and training sessions. 5 subjects (3 E, 2 C) did not complete the possible contributing factors such as a greater number of patients
12-week program. HRpeak and RPEpeak did not change across with lung disease, older patients and higher ASA scores in group B
tests, suggesting similar effort was exerted on repeat testing. HRrest compared to the other groups which may have resulted in the higher
decreased over time for both groups (p = 0.02), as did DBP (p < 0.001) incidence of PPC. There is a decrease in lung volumes and altered
while SBPrest remained stable. VO2 peak increased from baseline to mucus clearance post surgery which may lead to PPC. Previous
post-training in both groups (p < 0.001) but significantly more for E studies have shown high sitting, deep breathing with coughing
subjects (from 13.2±3.5 to 16.3±4.9 ml O2 /kg/min; 23.5% increase) and mobility improve lung volumes, enhances alveolar ventilation,
than C subjects (from 14.3±4.7 to 15.2±4.2 ml O2 /kg/min; 6.3% mucous clearance and restoration of independent mobility. As all
increase). VO2 peak did not change in either group between post- three groups did one or combination of these techniques there was
training and 6-month follow-up. CONCLUSIONS: BWSTT is a safe no significant differences between the groups PPC or restoration
of independent mobility. IMPLICATIONS: PPC develops in high risk Research Report Platform Presentation
patients after abdominal surgery and physiotherapy techniques of an 2657 Tuesday 5 June 09:30
addition of deep breathing to an early mobility or mobilising on day PP Crystal Pavilion A
three is equally effective in improving recovery. KEYWORDS: post STUDENT PERCEPTIONS OF PEER LEARNING IN THE
operative pulmonary complications, early mobilisation, deep breath- PRACTICE SETTING: A Q-METHODOLOGICAL STUDY
ing exercise. FUNDING ACKNOWLEDGEMENTS: nil. CONTACT:
Baldry Currens J; University of East London, London, UK
[email protected]
ETHICS COMMITTEE: Concord Hospital Ethics Committee, Concord PURPOSE: This study explored undergraduate physiotherapy stu-
Hospital Road, Concord, NSW 2139, Australia approved the study. dent perceptions of peer learning (PL) in the practice setting.
Secondarily, it considered whether perceptions varied with pro-
gramme type. RELEVANCE: Practice-based learning models that
promote PL are now widespread. Whilst frequently initiated in
1991 Tuesday 5 June 09:10 response to placement scarcity, recognition of enhanced learning
VCEC Meeting Rooms 19-20 with PL is growing. Research has explored placement outcome,
MOTOR IMAGERY PRACTICE FOR GAIT REHABILITATION OF though less is known of students’ perceptions regarding PL, and
CHRONIC POST-STROKE HEMIPARESIS whether these vary across different programmes of study. This
Dunsky A, Dickstein R, Deutsch J; University of Haifa, Haifa, Israel study also supports evaluation of the Situated Learning programme
(SLP), a new physiotherapy education model involving work-based
PURPOSE: To study the contribution of motor imagery practice to the learning. PARTICIPANTS: Student volunteers were recruited from
walking performance of community dwelling individuals with chronic two physiotherapy programmes in one institution. Group A comprised
post-stroke hemiparesis. RELEVANCE: Following a stroke, many students undertaking traditional block placements with a peer
patients rapidly re-enter the community with residual impairments and (n=54), whilst Group B comprised SLP students who work with the
disabilities that interfere with community ambulation. Because of lack same peer throughout the degree (n=25). Gender, age, ethnicity
of community services, and in order to avoid falling, these patients and educational attainment were comparable across groups: 34
are often discouraged from independently practicing gait activities (63%) and 15(60%) respectively were female; mean age was 23.3
at home. Consequently, their limited mobility predisposes them to and 27.8 years; 39 (72.2%) and 19 (76%) self-defined as white
a sedentary lifestyle, which further reduces functional capacity and British; and 23 (42.6%) and 15 (60%) had previously studied
affects their quality of life. The practice of motor tasks via imagery has at degree level. METHODS: Q methodology (Stephenson, 1935;
been proposed as a mode of exercise therapy which is safe, bears Brown, 1980) was used to explore patterns of perceptions. A
little cost, and is not dependent on other persons. PARTICIPANTS: balanced set of sixty statements were developed from qualitative
Seventeen individuals (15 men, 2 women, mean age 57.5 ±9 years, interviews and current literature. Students were asked to sort
eleven of them with right and six with left hemiparesis) volunteered statements according to those they ‘Most Agreed’, ‘Most Disagreed’
to participate. They were afflicted by a stroke (ischemic in 14 and or felt ‘Neutral’ about, and their configurations were recorded. Post
hemorrhagic in 3 participants) 46±27 months before enrolment. All Q-sort interviews, taped and transcribed, asked respondents to
subjects signed and informed consent, as required by the IRB of the explain their Q-sorts. ANALYSIS: Data were analysed using PQ
ministry of health who had approved the study. METHODS: Each method software (Schmolk, 2002). For each group, factor analysis
subjects received 15 minutes of imagery gait practice in their homes, using Principal Components Analysis and Varimax Rotation was
three days a week for six weeks. The intervention addressed gait undertaken. Emerging factors represented characteristic perceptions
impairments of the affected lower limb and task-specific gait training. of PL within each group. These were combined in a second
Specifically, imagery practice focused on increasing the force of push order analysis, producing factors relevant to both groups. Factors
off and lengthening stance duration of the affected lower extremity were explored with reference to post Q-sort transcripts. RESULTS:
as well as increasing walking speed. Walking ability was evaluated Factor correlation across groups was evident (0.52, 0.6, 0.93).
in the lab before the intervention (Pre), at three weeks (mid-term), at After second order analysis, three factors represented both groups’
the end of the intervention (post), and at three weeks after its end perceptions. Factor One (34% of variance, EV=2.0428) portrayed
(follow-up). Lab measurements included: walking speed, step and a collaborative view of learning. PL was valued highly, seen as
stride length, cadence, single and double support time and sagittal bouncing ideas, rehearsing techniques, reinforcing understanding,
kinematics of the knees and ankle joints. Walking ability was also modelling appropriate behaviour and providing support. Factor Two
assessed using clinical and functional scales administered by an (26% of variance, EV=1.552) portrayed a more conditional view
independent tester. ANALYSIS: Descriptive and ANOVA statistics of PL. Peer explanation was considered helpful and confidence-
were applied, using SPSS RESULTS: Walking speed increased 40% building, though possible only if peers were compatible, had similar
at post test. This improvement was largely maintained at follow- levels of ability and showed trust and respect. Factor Three (25%
up. The effect-size of the intervention on walking speed was found of variance, EV=1.4755) portrayed PL as involving comparison and
to be moderate (0.641). Significant increase was found in stride competition. Being compared, feeling exposed, and a peer knowing
length, cadence, and single-support time on the affected lower more, were perceived uncomfortable, though measuring oneself
limb, while double-support time significantly decreased. Gait pattern against another or showing greater knowledge were viewed positively.
assessed with Tinetti gait scale, and gait independence judged by the Each factor had at least 16 statements that significantly discriminated
Modified Functional Walking Categories Index also improved as well. it (p < 0.05)from others. CONCLUSIONS: Shared perceptions of PL
CONCLUSIONS: Walking speed and independence improved after a across both programmes suggests mode of study is not significant to
six week home based mental practice training program. The findings PL. Emerging factors support literature locating PL as a constructivist
justify the ongoing imagery practice of gait activities as a mean to activity that enhances learning (Factor One), and acknowledges
decrease deterioration and enhance walking ability of home dwelling pre-conditions that support development of a learning relationship
individuals with hemiparesis. IMPLICATIONS: An impairment and (Factor Two). A contested view of competition is suggested in Factor
task based mental practice home based program that produced Three. IMPLICATIONS: Awareness of student perceptions of PL
positive effects for walking of individuals post-stroke may be now will aid preparation by students, programme designers and clinical
tested on other tasks and rehabilitation populations. KEYWORDS: educators. KEYWORDS: Q-method; peer learning; practice-based
Stroke, Gait, Mental Practice. FUNDING ACKNOWLEDGEMENTS: learning. FUNDING ACKNOWLEDGEMENTS: University of East
None. London. CONTACT: [email protected]
ETHICS COMMITTEE: The IRB of the Flieman Geriatric Rehabilita- ETHICS COMMITTEE: University of East London Research Ethics
tion Hospital, Haifa, Israel Committee
MEASUREMENT OF ETHICAL DECISION MAKING ABILITY THE COST-EFFECTIVENESS OF PRIMARY THERAPIST MODEL
OF UNIVERSITY OF NORTH DAKOTA PHYSICAL THERAPY FOR THE MANAGEMENT OF PATIENTS WITH RHEUMATOID
STUDENTS ARTHRITIS
Mabey R, Salzbrun C, Fox R, Danks M; University of North Dakota, Li L1−4 , Maetzel A3,5 , Davis A3,6 , Lineker S6 , Bombardier C3,4 ,
Grand Forks, ND, USA Coyte P3 ; 1 University of British Columbia, Vancouver, Canada;
2 Arthritis Research Centre of Canada, Vancouver, Canada;
PURPOSE: This study measures the ethical decision making ability 3 University of Toronto, Toronto,; 4 University Health Network, Toronto,
of Physical Therapy (PT) students at Years 1 and 3 of a three-year
program. RELEVANCE: Literature of other professions suggests a Canada; 5 Canada Amgen Europe GmbH, Lucerne, Switzerland;
6 Arthritis Community Research & Evaluation Unit, Toronto, Canada
relationship between the ethical decision making ability of students
and future ethical practice. Few published studies address the ethical PURPOSE: To estimate the incremental cost-effectiveness of ser-
decision making ability of PT students. PARTICIPANTS: PT students vices delivered by rheumatology-trained primary therapists compared
completed the Defining Issues Test 2 (DIT2) upon admission to the with those provided by traditional physical and / or occupational
program and as they completed their final semester of academic therapists for managing rheumatoid arthritis (RA). Under the
course work. The DIT2 is part of routine departmental outcomes primary therapist model (PTM), rheumatology-trained rehabilitation
assessment activities. METHODS: The DIT2 was given to students therapists, regardless of their disciplinary background, provide both
entering the program in 2003, 2004, and 2005. A second DIT2 was physical therapy (PT) and occupational therapy (OT). RELEVANCE:
given to the 2003 admission cohort in the final semester of their This is one of the first studies that examine the economic value
academic course work. The DIT2, developed at the University of of an innovative rehabilitation model involving physical therapists.
Minnesota (UMN), is considered valid and reliable. Tests were scored The results can inform health care administrators’ decisions on
at the UMN and the file returned to the department for analysis. health services delivery for patients with RA. PARTICIPANTS:
ANALYSIS: Traditional statistics described findings and analyzed Between November 1999 and May 2002, 143 patients with RA,
differences in scores. Analyses were performed with SPSS version referred by 25 rheumatologists, were randomized to the PTM
11.0; alpha was set at 0.05. RESULTS: There were no differences or traditional treatment (TT) group. Eligible patients were adults
in students’ N2 (moral development) or P scores (post-conventional requiring rehabilitation treatment and not receiving PT / OT in the
schema scores) between admit years [N2 scores: F(2,126) = 0.025, past 2 years. METHODS: The economic evaluation was conducted
p = 0.975. P scores: F(2,126) = 0.162, p = 0.850]. Entering students within the context of a randomized controlled trial. Health outcomes
were further analyzed as a single sample (n=129). For entering were expressed in terms of quality-adjusted life years (QALYs),
students, the mean N2 score was consistent with the national which were measured with the EuroQol Instrument (EQ-5D) at
average (t(128)= −1.713, p = 0.089). The mean P score (35.32) was baseline, discharge (6 weeks), and 6-months. Direct and indirect
lower than the national mean of 37.80 (t(128)= −2.053, p = 0.042). costs, including patients’ visits to health professionals, use of
Students with a conservative political preference demonstrated lower investigative tests, hospital visits, use of medications, purchases of
N2 scores than those with a liberal preference (F(4.121)=3.068, adaptive aids, and the productivity loss incurred by patients and
p = 0.019). Post hoc analysis revealed a difference between very their caregivers, were collected monthly. ANALYSIS: Incremental
conservative (M=21.13) and somewhat liberal (M=39.68) groups. cost-effectiveness was calculated by dividing the additional costs of
Similar findings were found for P scores [F(4,121) = 3.553, p = 0.009], the PTM into the marginal benefits gained with the PTM approach.
with differences between very conservative (M=24.33) and somewhat Bootstrap samples were used to determine the robustness of the
liberal (M=41.21) groups. There were no differences in scores findings. RESULTS: From 143 consenting patients, 32 dropped out
between males and females (N2 scores: t(126)=-.960, p = 0.339; P after baseline assessment, to leave 111 for analysis (PTM=63,
scores: t(126)=-.448, p = 0.655), or between students 23 or TT=48). Majority female (PTM=87.3%, TT=79.2%), with mean age
24 years of age (N2 scores: t(123)= -.274, p = 0.785; P scores: of 54.2 years and 56.8 years for PTM and TT groups, respectively.
t(123)=-.108, p = 0.914). For students tested twice, the mean N2 Average disease duration was 10.6 years and 13.2 years for
score was higher at Year 3 (41.15) than at Year 1 (35.11) (t(88)=- each group, respectively. A statistically significant difference in
2.152, p = 0.034). There was no difference in P scores between the EQ-5D of 0.107 was observed at baseline (PTM: 0.463 +/−
years (t(88)=-1.281, p = 0.203). Finally, the Year 3 N2 (M=41.14) 0.52; TT: 0.57 +/− 0.59). Consequently, QALYs were calculated
and P (M=37.89) scores were lower than national averages of by adjusting for the baseline values. From a societal perspective,
44.97 and 44.87, respectively (N2 scores: t(46)=-2.230, p = 0.031 PTM generated higher mean QALYs (0.068 +/− 0.04) and resulted
and P scores: (t(46)=-3.938, p < 0.001). CONCLUSIONS: This study in a higher average cost (CAN$6,848, interquartile range (IQR):
is preliminary and includes students from a single site. Several $1,984, $9,320) compared to TT (QALY = −0.017 +/− <0.001;
concerns are raised: Why are several mean scores lower than costs = CDN$6,266, IQR: $1,938, $10,194) in 6 months, although
national averages? Are scores site specific, or would a multi- differences in both measures were not statistically significant.
program study produce similar results? If skills of PT students This yielded an estimated incremental cost-effectiveness ratio of
are limited, should ethics courses be added to the curricula? CDN$13,675 / QALY gained (95% non-parametric CI: −$73,469
Would additional ethics education improve scores? IMPLICATIONS: to $230,334). CONCLUSIONS: The PTM appears to be a cost-
Educational programs prepare future practitioners. Selected literature effective alternative to the traditional PT / OT, and its integration into
suggests a relationship between the ethical decision making ability of rheumatology care over the short term comes at reasonable societal
students and future ethical practice. The students in this study scored costs. IMPLICATIONS: Further investigations will be required to
lower than national averages. Whether this will effect clinical practice assess the long-term economic consequences of the care model
is not known. KEYWORDS: ethical decision making; DIT2; physical in managing RA and other rheumatologic conditions. KEYWORDS:
therapy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: Rheumatoid arthritis, Rehabilitation, Cost-effectiveness analysis.
[email protected] FUNDING ACKNOWLEDGEMENTS: This study was completed
through the support of Canadian Institutes of Health Research
Doctoral Research Award and the Canadian Arthritis Network
Graduate Student Award. CONTACT: [email protected]
Board
PEDAGOGICAL RELATIONSHIP AMONG CLIENT AND EXPERT PREVALENCE AND ASSOCIATED FACTORS OF URINARY
Piirainen A; Helsinki University and Laurea University of Applied INCONTINENCE IN COMMUNITY-DWELLING ELDERLY: OURO
Sciencis, Espoo, Finland PRETO STUDY, BRAZIL
PURPOSE: This thesis is a phenomenological study of relationships Dias R1 , Marques L2 , Machado-Coelho G3 , Barbosa J2 , Freitas S4 ,
experienced between client and expert. The aim of this research was Nascimento Neto R5 , Silva A6 , Chaimowicz F6 ; 1 Physical Therapy
to determine client-expert relationships in physiotherapy situations. Department, Federal University of Minas Gerais, Belo Horizonte,
RELEVANCE: Experts’ relationships in physiotherapy situations Brazil; 2 Health and Biological Science Department, UNI-BH,
have been studied earlier as being healing, health promotion or Belo Horizonte, Brazil; 3 Pharmaceutic Science School, Federal
interaction. PARTICIPANTS: The study explored the experiences University of Ouro Preto, Ouro Preto, Brazil; 4 Clinical and Social
of 16 physiotherapists and 16 clients of physiotherapy situations Nutrition School, Federal University of Ouro Preto, Ouro Preto,
in special healthcare, in a private physiotherapy facility, and in Brazil; 5 Instituto de Hipertensão Arterial; 6 Medicine Department,
a primary health care setting. METHODS: Data were collected Federal University of Minas Gerais, Belo Horizonte, Brazil
through separate open-ended one-to-one interviews with clients PURPOSE: The prevalence of urinary incontinence (UI) in the elderly
and physiotherapists immediately after the encounter at the same population is frequently underestimated. The aims were: estimate
premises where the physiotherapy session had taken place. The prevalence of UI in community-dwelling elderly; analyze if making
open-ended interviews key question was to describe what the three questions about a probable UI enhance diagnose accuracy;
interviewer had experienced in the situation just ended. ANALYSIS: and identify associated factors to symptoms of UI. RELEVANCE:
The study’s first step was the individual description of the experienced UI has a significant physical, social and psychological impact on
situation. After description, analysis continued to individual meanings elderly individuals, but proper and early diagnose could prompt
and meaning units and synthesis. In the second part of the research, Physical Therapy intervention. PARTICIPANTS: 198 community-
client and expert standpoints were established by compared and dwelling elderly consented to participate (Ethics Approval Number
united individually experienced meaning units.The interpretation UFOP 2001/26). METHODS: A population-based, cross-sectional
was done by uniting and comparing clients’ and physiotherapists’ study of a randomly representative sample. Probable cognitive
individual meaning nets to get the two points of view of the deficits (Informant Questionnaire of Cognitive Decline in the Elderly-
interaction. RESULTS: The client’s standpoint was directed by IQCODE) was investigated, elderly with positive screening were inter-
the essential strangeness of her body. From the physiotherapy viewed with a proxy. Participants were submitted to a comprehensive
experts standpoint was directed the essential goal to cure the assessment: depression screening (Geriatric Depression Scale),
client through exercises or action. From the shared experience’s functional disability assessment (Health Assessment Questionnaire),
point of view the situation was a process which had spontaneous questions about UI, falls, oral health, vision and hearing problems,
shared security, shared trust and active common understanding social isolation and prevention, and to a clinical assessment of
and common language parts. From those two standpoints, the urinary symptoms and history of obstetric, gynecologic, urinary and
relationships between client and expert seemed to be pedagogical proctologic problems. ANALYSIS: Pearson’s Qui-squared or Exact
relationships. In pedagogical relationships there is importance in Fisher test to verify proportion differences in demographic and
ethical, epistemological, existential and aesthetical standpoints. It clinical variables; Odds ratio (OR) with 95% CI to test power of
was evident as result of the research that the pedagogical process associations; Multiple Logistic Regression with significant (p < 0.10)
can progress thru in a short time from spontaneous to active or it and plausible variables to determine independent effect. RESULTS:
can stop at the spontaneous area. The spontaneous, making visible 179 elderly (90.4% of the sample) were assessed. Median age
communication and creating language dialogues can change the was 69.89±7.6 years, 76% were women, and 63.9% presented
direction of the pedagogical process. CONCLUSIONS: According to incontinence (women 68.8%; men: 54.9%). UI prevalence, assessed
the results of this thesis only the active language creative dialogue by the elderly comprehensive assessment, was 63.9%. Making three
can promote a client’s welfare so that she can discuss it with her questions, instead of only one, about urinary loss increased the
family or colleagues IMPLICATIONS: The research results provide prevalence of UI from 53.7% to 63.9% (p < 0.01). Related to UI
a challenge to develop client-expert relationships in physiotherapy symptoms, urgency urinary loss was the most frequent condition
so that a meaningful pedagogical process can take place in among the incontinents. The majority of the incontinents reported
different kinds of physiotherapy relationships. The other challenge mild symptoms, but more than 50% had reported discomfort related
is to study how the pedagogical process takes place in other to that condition. The logistic regression analysis has yielded an
professions relationships and how education can prepare experts independent association between UI and age (70+ years; OR =
to identify and instruct the pedagogical process. KEYWORDS: 2.98; CI = 1.16–7.61; p = 0.02) and economic status (low; OR =
Client-expert-relationship, pedagogical relationship, phenomenology, 7.7; CI = 1.66–35.57, p < 0.01), adjusted by probable depression,
experience, meaning analyse, dialogue, physiotherapy. FUNDING bowel constipation and disability to stand from a sitting position.
ACKNOWLEDGEMENTS: The Finnish Work Environment Found; The multivariate analysis stratified by age has yielded, in those
Laurea University of Applied Sciences. with less than 70 years, an independent association between
ETHICS COMMITTEE: Helsinki University Hospital’s ethical commit- UI and gender (female; OR = 3.56; CI = 1.12–11.30; p = 0.02).
tee Among the individuals with 70 years and more, UI prevalence
was associated to bowel constipation (OR = 3.07; CI = 3.07–9.27;
p = 0.04). CONCLUSIONS: The prevalence of UI in our population
was high. UI diagnose accuracy was higher after making three
questions, when comparing with only one. Recognition of associated
factors and awareness of the condition are important to delivery
an adequate intervention Physical Therapy. IMPLICATIONS: To
change this scenario it might be raise health professional awareness
about accurate investigation of this problem and to promote health
education actions, expliciting that UI is a common elderly health
problem and that the identification of those with incontinence or
at risk of developing the condition is the first step towards a
solution. KEYWORDS: Elderly, Urinary Incontinence, Prevalence. donated by Keiser Sports Health Inc, Fresno, CA. CONTACT:
FUNDING ACKNOWLEDGEMENTS: Financial support: CNPq – [email protected]
Brazilian Funding Research Agency. CONTACT: [email protected] ETHICS COMMITTEE: Human Research Ethics Committee of the
ETHICS COMMITTEE: Ethics Committee of the Federal University University of Sydney, Australia
of Ouro Preto, Brazil – Nr:2001/26
Research Report Platform Presentation 1112 Tuesday 5 June 09:30
1565 Tuesday 5 June 09:30 VCEC Meeting Room 18
VCEC Meeting Room 17 TRUNK STABILISATION EXERCISES IN PATIENTS WITH
ADAPTATION TO PROGRESSIVE RESISTANCE TRAINING (PRT) STERNAL INSTABILITY FOLLOWING CARDIAC SURGERY
IN CHRONIC STROKE POPULATION El-Ansary D1,2 , Adams R2 , Waddington G1 ; 1 University of
Lee M1 , Davis G1 , Kilbreath S1 , Fiatarone Singh M1,2 , Zeman B3 ; Canberra, Australia; 2 University of Sydney, Australia
1 Faculty of Health Sciences, University of Sydney; 2 Faculty of
PURPOSE: Sternal instability following cardiac surgery is a post-
Medicine, University of Sydney; 3 Coorabel Adult Service, Royal
operative complication that impacts on the patient’s quality of life,
Rehabilitation Centre
contributes to increased length of stay in hospital and overall cost
PURPOSE: This study investigated the time-course of muscle of care. Many of these patients do not have the option of surgical
adaptation as a consequence of PRT in persons following stroke. repair due to the increased risks that are associated with further
RELEVANCE: It is well known that high intensity PRT is the optimal surgery. RELEVANCE: It is proposed that contraction and activation
exercise modality to improve muscle strength in other cohorts; of the abdominal and anterior thoracic cage muscles may assist in
however, the time-course of adaptation to PRT has not been defined stabilising the sternum by reduction of excessive motion during trunk
in persons following stroke. PARTICIPANTS: Forty-eight chronic movement. If the degree of excessive motion between the two sternal
stroke survivors (mean age:63±9 yrs, time since stroke: 57±54 edges in the patient with an unstable sternum can be minimised
months) were recruited from the community who were able to this may also reduce the associated pain and discomfort reported
walk independently. METHODS: A single-blinded, sham exercise- by patients and in turn offer a conservative management option
controlled factorial design with an intention-to-treat analytic strategy for sternal instability. PARTICIPANTS: Nine patients presenting with
was employed for this randomized clinical trial. Participants were sternal instability following cardiac surgery were included in this study.
randomly allocated amongst PRT + cycling, PRT + sham cycling, METHODS: Subjects participated in a prospective, blinded clinical
sham PRT + cycling, or sham PRT + sham cycling groups. PRT trial. This involved a six-week exercise program as well as six weeks
Training consisted of 30 exercise sessions, conducted over a 10– of rest. Measures taken included: sternal separation by ultrasound,
12 week period, with 3 sessions per week. The training resistance patient self-reports (SFS) and video footage of two functional tasks.
was re-adjusted according to a new 1RM every 2nd week and In addition to set tasks subjects were asked to nominate other
perceived exertion every session. The outcomes were unilateral tasks that they found difficult and these were incorporated into the
muscle strength assessed by 1 repetition maximum (1RM) measured SFS. Rating scales were used to obtain measures of pain and
on pneumatic resistance machines (leg press, knee extension, knee discomfort, and ease of performance. The resulting video footage
flexion, hip abduction, ankle plantarflexion). ANALYSIS: Simple was assessed for movement control and quality by ten qualified
descriptive statistics were used to summarize the progression of physiotherapists and twenty physiotherapy students. ANALYSIS:
training. To examine the semi-weekly changes that occurred with Repeated measures Analysis of Variance was conducted to assess
training, repeated measures ANOVA with Helmert contrasts was effects, with contrasts written across occasions of measurement to
performed for each lower limb muscle group tested only in subjects examine for trends in data over time. RESULTS: Sternal separation:
who were in the PRT group (PRT + cycling, PRT + sham cycling). there was a significant difference in sternal separation measures
RESULTS: The intensity of strength training was on average above obtained by ultrasound in both the supine and seated positions
80% of the most recent 1RM (the intended intensity) for those in following a six week exercise program. Participants who trained
the PRT groups. Overall, participants in the PRT group significantly first maintained the gains of training in the supine position more
improved both their affected and unaffected lower limb muscle so than in the seated position. Patient self reports: there was a
strength during the first 6-8 weeks of training (66-76%), but then significant difference in the ratings of pain and discomfort following
plateaued in the final 2-4 weeks (Repeated-measures ANOVA the exercise program (p < 0.03) noted for the group. This effect
with Helmert contrasts: p < 0.05). A posteriori statistical analyses was maintained in the subgroup that commenced the exercises
revealed that the leg press and knee flexion demonstrated significant first (p < 0.04). In addition, for the group that commenced with a
improvement semi-weekly until Week 8, but then plateaued (ie, no rest period a significant change in reported ratings was observed
further improvement on average) thereafter (p > 0.05). In contrast, following the exercise program (p < 0.02). Video analysis: ratings
knee extension and hip abduction showed significant improvements of movement quality and movement control did not differ with
semi-weekly until Week 6 (p < 0.05), but plateaued during the final rater experience, and showed the greatest change for everyday
four weeks (p > 0.05). Analysis of intended versus actual intensity movements such as going from supine to sitting and reaching
showed that the actual loads used were above the theoretical for an object in the seated position. CONCLUSIONS: A six week
intended progression (3% per session) up to approximately 6 weeks program of specific stabilisation exercises of the trunk significantly
for most exercises and then fell below the intended progression. improved measures of: sternal separation, self report regarding pain
CONCLUSIONS: High intensity PRT effectively strengthens both and discomfort, and movement quality and control. IMPLICATIONS:
affected and unaffected lower limb muscles in older chronic stroke Stabilisation exercises aimed at improving recruitment of muscles of
survivors almost 5 years post-stroke. Adaptation was linear in the the anterior chest wall and abdomen may be an appropriate inclusion
first 6-8 weeks of training, during which time progressive overload in the rehabilitation program of patients with sternal instability
was possible each session. IMPLICATIONS: A rehabilitation program following cardiac surgery. On the basis of the data obtained in
targeting muscle strength in chronic stroke, as in other cohorts, will the current study, training should incorporate positions patients find
produce musculoskeletal adaptations as long as progressive high- primarily symptomatic (eg supine) in addition to those that simulate
intensity loading techniques are used. KEYWORDS: CVA, exercise, functional tasks. KEYWORDS: Cardiovascular, Exercise, Ultrasound.
lower limb. FUNDING ACKNOWLEDGEMENTS: The project was FUNDING ACKNOWLEDGEMENTS: University of Sydney, Australia.
financially supported by the National Health and Medical Research CONTACT: [email protected]
Council of Australia (Project 302013). Keiser K400 Electronics were ETHICS COMMITTEE: The University of Sydney, Australia.
Research Report Platform Presentation Study, Queensland Health Allied Health Research Grant. CONTACT:
2355 Tuesday 5 June 09:30 s.kuys@griffith.edu.au
VCEC Meeting Rooms 19-20 ETHICS COMMITTEE: Princess Alexandra Hospital Research and
STRUCTURED TREADMILL WALKING FOR STROKE PATIENTS: Ethics Committee; University of Queensland Medical Research
THE IMPACT OF WALKING SURFACE AND CARDIOVASCULAR Ethics Committee
DEMAND ON GAIT QUALITY
Kuys S1,2 , Brauer S3 , Ada L4 ; 1 Griffith University, Gold Coast, Research Report Platform Presentation
Australia; 2 Princess Alexandra Hospital, Brisbane, Australia; 2810 Tuesday 5 June 09:50
3 University of Queensland, Brisbane, Australia; 4 University of
Sydney, Sydney, Australia POSITIONS THAT MATTER IN PROBLEM-BASED LEARNING:
PURPOSE: The purpose of this study was to determine if walking CHARACTERISING STUDENT PERFORMANCE OF SOCIAL
quality in stroke patients was different: when walking overground INTERACTION THROUGH THEIR CONVERSATION IN
compared with walking on a treadmill; and when cardiovascular COLLABORATIVE GROUP WORK
demand was increased during treadmill walking. RELEVANCE: Remedios L; University of Melbourne, Melbourne, Australia
Following stroke, most survivors are able to walk but few manage
this easily in the community significantly contributing to the ongoing PURPOSE: This study uses Positioning Theory (Harre and Van Lan-
disability associated with stroke. While treadmill training is increasing genhove, 1991) to examine how students perform their collaboration
in popularity as a mode of retraining walking, the impact of this type in a small group learning contexts. Positioning theory is a theoretical
of training on gait quality has not been investigated. Results of this framework that focuses on the way in which we position [identify]
project will be directly applicable to physiotherapists rehabilitating others and ourselves through conversation. Individuals position
themselves relative to each other through adopting, assigning,
walking in stroke survivors and should improve knowledge of the
contesting and subverting positions within their social context through
impact of treadmill training on stroke survivors. PARTICIPANTS:
communication/cultural conventions. This presentation examines the
20 stroke survivors currently undergoing inpatient rehabilitation
key positions that were adopted by and assigned to students in a
were recruited to these studies. Gender was evenly distributed
PBL context in an Australian physiotherapy undergraduate setting.
with 45% being male. Average age of participants was 55.9
RELEVANCE: Small group collaborative learning is increasingly
(±12) years with a range of 38-78 years. Participants were
being used to promote the development of professional attributes
medically stable, referred for physiotherapy, demonstrated walking
and competencies. In small group collaborative contexts such as
deficits, provided informed consent and scored at least 3 on
PBL, the educator is positioned as a facilitator who scaffolds the
Motor Assessment Scale, Item 5, Walking. Equivalence analyses
development of student skills. A fine grained analysis of how
indicated that 15-20 participants would be required to determine
students operate within the learning context will add significantly
minimum clinical differences. Ethical approval for study was granted
to educators’ understanding of how to best support each learner
by institutional Medical Research Ethics Committees. METHODS:
to full engagement with the learning agenda. PARTICIPANTS:
Two counterbalanced descriptive studies were conducted. In the
Seventeen Australian-educated and 13 Asian-educated students
first study, participants underwent a ten minute overground walking volunteered to participate in a qualitative research project on PBL.
intervention and a ten minute treadmill walking intervention (in Consent to videotape PBL sessions was gained from all members
different sessions on different days) where heart rates during of the groups to which these 30 students belonged. For this study,
each intervention were matched. In the second study, performed the video data from seven PBL tutorial sessions were analysed.
on another day, participants walked at predetermined heart rates In total, the conversational exchanges of seventy students and
equivalent to 40, 50 and 60% heart rate reserve, the minimum seven tutors were analysed for identification of positioning practices.
intensity capable of improving cardiorespiratory fitness. For both METHODS: This study was a subset of a two-year ethnographic
studies, spatial and temporal gait measures were taken pre study that examined the experiences and responses of overseas-
and post each intervention when walking over an 8m Gaitrite educated (Asian-educated) students to PBL learning in an Australian
mat. Hip, knee and ankle joint measures were taken at stance learning context. Participant observation, semi-structured interviews,
and swing phases of gait via 2D posterior and lateral webcam videotape of PBL sessions and videotape stimulated recall interviews
footage during overground and treadmill walking. Reliability of were used. For this secondary analysis, video data of seven tutorials
using the webcam for angle measures has previously been were the major data source. ANALYSIS: Positioning theory involves
published, and will be confirmed for this population in this study. the examination of conversation between persons to interpret how
ANALYSIS: In the first study repeated measures (RM) analysis individuals position themselves relative to each other. An existed
of variances (ANOVAs) were used to determine any task effect list of positions commonly assigned and adopted in small group
(overground vs. treadmill) and time effect (pre vs post) in gait collaborative work among senior school students (Barnes, 2003) was
parameters. RMANOVAs were also used to determine any effect of expanded and modified into a list of positions commonly adopted
increased cardiovascular demand on gait parameters. RESULTS: and assigned by students in PBL tutorials. RESULTS: A list of
No differences were found between an overground walking and 12 positions with subsets was developed. Each position and its
treadmill walking intervention on spatio-temporal gait parameters. No subset were described in terms of social practice. The role of ‘ideal’
differences were found in spatio-temporal gait parameters following PBL student was defined as a flexible and responsive adoption
treadmill walking at increasing cardiovascular demand. There were of all positions consistent with the PBL agenda and avoidance
no differences in joint kinematics at hip, knee or ankle movement of positions in conflict with the PBL agenda. CONCLUSIONS:
during stance and swing phases of gait at increasing treadmill Students positioning activities provides a view on how students
speeds. CONCLUSIONS: Treadmill walking does not negatively negotiate their social context and the power their carry in shaping
impact on gait spatial temporal parameters, joint kinematics or their learning. The PBL context should be viewed as a space to
walking pattern compared to overground walking or when walking develop students’ skills in productive positioning activity. Data from
at increasing cardiovascular demands. IMPLICATIONS: It is feasible this study suggested that tutors have a powerful role in positioning
to use treadmill walking during inpatient rehabilitation to retrain students and further research is needed into the positioning activity
walking capacity in stroke patients able to walk without compro- of tutors. IMPLICATIONS: This study provides tutors with insights
mising gait quality. KEYWORDS: Professional Practice – Exercise. into how students negotiate the sociocultural context of small
FUNDING ACKNOWLEDGEMENTS: Australian Physiotherapy As- group learning. Knowledge of practice can inform tutors efforts to
sociation Queensland Branch Dorothy Hopkins Award for Clinical further scaffold students’ learning. KEYWORDS: PBL,Positioning
Theory,sociocultural contexts,. FUNDING ACKNOWLEDGEMENTS: patients’ perspective is essential to the future development of
Australian Post-graduate Scholarship, The University Of Melbourne. physiotherapy services. KEYWORDS: Self Referral (Direct Access),
CONTACT: [email protected] Patients views, Primary Care. FUNDING ACKNOWLEDGEMENTS:
ETHICS COMMITTEE: The University Of Melbourne, Faculty of Work was unfunded but supported by Tayside Primary Care Trust and
Education Human Research Ethics Committee. Glasgow Caledonian University. CONTACT: [email protected]
ETHICS COMMITTEE: Ethical approval for this study was granted
by Tayside Research Ethics Committee and by Glasgow Caledonian
University Research Ethics Committee
SELF REFERRAL (DIRECT ACCESS)TO PHYSIOTHERAPY Research Report Platform Presentation
VIEWS AND PERCEPTIONS OF SERVICE USERS AND 2803 Tuesday 5 June 09:50
NON-USERS VCEC Meeting Room 16
Webster V1 , Holdsworth L2,3 ; 1 Glasgow Caledonian University, THE DEVELOPMENT OF A MOBILITY OUTCOME MEASURE
Glasgow, Scotland, UK; 2 Tayside Primary Care Trust, Dundee, FOR OLDER GENERAL MEDICAL PATIENTS IN THE ACUTE
Scotland, UK; 3 Forth Valley NHS, Stirlingshire, Scotland, UK CARE SETTING
de Morton N1,2 , Keating J1 , Berlowitz D2 , Davidson M3 ; 1 Department
PURPOSE: The development of patient self referral (Direct Ac-
of Physiotherapy, Monash University, Melbourne, Australia; 2 Northern
cess) to physiotherapy has prompted the demand for evidence
Clinical Research Centre, Northern Health, Melbourne, Australia;
regarding appropriateness, cost effectiveness and efficacy of this 3 School of Physiotherapy, La Trobe University, Melbourne, Australia
mode of access. This study aimed to investigate the views,
attitudes and experiences of General Practitioner(GP) and Self- PURPOSE: Clinicians and researchers require an outcome measure
referral(SR) patients and to compare those with non-users(NU) that can sensitively measure and monitor changes in mobility for
of physiotherapy services within the Scottish NHS. RELEVANCE: older acute general medical patients. This report describes the
Recent healthcare reforms have encouraged the involvement of development of a physical performance mobility measure specifically
service users when designing or re-designing services. Patient self designed for this patient population. RELEVANCE: Physiotherapists
referral to physiotherapy has been a significant development in commonly assess and treat older medical patients during acute
service delivery yet very little published evidence exists regarding hospitalisation. Existing instruments for measuring mobility are
the views and perceptions of patients or the general public. inadequate for assessing people across the broad spectrum of
PARTICIPANTS: All patients attending the physiotherapy clinic in abilities that exists in this patient population. PARTICIPANTS: 89
one year were recruited. 264 GP and 76 SR with 82.8% (n=208) consecutive general medical patients aged 65 years and older who
and 92.1% (n=70) response rates respectively. In order to identify were admitted to an acute care hospital. The mean patient age was
the views and perceptions of the general public to physiotherapy 79.2 years (sd=7.1), 53% were female and 88% were admitted from
and Self referral a sample of non-users was included. A stratified home. At hospital admission, mean Barthel Index and Hierarchial
sample of 250 individuals(NU) with no experience of physiotherapy Assessment of Balance and Mobility (HABAM) scores were 81.3
during the previous five years were randomly selected from the (sd=22.8) and 18.1 (sd=6.8) respectively. METHODS: Mobility items
practice population 207 responded (82.8%). METHODS: A postal were generated from existing scales, patient interviews and focus
questionnaire was developed to allow service users and non users to groups with experts. A total of 51 items were pilot tested. Patients
be included. In addition this method allowed respondents to complete were assessed every 48 hours during hospital admission. A head-
the questionnaire anonymously which was hoped would encourage to-head comparison of the new mobility measure was performed
open and honest responses. ANALYSIS: All questionnaires were with the Barthel Index and the HABAM. ANALYSIS: Rasch analysis
analysed using PinPoint software. Frequency distributions were was used to rank items in a hierarchy of difficulty from easiest to
reported in percentages and non-parametric testing was used to hardest. Item response patterns that showed misfit to the Rasch
study differences between groups. Chi Squared testing examined model were identified and the item excluded. Inter rater and test retest
associations between groups. Ordinal and continuous data was reliability were quantified by the Minimum Detectable Change at
examined using Mann Whitney testing. The level of significance 90% confidence (MDC90 ). Instrument responsiveness and Minimally
was 5% and confidence levels 95%. RESULTS: Despite a publicity Clinically Important Difference (MCID) were calculated using criterion
campaign prior to the introduction of self referral 51% GP and 78.3% and distribution based methods. Criterion based methods were
NU were unaware they could refer themselves(p < 0.0001). Levels of calculated by reference to an independently measured global rating of
knowledge were not different between user groups but significantly so change scale. RESULTS: 215 mobility assessments were performed.
between users and non users (p = 0.003). Approximately 65% of GP Seventeen mobility items were selected for inclusion in the new
and SR patients (p > 0.99) still had symptoms but a greater proportion measure. The item hierarchy ranged from able to sit unsupported
of SR were continuing to improve (p < 0.0001). Vast majority of (easiest item) to standing on one leg with eyes closed (hardest
all groups were opposed to only doctors being able to refer to item). The 17-item scale fitted the Rasch model and items operated
Physiotherapy (76.5%GP, 85.9% SR, 69.5% NU). Despite low levels consistently across the scale spectrum regardless of patient age,
of knowledge being perceived over 90% of all respondents agreed gender, cognition, primary language or time of administration during
physiotherapy was effective in the treatment of musculoskeletal hospitalisation. An interval-level scoring system was developed with
conditions (93.7%GP, 95.8% SR, 90.3 NU) with three quarters of a score range from 0 to 100. The MDC90 and MCID were calculated
all groups happy for physiotherapists to make decisions regarding to be approximately 10 points. The new mobility measure removes
fitness for work. Considerable differences between the groups the ceiling effects of the Barthel Index and HABAM and is more
was identified in relation to ‘confidence to know when to refer responsive to change than the Barthel Index. Although not directly
themselves’ with>70% User Group compared to 42.9% Non-Users compared in this research, the new mobility measure also overcomes
The highest level of agreement was expressed by the SR, 74.3% the known floor effect of the Timed Up and Go (TUG) in this patient
CONCLUSIONS: The findings of this study indicate that both population. CONCLUSIONS: This new mobility measure is a broad
previous users and non users are in favour of self referral to unidimensional measure of mobility that produces interval level data,
physiotherapy but more work needs to be done by the profession to has minimal equipment requirements, is quick and easy to administer
market services and educate the public as to when a physiotherapist in the acute care setting and has superior measurement properties
should be the first point of contact for patients. IMPLICATIONS: to the Barthel Index, HABAM and the TUG. IMPLICATIONS:
Knowledge of accessing and experiencing physiotherapy from the The new mobility measure provides clinicians and researchers
with an advanced method for monitoring and measuring patient ACKNOWLEDGEMENTS: This study has received financial support
mobility in the acute care setting. KEYWORDS: Measurement, from The Norwegian Fund for Post-graduate Training in Physio-
Aged Care. FUNDING ACKNOWLEDGEMENTS: This research was therapy and from Clinical Services, Trondheim University Hospital,
funded by The HCF Health and Medical Research Foundation Norway. CONTACT: [email protected]
and the National Health and Medical Research Council (NHMRC). ETHICS COMMITTEE: Regional Committee for Medical Research
CONTACT: [email protected] Ethics in Norway, REK
ETHICS COMMITTEE: The Northern Hospital and Monash Univer-
sity Human Research Ethics Committees
1601 Tuesday 5 June 09:50 DEVELOPMENT OF A RISK ASSESSMENT MODEL TO
VCEC Meeting Room 17 PREDICT PULMONARY RISK FOLLOWING UPPER ABDOMINAL
CHANGES IN MOTOR NETWORK IN PERSONS WITH SURGERY
ACUTE STROKE EVALUATED WITH FUNCTIONAL MRI AND Scholes R1 , Denehy L2 , Sztendur E3 , Browning L2 ; 1 Physiotherapy
FUNCTIONAL TESTS Department, School of Primary Health Care, Faculty of Medicine,
Askim T1,2 , Indredavik B3,4 , Haraldseth O5 , Håberg A5 ; 1 Department Nursing and Health Sciences, Monash University, Melbourne,
of Community Medicine and General Practice, Faculty of Medicine, Australia; 2 School of Physiotherapy, Faculty of Medicine, Dentistry
Norwegian University of Science and Technology, Trondheim, and Health Sciences, The University of Melbourne, Melbourne,
Norway; 2 Clinical Services, University Hospital of Trondheim, Australia; 3 School of Computer Science and Mathematics, Victoria
Norway; 3 Stroke Unit, University Hospital of Trondheim, Norway; University, Melbourne, Australia
4 Department of Neuroscience, Faculty of Medicine, Norwegian
PURPOSE: The incidence of post-operative pulmonary complica-
University of Science and Technology, Trondheim, Norway;
5 Department of Circulation and Medical Imaging, Faculty of Medicine, tions (PPC) following upper abdominal surgery (UAS) has been
reported in recent years as between 9-40%. The presence of pre-
Norwegian University of Science and Technology, Trondheim, Norway
operative, intra-operative and post-operative risk factors have all
PURPOSE: Most patients suffering from stroke experience some been reported to contribute to the development of PPC. However,
functional recovery for the first three months following the injury. finding absolute predictors of PPC remains elusive. The ability to
The knowledge about factors facilitating this recovery is very limited identify patients at high risk of PPC could prioritise care for those
and the knowledge about changes in motor network during this time who would benefit most from respiratory physiotherapy. The aim
is limited as well. The purpose of this study was to investigate of this study was to identify key risk factors associated with the
the relationship between functional recovery and brain activation development of PPC following elective upper abdominal surgery and
patterns in persons with unilateral hand impairment after ischemic to formulate a weighted, clinically viable risk assessment model to
stroke in the acute and chronic phase. RELEVANCE: Functional predict the development of PPC in patients undergoing elective upper
MRI (fMRI) is increasingly used to study brain activation during abdominal surgery. RELEVANCE: This prospective, multicentre
motor tasks. More knowledge about motor network activation is study identified risk factors associated with the development of PPC
of major interest to understand the motor recovery after stroke and developed a weighted risk prediction model to predict UAS
and to develop more effective interventions to regain function in patients at high risk of PPC. PARTICIPANTS: Two hundred and
patients with unilateral upper extremity paresis. PARTICIPANTS: seventy-two consecutive elective upper abdominal surgey patients
11 right handed persons with the diagnosis of stroke (4 women), were recruited pre-operatively into the study from three major tertiary
aged from 69 to 74 years old, with unilateral hand paresis and teaching hopsitals in Melbourne, Australia. Patients were included if
intact language were included. METHODS: All patients were treated they understood written and spoken English and were scheduled
in an acute stroke unit combined with early supported discharge. for elective UAS, which was defined as “an incision above or
They underwent diagnostic MRI, fMRI and functional hand/arm tests extending above the umbilicus”. All patients were given written
within 4-7 days from first sign of symptoms and three months later. and verbal information on the project and written informed consent
The functional tests were Nine Hole Peg Test, Frenchey Arm Test, was obtained. METHODS: All patients were assessed across 17
Motor Assessment Scale (arm and hand function items) and grip pre-operative and intra-operative risk factors for the development
strength. ANALYSIS: fMRI data was analyzed in SPM5 using the of PPC. PPC was defined and diagnosed using multiple clinical,
general linear model, second level random effects analysis and T-test. radiological and pathological criteria in order to identify clinically
Motor recovery data was used in a covariate analysis. RESULTS: All significant PPC. Patients received standardised written pre-operative
patients had subcortical infarction. Two strokes also included cortex, education on deep breathing exercises and the importance of
but not primary motor cortex. There was significantly improved hand early mobilisation. In addition, patients received one standardised
function as measured with all functional tests from acute to chronic post-operative physiotherapy treatment on the first post-operative
phase. In self paced finger tapping significantly increased activation day. Patients were monitored daily until discharge for signs of
was found in ipsilateral primary motor and somatosensory cortex in PPC. ANALYSIS: Data was analysed using univariate analysis
the chronic compared to the acute phase. The covariate analysis and forward stepwise logistic regression to determine the variables
demonstrated that contralateral primary motor cortex activation was for inclusion in a risk prediction model for PPC. RESULTS: The
connected to increased grip strength. Contralateral supramarginal incidence of PPC was 13% (n=35). Five risk factors were idenitifed
gyrus and bilateral parietooccipital sulcus activation were associated by univariate analysis as significant predictors of PPC: duration of
with increased performance in all tests. CONCLUSIONS: In all anaesthesia (odds ratio (OR)=4.322); surgical category (OR=2.272);
patients with acute impaired hand function and infarction not current smoking (OR=2.109); respiratory co-morbidity (OR=2.057)
encompassing primary motor cortex, improved hand function lead to and predicted VO2 max (OR=2.027). Logistic regression was used
increased activation in primary motor cortex in the chronic compared to develop a weighted PPC risk prediction model. The risk prediction
to acute phase. The increased parietal activation corresponding model predicted 82% of patients who developed a PPC. High
to improved functional tests demonstrated the importance of the risk patient were 8.4 times more likely to develop a PPC than
posterior right parietal cortex in motor attention and preparation. low risk patients. CONCLUSIONS: These results provide a model
IMPLICATIONS: We suggest further examination of posterior parietal for predicting clinically significant PPC in the upper abdominal
cortex to investigate its importance for hand function recovery. surgery population. Further validation of the risk prediction model
KEYWORDS: stroke, motor recovery, brain activation. FUNDING could allow prioritised pre-operative and post-operative respiratory
care for high risk patients. IMPLICATIONS: The ability to identify knee flexor contracture (p < 0.05) and quadriceps spasticity (p < 0.01).
and manage patients at high risk of PPC, with exclusion of CONCLUSIONS: Some gait deviations are linked to underlying
lower risk groups from post-operative physiotherapy, could reduce neurological impairments and this knowledge may help to guide phys-
unnecessary intervention, improve cost effectiveness and prioritise iotherapy treatment. This was an exploratory study involving multiple
care for those who would benefit most from physiotherapy through variables therefore increasing the likelihood of a type I statistical error.
the implementation of evidence based practice. KEYWORDS: Further research should focus on particular results and test only
upper abdominal surgery, post-operative pulmonary complications, selected variables i.e. the relationship of knee flexor weakness and
risk prediction. FUNDING ACKNOWLEDGEMENTS: St. Vincent’s knee hyperextension and further test the relationships with specific
Hospital, Melbourne Research Grant. intervention programmes i.e. the effects of knee flexor strengthening
ETHICS COMMITTEE: The study was approved by Melbourne and knee hyperextension. IMPLICATIONS: These results may help
Health Human Research Ethics Committee and St. Vincent’s Health to guide physiotherapeutic assessment and treatment intervention
Human Research Ethics Committee. to improve abnormal gait patterns following stroke. KEYWORDS:
Stroke, gait, analysis. FUNDING ACKNOWLEDGEMENTS: Present-
ing author was in receipt of a personal bursary from the Wales Office
of Research and Development in Health and Social Care. CONTACT:
835 Tuesday 5 June 09:50 [email protected]
VCEC Meeting Rooms 19-20 ETHICS COMMITTEE: Gwent Local Research Ethics Committee
THE RELATIONSHIP OF HEMIPARETIC GAIT DEVIATIONS
TO UNDERLYING NEUROLOGICAL IMPAIRMENT AND ITS
RELEVANCE TO PHYSIOTHERAPEUTIC INTERVENTION
Cooper A1,2 ,Wiles M3 , van Deursen R2 , Musa I2 ; 1 Physiotherapy PP Crystal Pavilion B & C
Department, Gwent Healthcare NHS Trust, Newport, UK;
2 Department of Physiotherapy Education, School of Healthcare OUTCOME MEASUREMENT OF “COMMUNITY” WEIGHT-
Studies, Cardiff University, Cardiff, UK; 3 Department of Neurology, BEARING ACTIVITY IN YOUNG PEOPLE WITH NON-
Opthalmology and Audiological Medicine, School of Medicine, PROGRESSIVE NEUROLOGICAL DISABILITIES: A SYSTEMATIC
Cardiff University, Cardiff, UK LITERATURE REVIEW
Dickens W1 , Tripathi C1 , Featherstone J1 , Croot E2 , Price F1 ;
PURPOSE: Many patients with stroke who regain the ability to 1 Sheffield Children’s Hospital NHS Foundation Trust; 2 University
walk do so with abnormal gait patterns. To improve abnormal gait
of Sheffield
patterns physiotherapists must determine the underlying causes in
order to provide effective treatment. There is a wealth of literature PURPOSE: Physiotherapists in the UK routinely measure weight
describing gait deviations commonly seen following stroke. However, bearing activity in young people with non-progressive neurological
the relationship of these common gait deviations with underlying disabilities using a range of published measurement tools. A
neurological impairments remains unclear. Therefore, this study systematic review was required to identify the most appropriate
aimed to determine the neurological impairments of patients with measurement tool(s) for use by physiotherapists in the community
hemiparetic stroke, explore their relationship to gait deviations and setting with this patient group. RELEVANCE: The use of appropriate
test whether observation of an individual patient’s gait deviation outcome measures is fundamental to determine effective practice.
helps determine their underlying impairments and therefore guide The results of this project will be used to inform decisions about
rehabilitation. RELEVANCE: The challenge for physiotherapists is current best practice and therefore impact on the delivery of
to determine the underlying impairments leading to an individual therapy to this patient group. This will ultimately impact upon clinical
patients gait pattern in order to provide appropriate and effective effectiveness. PARTICIPANTS: N/A METHODS: A two phase review
interventions to improve that patients gait. This study provides was required. In phase one, an extensive systematic review of the
further knowledge to aid physiotherapists in their assessment and medical, nursing and social sciences literature was undertaken to
treatment of abnormal gait patterns. PARTICIPANTS: A cross- identify and evaluate specific tools for measuring weight bearing
sectional study design was used and included a convenience sample activity in young people with non-progressive neurological disabilities.
of 31 patients who had a unilateral single stroke, no major lower A comprehensive search strategy was developed in collaboration
limb joint pathology and the ability able to walk with or without aid. with expert clinicians. Papers were identified according to explicit
METHODS: Gait deviations were identified through observational inclusion and exclusion criteria. Relevant papers were obtained and
gait analysis. Neurological impairments were identified from a reviewed. Results were entered into a Reference Manager® version
comprehensive clinical examination including muscle bulk, range of 11 database. Phase two, to identify the most appropriate tool(s) and
movement and resistance to passive movement measures, and from eliminate unsuitable tools through assessment of scientific rigor, is
the measurement of EMG responses of four lower limb muscles still underway. This will be reported at a later date. Ethical approval
to quick and slow stretch, isometric force-EMG relationships and was obtained from South Sheffield Research Ethics Committee. The
muscle activation during gait. ANALYSIS: Patients with and without study was registered with the NHS Trust research office for research
particular gait deviations were compared in terms of their clinical governance purposes. ANALYSIS: Key data were elicited from the
examination results in particular contracture and muscle wasting, included studies using a pre-determined data extraction form. Data
EMG stretch responses as a measure of spasticity, weakness and extraction was undertaken independently by two reviewers and any
agonist/antagonist coactivation during isometric force production, and discrepancies were resolved by discussion. RESULTS: 514 papers
abnormal muscle activation patterns during gait. Data analysis used a were identified from the initial search. 82 fulfilled the strict inclusion
range of non-parametric and parametric procedures and was carried criteria, covering 55 measurement tools. A further nine tools were
out using SPSS v10. RESULTS: Certain gait deviations appear to identified from the grey literature. Initial assessment identified a range
be related to particular underlying impairments. Sustained pelvic of problems with these tools: excessively broad or too restrictive (e.g.
rotation was related to gastrocnemius spasticity (p < 0.05), knee flexor diagnosis, age); an absence of activities of specific interest and/or
weakness (p < 0.0005) and quadriceps weakness (p < 0.005). Knee requiring a standardised environment that would be inappropriate
hyperextension during stance was related to quadriceps spasticity to a community setting. The level of scientific rigor with which
(p < 0.05) and knee flexor weakness (p < 0.001). Excessive knee the tools had been developed and validated was also extremely
flexion in stance was related to an inability to fractionate (p < 0.05) and variable. CONCLUSIONS: The literature reveals a bewildering choice
in some patients knee flexor contracture. Reduced or absent knee of outcome measurement tools with many being advocated without
extension during swing was related to knee flexor spasticity (p < 0.05), specific validation. Our analysis has identified a list of candidate
tools that require rigorous critical appraisal against common criteria. for future study. IMPLICATIONS: Being able to widen access to
Phase two will extend the analysis by reviewing these identified physiotherapy services in the UK and allow self referral has significant
tools systematically. IMPLICATIONS: Findings from the review implications for services, NHS costs, society in terms of employment
will enable therapists to make an informed choice between the and patient choice, empowerment and satisfaction, implications that
outcome measurement tools available for use with this patient group. are also of global interest. KEYWORDS: Self referral, direct access,
KEYWORDS: Paediatric, neuro-disabilities, outcome measurement. national trial. FUNDING ACKNOWLEDGEMENTS: This work was
FUNDING ACKNOWLEDGEMENTS: Sheffield Health and Social undertaken with the support of the participating sites and from our
Research Consortium. CONTACT: [email protected] employer organisations, NHS Forth Valley and Glasgow Caledonian
ETHICS COMMITTEE: Approved by South Sheffield Research Ethics University. CONTACT: [email protected]
Committee. Study registered with the NHS Trust research office for ETHICS COMMITTEE: Ethical approval for the study was granted
research governance purposes. by the Multi-centred Research Ethics Committee (Scotland) ref. No.
MREC/02/0/37.
821 Tuesday 5 June 10:10 Research Report Platform Presentation
VCEC Meeting Rooms 11-12 3231 Tuesday 5 June 10:10
ARE SELF REFERRING (DIRECT ACCESS) PATIENTS VCEC Meeting Room 16
DIFFERENT FROM THOSE REFERRED BY THEIR GP?: THE RELIABILITY AND VALIDITY OF LOWER EXTREMITY SEN-
RESULTS OF A NATIONAL TRIAL SORY TESTING IN OLDER COMMUNITY-DWELLING ADULTS
Holdsworth L1,3 , Webster V2,3 ; 1 NHS Forth Valley, United Kingdom; Shaffer S1 , Harrison A1,2 , English M2 , Brown K2 , Brennan K2 ,
2 Glasgow Caledonian University, United Kingdom; 3 The Scottish LeFever C2 ; 1 University of Kentucky, Doctoral Program in
Physiotherapy Self Referral Study Group, United Kingdom Rehabilitation Sciences, Lexington, United States; 2 University of
Kentucky, Division of Physical Therapy, Lexington, United States
PURPOSE: Since 1997, United Kingdom (UK) healthcare reforms
have encouraged the development of primary care, widening of PURPOSE: Various forms of lower extremity sensory testing (LEST)
access and urged for innovation in service delivery models to benefit exist, and debate continues as to the most efficient, reliable,
patient care. RELEVANCE: The ability of patients to refer themselves and meaningful protocol for screening older adults. Therefore,
to physiotherapy, although used widely in private practice has not the objectives of this study were to assess the reliability and
been the traditional mechanism within UK National Health Services validity of LEST measures, and their relationship to balance and
(NHS) with access controlled by GPs acting as gatekeepers. This falls in older community dwelling adults. RELEVANCE: Further
was primarily due to concerns that services would be overwhelmed clarification of the psychometric properties of sensory testing and
by the resultant demand. Pilot data indicated that this may not be the the influence that such measures have on fall risk in older adults
case and that self-referring patients were different. It was decided will enhance the current level of physical therapy evidenced based
to undertake a national trial of patient self-referral (SR) to NHS practice. PARTICIPANTS: Thirty-one (18 females and 13 males)
physiotherapy providers to either confirm or refute these findings community dwelling elders (mean+ standard deviation=67.1+9.9
PARTICIPANTS: 3,010 patients (>16 ys) and 100 physiotherapists years)volunteered and completed sensory testing in a health fair
from 29 primary care locations representing a range of socio- setting. METHODS: The sensory protocol included light touch, reflex
economic and geographical settings throughout Scotland were (knee and ankle), monofilament, and quantitative vibration perception
included. METHODS: Self-referral was introduced in each site in threshold (QVPT) testing. Monofilament (5.07/10-g) testing (MT)
parralel to GP (open) access. Demographic and clinical data relating was conducted bilaterally at the lateral ankles, dorsal great toes,
to all referrals was collated over a full year. All patients were followed and various sites on the plantar aspect of the feet. Quantitative
up one month after discharge by questionnaire to ascertain their vibration perception thresholds were obtained from the great toe
status and views about access and physiotherapy. The GP workload and served as the reference standard for distal sensory neuropathy
and associated NHS costs by referral category were also established. (DSN). Sensory testing was repeated by a second examiner
ANALYSIS: Quantitative analysis was carried out using appropriate who was blinded to prior test results. Fall history and balance
non-parametric tests (Chi squared & Mann Whitney) while qualitative measures (four square step test, functional reach, and timed up
data was processed and analysed using PinPoint Questionnaire and go) were also collected by additional examiners. ANALYSIS:
software package which included appropriate descriptive and non- Data analysis included descriptive statistics, intraclass correlation
parametric tests RESULTS: There was no relationship between coefficients(ICC), standard error of measurement(SEM), kappa
gender, age group, outcome as determined by both physiotherapist statistics, and Spearman rank correlations. Sensitivity, specificity,
and patient or number of physiotherapy contacts and referral group. and likelihood ratios for sensory measures were also calculated
However greater proportions of SR’s: presented with low back and to assess the accuracy for DSN and fall risk. RESULTS: Reflex
neck conditions (54% vs. 42.5%, p < 0.001), reported having their (kappa=.39-.73), light touch (kappa=.35-.74), and individual sites for
symptoms for less than 14 days (14% vs. 8.5% p = 0.011), were MT (kappa=.32-.79) exhibited poor to excellent inter-rater reliability.
absent from work in lower proportions, 19.5% vs. 27.5%, p = 0.048) Agreement on QVPT (ICC=.79-.95; SEM=2.9-6.2 V; kappa = 0.86)
and were absent for half the mean time (2.5 days vs. 6 days); and collective MT sites (kappa = 0.68-0.84) demonstrated good to
completed their treatment (76% vs. 68.5% p = 0.002) and despite excellent inter-rater reliability. Utilizing multiple monofilament trials
non preferential treatment waiting time, were seen within two weeks and sites resulted in sensitivity of 72%, specificity of 100%, a
(44% vs. 35.5%, p < 0.001). SR’s reported having fewer similar levels positive likelihood ratio (+LR) of 6.0, and a negative likelihood ratio
of continuing symptoms but that they were improving to a greater (−LR) of 0.36. Monofilament testing was also highly specific (95%;
extent. They were more: satisfied with their intervention, confident in +LR=6.3) and the only sensory measure with a significant (rs= 0.47;
their knowledge of and when to access physiotherapy and supportive p = 0.008) relationship to falls in the previous year. CONCLUSIONS:
of autonomous behaviours and ease of access (p < 0.001). In terms Monofilament and QVPT testing were reliable measures in this
of costs, SR’s had lower NHS associated costs per episode (£66.31 sample of older community dwelling adults. Monofilament testing
vs. £88.99 (GP) attributed to lower prescribing, referral for x-ray also demonstrated a high degree of specificity, but lacked adequate
and to secondary care, GP & physiotherapy contacts (p < 0.001). sensitivity as a sole screening procedure for DSN. Finally, the
CONCLUSIONS: SR’s would appear to have a different profile from correlation between falls and monofilament testing warrants further
that of GP referrals however the reason/s why patients choose investigation. IMPLICATIONS: Findings imply that the selected QVPT
to refer themselves or not is unknown and represents an area and MT protocols were reliable between raters. Monofilament testing
was also specific for identifying older adults with DSN and a past of the New Zealand Society of Physiotherapists Inc. CONTACT:
history of falling. Further prospective research is needed to validate [email protected]
these findings and the relationship between sensory impairments and ETHICS COMMITTEE: Auckland University of Technology Ethics
falls in older adults. KEYWORDS: Sensory testing, neuropathy, falls. Committee (AUTEC) approved this project August 2004.
FUNDING ACKNOWLEDGEMENTS: This research was not funded.
ETHICS COMMITTEE: University of Kentucky Institutional Review
Board 2834 Tuesday 5 June 10:10
PREVENTION OF PULMONARY COMPLICATIONS AFTER
UPPER ABDOMINAL SURGERY BY PREOPERATIVE PHYSICAL
3070 Tuesday 5 June 10:10 THERAPY: A RANDOMIZED CONTROLLED PILOT STUDY
Dronkers J1 , Veldman A2 , Hoberg E3 , van der Waal C4 , van
MUSCLE POWER PERFORMANCE AFTER STROKE Meeteren N5 ; 1 Physiotherapist and Human Health Scientist,
Stavric V, McNair P; Physical Rehabilitation Research Centre, Department of Physiotherapy, Gelderse Vallei Hospital, Ede, The
Auckland University of Technology, Auckland, New Zealand Netherlands Member of the Department of Physiotherapy Research,
Academy of Health Sciences Utrecht. University teacher, Master
PURPOSE: After stroke, muscles lose strength and the ability to
of Physiotherapy Research, Utrecht University, The Netherlands;
generate force. While it is accepted that muscle force is lost after 2 Physiotherapist, Head of the Department of Physiotherapy,
stroke, little is known about the effect a stroke has on the ability to
Gelderse Vallei Hospital, Ede; 3 Physiotherapist, Department
generate muscle power. The aims of this study were to investigate
of Physiotherapy, Gelderse Vallei Hospital, Ede; 4 Surgeon,
muscle power performance at differing loads and to determine at
Department of Surgery, Gelderse Vallei Hospital, Ede; 5 Associate
what load muscle power is best elicited. A secondary aim was to
Professor Section Rehabilitation, Department of Neurology and
ascertain whether there is a relationship between muscle power
Neurosurgery, Rudolf Magnus Institute of Neuroscience, University
and certain functional tasks. RELEVANCE: Power may be important
Medical Center Utrecht, The Netherlands Head of the Department
in functional activities requiring fast joint movement. As such, a
of Physiotherapy Research, Academy of Health Sciences Utrecht.
better understanding of how muscles after stroke produce power
Head of the Master of Science in Physiotherapy Research of the
can better direct rehabilitation approaches whose aim is to improve
Utrecht University, The Netherlands
functional mobility. PARTICIPANTS: 58 hemiplegic and age and
gender matched control participants were recruited from community PURPOSE: The purpose of this pilot study was to investigate the
stroke groups and via newspaper advertisements that were run feasibility and effects of preoperative inspiratory muscle training (IMT)
in the greater Auckland area. METHODS: A cross-sectional study on the incidence of atelectasis in patients at high risk of postoperative
design was used to investigate muscle power performance and pulmonary complications (PPCs) scheduled for elective abdominal
functional tasks. Leg muscle power was measured using a modified aortic aneurysm (AAA) surgery. RELEVANCE: PPCs frequently
leg press machine at 30, 50 and 70% of 1 repetition maximum occur after upper abdominal surgery and are the leading cause of
(RM) load. Participants were positioned on the leg press machine postoperative morbidity and mortality and increase hospital length
and asked to push, with a single leg, as hard and as fast as they of stay, medical consumption, and hence costs. Improvement of the
could. Data was collected via a transposed force platform mounted respiratory function by preoperative IMT may reduce the incidence
on the leg press and a linear transducer connected to the trolley. of PPCs. In that case, this treatment has to be implemented in the
From these, power was able to be calculated. Maximum speed multidisciplinary perioperative care. PARTICIPANTS: Twenty high-
was also recorded for the following functional tests: walking 10 risk patients were recruited from the surgery outpatient department
metres; standing up from a chair 10 times; and climbing 10 steps. of the Gelderse Vallei Hospital in Ede, the Netherlands. The
ANALYSIS: 3x3 ANOVA was used to compare the values of the primary inclusion criteria were elective surgery for aneurysm of
paretic leg, non-paretic leg and control leg power outputs over the the abdominal aorta (AAA) with a scheduled delay until surgery
three percentages of 1RM. Pearson product moment correlation of at least 2 weeks, and at least one of the following risk factors:
coefficient analysis was performed between the each of the peak age >65 years, smoking, chronic obstructive pulmonary disease
power outputs and each of the functional tasks. RESULTS: The (COPD), and overweight. METHODS: In this single-blind randomized
results showed that peak muscle power values differed significantly controlled pilot study, the patients were randomly assigned to receive
within paretic and non-paretic and control legs. Peak leg power in preoperative IMT or usual care. Effectiveness outcome variables
all three leg groups was greatest when pushing against a load of were atelectasis and inspiratory muscle strength, and feasibility
30% of 1RM. Paretic leg peak power tested at 30% of a 1RM outcome variables were adverse effects and patient satisfaction
(Mean=401.7; SD=242 W) was significantly lower (p < 0.05) than the with IMT. ANALYSIS: Incidence and prevalence outcomes were
non-paretic leg (Mean=844.1; SD= 405 W). Both the paretic and analyzed with the Fisher exact test and the Mann-Whitney U test,
non-paretic legs generated significantly lower peak power (p < 0.05) respectively. Differences within and between the intervention and the
than the control leg (Mean=1219.1; SD=509.8 W). Correlations were control groups were tested with the paired and independent t-tests,
found between the paretic leg peak power and gait speed and stair respectively. Postoperative outcomes were analyzed by repeated
climbing (R= 0.6-0.7, p < 0.05). No correlation was found between measures analysis of variance with treatment as the between subject
paretic leg peak power and chair stands. CONCLUSIONS: There factor. RESULTS: Despite randomization, patients in the intervention
are significant differences between the paretic and the non-paretic group were significantly older than the patients in the control group
leg in power production after stroke. As well, there are significant (70 ±6 years versus 59 ±6 years, respectively; p = 0.001). Eight
differences between the non-paretic, or good, leg and legs of those patients in the control group and three in the intervention group
not affected by stroke. Power appears to be related to a number of developed atelectasis (p = 0.07). The median duration of atelectasis
functional activities. IMPLICATIONS: Strength training alone may not was 0 days in the intervention group and 1.5 days in the control
be enough for people affected by stroke to achieve functional mobility. group (p = 0.07). No adverse effects of preoperative IMT were
An understanding of how muscle power can be assessed and trained observed and patients considered that IMT was a good preparation
may have added benefits to muscle strengthening and functional for surgery. Mean postoperative inspiratory pressure was 10% higher
retraining in stroke rehabilitation. KEYWORDS: stroke, muscle in the intervention group. Patients had no adverse effects and
power. FUNDING ACKNOWLEDGEMENTS: Auckland University were satisfied with IMT. CONCLUSIONS: Preoperative IMT is well
of Technology, Auckland, New Zealand and the Neurology Group tolerated and appreciated and, based on the borderline significant
differences between both groups differing in age at the expense of may form the bases for an intervention to improve gait speed.
the intervention group, seems to reduce the incidence of atelectasis Future intervention research needs to examine which impairment
in patients scheduled for elective AAA surgery. IMPLICATIONS: and functional changes occur with different types of interventions.
A controlled trial will be performed to test, in a sufficient number KEYWORDS: stroke, impairment, function, gait speed. FUNDING
of patients randomized by means of a stratified randomization ACKNOWLEDGEMENTS: N/A. CONTACT: [email protected]
procedure, whether IMT has a positive effect on other PPCs, such ETHICS COMMITTEE: Partners Health Care, Spaulding Hospital
as pneumonia. KEYWORDS: Inspiratory muscles; Preoperative care; IRB
Frail Elderly. FUNDING ACKNOWLEDGEMENTS: This work was
funded by Hospital Gelderse Vallei. CONTACT: [email protected]
ETHICS COMMITTEE: The research protocol was approved by the
Medical Ethics Committee of the University Medical Center Utrecht, 550 Tuesday 5 June 10:45
the Netherlands. PP Crystal Pavilion A
THE IMPACT OF URBAN OR RURAL RESIDENCE ON HEALTH
RELATED QUALITY OF LIFE IN XHOSA SPEAKING PEOPLE
WITH DISABILITIES
VCEC Meeting Rooms 19-20 Jelsma J1 , Eide A2 , KaToni M3 , Loeb M2 , Maart S1 ; 1 University of
Cape Town, South Africa; 2 Sintef Research Organisation, Norway;
THE RELATIONSHIP BETWEEN DEMOGRAPHIC AND 3 Disabled People Organisation, South Africa
PHYSICAL IMPAIRMENT MEASURES AND GAIT SPEED IN
COMMUNITY DWELLING PERSONS WITH STROKE PURPOSE: This study aimed to establish the determinants of Health
Related Quality of Life (HRQoL) in rural and urban samples of
Sullivan P; MGH Institute, Boston, MA, USA
South African Xhosa-speaking people with disability. RELEVANCE:
PURPOSE: The purpose was to examine if demographic and As physical therapists become more holistic in their approach to inter-
impairment measures were related to gait speed in community vention, HRQoL increasing becomes a valid measure of outcome. In
dwelling persons with stroke. RELEVANCE: Improved gait speed is addition, the importance of environmental factors on the experience
an outcome for many patients. Understanding which interventions of disability is now well recognised [1]. PARTICIPANTS: Samples of
enhance function is critical. One approach integrates exercise convenience were drawn from 15 rural districts of the Eastern Cape
procedures focused on improving physical impairments with practice and two urban areas in the Western Cape. The Eastern Cape is a
of the function. The task-oriented perspective practices the functional resource poor area with the majority of the population resident in rural
activity while progressing feedback and learning variables. If communities. The infrastructure is undeveloped with poor roads and
impairment measures are found to contribute to gait speed increased limited electricity and water supply to households. The urban sample
support for that intervention approach would exist. PARTICIPANTS: was drawn from informal settlement areas in both Cape Town and a
50 community dwelling persons with stroke METHODS: Subjects smaller town in the Western Cape that is undergoing rapid industrial
completed a demographic questionnaire and were assessed on development and has consequently attracted many migrant workers.
measures of lower extremity function, strength, balance and gait The sample was identified through a “snowballing” process initiated
speed. The demographics included age, gender, height, weight, time by enumerators who were all members of Disabled People South
since stroke, side of involvement, use of device, and co-morbidities. Africa, an organisation of people with disabilities that advocates
Impairment measures were Fugl-Meyer Assessment Lower Extremity for the rights of their members. METHODS: Instrumentation: The
Function (FM), timed sit to stand (STS) for lower extremity strength, validated Xhosa version of the EQ-5D [2] [3] was utilised. The EQ-
and Berg Balance Scale (BBS). Gait speed was the time to 5D has five descriptor domains; mobility, self-care, usual activities,
walk 10-meters at preferred and fastest safe speed. ANALYSIS: pain/discomfort and anxiety/depression. In addition there is a Visual
Descriptives provided frequency and mean values; correlations Analogue Scale (VAS) which ranges from 0 (worst imaginable health
compared demographics and impairment measures to gait speed. state) to 100 (best imaginable health state). ANALYSIS: Multiple
A series of multiple regression analyses determined the variables regression analysis was used to establish which variables were
that accounted for gait speed variance. RESULTS: The mean age predictive of the VAS score. Gender, area of residence and presence
was 59.8 yrs; 19 were female, 27 did not use assistive device. The of problems in each descriptor domain were entered in a stepwise
10 meter preferred speed: females 18.5 sec (sd=12.8), males 14.9 regression model. RESULTS: The sample consisted of 244 rural and
sec (sd=10.3), maximum speed: females 14.1 sec (sd=10.6), males 61 urban respondents, demonstrating a preponderance of physical
11.6 sec (sd=8.4). The demographic and impairment measures disabilities (77% of rural and 62% of urban respondents). The
were correlated to gait speed: age r=.43, FM r=.53, STS r=.70, urban sample reported more problems in each of the descriptor
and BBS r=-.82. Age was the only significant demographic and domains. The VAS score showed a bimodal distribution. The results
accounted for 15% of gait speed variance. Of the impairment of the multiple regression analysis indicated that the presence
measures, the total BBS, STS and FM scores accounted for 80% of pain detracted most from HRQoL (−20%), followed by anxiety
of gait speed variability. Individual FM and BBS items that explained and depression (−10%) and difficulty with performance of usual
walking speed were: combining movement synergies, and standing: activities (−10%). Rural participants, with the same impairment level,
unsupported, feet together, reaching forward, and alternate foot stool reported 8% poorer HRQoL. CONCLUSIONS: Urban living, even
touching. These accounted for 88% of walking speed variance. within a resource poor, informal settlement appears preferable to
CONCLUSIONS: Our subjects gait speed is similar to other reports rural living for people with disabilities. Many of the respondents
of persons with stroke. Gender, height and weight did not influence reported good HRQoL despite having disabilities and it appears
gait speed, dissimilar to reports of healthy elderly. Gait in persons that the presence of a disability per se does not necessarily lead
with stroke seems more related to disease specific impairments than to a poor HRQoL. IMPLICATIONS: Intervention aimed at reducing
anthropometric factors. The combination of recombining synergistic pain and alleviating anxiety and depression are most likely to
movement, maintaining standing with usual and narrow base, forward improve the HRQoL of people with disability who are similar to
weight shifting, standing unilaterally, and transitioning between sitting this sample. The effect of place of residence would need to be
and standing were highly related to gait speed. IMPLICATIONS: factored in when planning and evaluating programmes such as
Measures of physical impairments are highly related to gait speed in the provision of disability grants or physical therapy in the urban
community dwelling persons with stroke. Support for an intervention and rural settings. 1. World Health Organisation. The International
program to improve relevant impairments is provided. The treatment Classification of Functioning and Disability – Beta-2 Draft. Geneva:
procedures that would enhance this combination of impairments WHO, 1999. 2. Brooks R, Group EuroQol. EuroQol: the current
state of play. Health Policy 1996; 37:53-72. 3. Jelsma J, Amosun IMPLICATIONS: When treating patients with CNP physiotherapists
D, Mkoka S, Nieuwveld J. The reliability and validity of the Xhosa should assess and attempt to modify cognitive factors, which may
version of the EQ-5D. Disability and Rehabilitation 2004; 26:103- bring about important reductions in disability. KEYWORDS: Neck,
108. KEYWORDS: Health related quality of life, disability, urban/rural. cognitive factors. FUNDING ACKNOWLEDGEMENTS: This study
FUNDING ACKNOWLEDGEMENTS: The Norwegian and South was funded by the Physiotherapy Research Foundation (CSP, UK).
African Research Foundations funded this project through Grant CONTACT: [email protected]
Number: 158166/V10. CONTACT: [email protected] ETHICS COMMITTEE: Ethical approval was granted by the North
ETHICS COMMITTEE: University of Cape Town Medical Research Manchester Local Research Ethics Committee (Manchester, UK).
Ethics Committee.

THE ROLE OF COGNITIVE FACTORS IN CHRONIC NECK PAIN IMPLICIT LEARNING OF MOTOR SEQUENCES BY PERSONS
WITH PARKINSON’S DISEASE IN HOEHN & YAHR STAGE III
Thompson D1,2 ,
Urmston M1,2 ,
Watson P3 ,
Oldham J2 ,
Woby S1,2 ;
1 1. Physiotherapy Department, North Manchester General Hospital, Kerckhofs E1 , Deroost N2 , Coene M1 , Soetens E2 ; 1 Vrije
Manchester, M8 5RB, UK; 2 2. Centre for Rehabilitation Science, Universiteit Brussel, Dept. Physical Therapy; 2 Vrije Universiteit
The University of Manchester, Manchester, M13 9WL, UK; 3 3. Brussel, Dept. Cognitive and Biological Psychology
Division of Pain Management and Rehabilitation, University of PURPOSE: We wanted to investigate 1) to what extent persons
Leicester, Leicester, LE5 4WP, UK with Parkinson’s Disease (PD) in Hoehn & Yahr stage III, are able
PURPOSE: Pain intensity alone does not appear to fully explain the to learn implicitly in a Serial Reaction Time (SRT)-task, 2) to what
disability levels exhibited by individuals with chronic neck pain (CNP) extent they can improve on a functional buttoning task by training,
(Webb et al, 2003). Therefore the aim of this study was to examine the and 3) if a relation can be found between the eventual learning
extent to which cognitive factors contributed to the levels of disability effects in both tasks. RELEVANCE: there is an ongoing controversy
exhibited by individuals with CNP. RELEVANCE: Although the in the literature about the question to what extent, persons with PD
strong association between cognitive factors and disability has been are able to learn implicitly motor sequences. PARTICIPANTS: 16
documented within the low back pain literature, such an association persons with PD were recruited from the Flemish Parkinson League.
has not been adequately demonstrated in individuals with CNP. De- They were compared with 16 controls who were matched for gender,
lineating the importance of specific cognitive factors in patients with age and education level. METHODS: all participants performed two
CNP is imperative as it would elucidate which factors practitioners tasks (each with two levels of complexity) in each of two sessions
need to target during treatment and allow interventions which target with an interval of 1 week. The first task was a SRT-computer task
these factors to be developed. PARTICIPANTS: Data were collected after Nissen & Bullemer (1987): they had to press a key as fast as
from 123 patients with CNP referred for physiotherapy at three possible with one of four fingers corresponding to the spatial location
hospitals. Exclusion criteria were inability to read English, signs of of a stimulus on the computer screen. Unknown to the participants,
serious pathology or psychiatric illness. The mean age of participants the order of stimulus locations followed a certain repeating (first
was 46.9 yrs (SD=15), 56% were female and average pain duration order or second order) sequence. The reaction times were recorded.
was 46 months (SD=79). METHODS: All participants completed As a measure for implicit learning we took the sudden increase of
validated measures assessing fear of movement, catastrophizing, the reaction time when the stimulus location sequence was set ad
hypervigilance, anxiety, depression and self-efficacy. Neck pain random. In the second task, the participants had to button as quickly
and disability were assessed with the Neck Disability Index (NDI). as possible a cardigan with 6 large or 6 little buttons (diameter of
ANALYSIS: Analyses were carried out in two stages. Firstly, principal 28 or 18 mm). ANALYSIS: reaction times were analysed by means
component analysis (PCA) with oblimax rotation was performed of a mixed ANOVA with groups as a between-subjects factor and
on the cognitive factors. In the second stage, multiple regression with blocks of trials and sequence order as within-subjects factors.
analysis was performed with NDI scores as the dependant variable. Buttoning times were analysed analogously with a mixed ANOVA but
Age, sex and pain duration (demographics) were entered in step one, with type of button as a within-subjects factor. RESULTS: In the SRT-
pain intensity in step two and the factors identified in the PCA in step task, the group of persons with PD did learn implicitly only the second
3. This allowed us to determine the extent to which cognitive factors order location sequence. A post hoc analysis showed that a subgroup
contributed to disability after adjusting for demographics and pain of persons with PD with lower cognitive functioning as measured by
intensity. RESULTS: The PCA identified a two factor solution, which the SCOPA-COG, didn’t learn implicitly, while persons with PD with
explained 68% of the variance in the cognitive factors. Factor one a higher level of cognitive functioning learned both sequences to
was labelled pain related fear (PRF) and included fear of movement, the same extent as the healthy controls. On the functional buttoning
catastrophizing and hyper-vigilance. Factor two included Self-Efficacy task however, the persons with PD improved with training to the
and Depression and was labelled as such (SED). In step one of the same extent as the controls and that was also the case for the
regression analysis demographic factors did not explain a significant patients who didn’t show implicit learning on the SRT-task. We found
proportion of the variance in disability. In step two, current pain a significant negative correlation between the implicit learning index
intensity explained 23% (p < 0.001) of the variance after accounting and the buttoning time. CONCLUSIONS: the ability of persons with
for demographics. The cognitive factors explained a further 35% PD to learn implicitly motor sequences, is associated with their level
(p < 0.001) of the variance in disability beyond that explained by of general cognitive functioning. Persons with PD in H&Y stage III
demographics and pain intensity. Examination of the beta weights can become quicker in buttoning by training. There is a significant
revealed that both PRF (b=0.26, p < 0.001) and SED (b = −0.55, correlation between the ability to implicit learning and the improve-
p < 0.001) explained unique variance. The final model explained 59% ment in buttoning time by training. IMPLICATIONS: the controversy
of the variance in disability. CONCLUSIONS: Cognitive factors were in the literature about the ability to learn implicitly in persons with PD,
a stronger predictor of disability than pain intensity. Specifically, can be explained at least partially by the fact that cognitive functions
higher levels of catastrophizing, pain related fear, hypervigilance have to be considered. KEYWORDS: implicit learning, Parkinson’s
and depression, and lower levels of self-efficacy were associated disease, motor learning. FUNDING ACKNOWLEDGEMENTS: This
with greater disability. Further studies should explore whether researched was supported by grant 0ZR994 of the Vrije Universiteit
modifying cognitive factors reduces disability in patients with CNP. Brussel. CONTACT: [email protected]
INFLUENCE OF FORWARD HEAD POSTURE ON BALANCE, HIGH-INTENSITY INSPIRATORY MUSCLE TRAINING REDUCES
FALL SELF-EFFICACY, AND PHYSICAL ACTIVITY IN DYSPNEA AND FATIGUE AND IMPROVES EXERCISE CAPACITY
COMMUNITY-DWELLING WOMEN 60 AND OLDER IN SUBJECTS WITH CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Nemmers T; Langston University, Langston OK, USA
Hill K1−3 , Jenkins S1,3,4 , Philippe D2 , Cecins N1,3,4 , Hillman D2 ,
PURPOSE: This research was designed to investigate the influence Eastwood P1,2,5 ; 1 School of Physiotherapy, Curtin University of
of the forward head posture on the known fall risk variables of Technology, Perth, Australia; 2 Department of Pulmonary Physiology,
balance, fall self-efficacy, and physical activity levels in healthy Sir Charles Gairdner Hospital, Perth, Australia; 3 Physiotherapy
older women living independently in the community. RELEVANCE: Department, Sir Charles Gairdner Hospital, Perth, Australia;
Physical Therapists work with the elderly, and the aged population 4 Asthma and Allergy Research Institute, University of Western
worldwide in progressively increasing. Age-associated postural Australia, Perth, Australia; 5 School of Anatomy and Human Biology,
decline is often assumed to be inevitable and incontrovertible. One University of Western Australia, Perth, Australia
significant decline appears to be a progressive forward movement of
the head in relation to the body, a component of the “senescent” PURPOSE: To investigate the effects of interval based high-
posture. Older women who develop a significant forward head intensity inspiratory muscle training (H-IMT) in subjects with chronic
posture may experience functional consequences in terms of loss obstructive pulmonary disease (COPD). RELEVANCE: Optimizing
of balance stability and an increased fear of falling. Additionally, function is a key goal in the management of patients with COPD.
a decrease in activity may be perceived by the individual as Inspiratory muscle dysfunction is common in these patients and
“protective” in nature. Identification of the forward head posture has been implicated in the origin of the symptoms (dyspnea) and
as a specific contributor to any one of these known fall risk disability (reduced exercise tolerance) characterizing the disease.
factors will assist physical therapists in developing more specific Therefore, interest has emerged in the role of specifically training
and effective evidence-based protocols for both prevention and the inspiratory muscles in patients with COPD. Previous studies of
intervention programs.6 PARTICIPANTS: One hundred twelve (112) inspiratory muscle training in this population have yielded mixed
healthy community-dwelling women ranging in age from 60 to results, reflecting a number of methodological shortcomings. This
95 years volunteered for this study. METHODS: Each subject study is unique in its methodological rigor. PARTICIPANTS: Subjects
completed two surveys: the Activity-specific Balance Confidence were recruited that had a diagnosis of COPD, a smoking history
Scale (ABC) and the Physical Activity Scale for the Elderly (PASE). greater than 10 pack years and a forced expiratory volume in one
Each subject’s balance was assessed utilizing the Berg Balance second (FEV1 ) of between 15 and 70% predicted. Exclusion criteria
Scale (BBS). The FHP was assessed via analysis of a profile were based on co-morbid conditions thought to adversely affect
photograph taken during the balance test. ANALYSIS: This study was test performance. METHODS: A double-blind randomised controlled
a prospective correlational research design. Descriptive indices were trial compared H-IMT with sham inspiratory muscle training (S-
completed for each variable. Bivariate correlations were completed IMT). Training was performed using a modified threshold training
to compare relationships among the variables of age, ABC, PASE, device and took place 3 times a week for 8 weeks. Each session
BBS, and FHP. RESULTS: The FHP was significantly inversely was fully supervised and comprised 7 cycles of 2 minutes loaded
correlated to the balance score (r = −0.598, p = .000); that is, a breathing separated by 1 minute rest. The H-IMT group trained
more severe forward head posture was associated with diminished at the maximum load tolerable for a two-minute work interval and
balance stability. Inverse correlations were also found between the load was increased as rapidly as symptoms permitted. The
the FHP and the variables ABC (r = −0.274, p =.002) and PASE S-IMT group trained at 10% of the maximal inspiratory pressure
(r = −0.436, p =.000). A significant positive correlation was found (PImax) and was not increased. Outcome measures were: PImax,
between the FHP and age (r = 0.417; p = .000). CONCLUSIONS: inspiratory muscle endurance (highest pressure sustained during
The significant inverse relationship between the FHP and BBS an incremental threshold loading task; Pthmax), functional exercise
supported the underlying premise of the study which postulated capacity (6 minute walk distance; 6MWD), dyspnea and fatigue
that the FHP placed the head near or outside the limits of (Chronic Respiratory Disease Questionnaire; CRDQ). ANALYSIS:
the balance stability envelope, and would adversely influence an Differences between and within groups were analysed using two-way
elderly woman’s balance capability. The inverse relationship between repeated measures analysis of variance (ANOVA). RESULTS: 16
the forward head posture and balance confidence and activity subjects (11 males, FEV1 37% predicted) underwent H-IMT and 17
level indicated that those women experiencing severe FHP also subjects (11 males; FEV1 36% predicted) underwent S-IMT. Over the
experienced diminished balance confidence and decreased activity 8-week training period, the training load in the H-IMT group increased
levels. The positive relationship between the FHP and age does from 45% to 101% of pre-training PImax (p < 0.001) and was
reflect evidence of the senescent posture. IMPLICATIONS: This unchanged in the S-IMT group. Following H-IMT, PImax increased
study provides a first tier of evidence to support the incorporation of by 29% (i.e. 18.0 ±12.6 cmH2 O; p < 0.001), Pthmax increased by
postural exercises for head position in balance training programs for 56% (i.e. 21.6 ±10.8 cmH2 O; p < 0.001), 6MWD increased by 6%
women 60 years and older. The findings further support the potential (i.e. 27.1 ±20.4 m; p < 0.001) and dyspnea and fatigue improved by
protective effect of high activity levels for balance stability and fall 1.4 and 0.9 points per item, respectively (p < 0.02). Following S-IMT,
self-efficacy in this subject population. KEYWORDS: forward head PImax increased by 8% (i.e. 5.2 ±8.6 cmH2 O; p = 0.023), dyspnea
posture, balance, falls. FUNDING ACKNOWLEDGEMENTS: none. improved by 0.9 points per item (p < 0.001) and Pthmax, 6MWD
CONTACT: [email protected] and fatigue were unchanged. The magnitude of change in PImax,
ETHICS COMMITTEE: Institutional Review Board, Oklahoma State Pthmax, 6MWD, dyspnea and fatigue was greater following H-IMT
University, Stillwater, OK, USA compared with S-IMT (p < 0.05). CONCLUSIONS: H-IMT improves
inspiratory muscle function, yields clinically meaningful reductions in
dyspnea and fatigue and modest gains in functional exercise capacity.
The effects of H-IMT combined with standard whole-body exercise
training warrants further investigation. IMPLICATIONS: Such training
should be considered in those subjects unable to participate in
whole-body exercise training due to musculo-skeletal co-morbid
conditions. KEYWORDS: inspiratory, training, dyspnea. FUNDING
ACKNOWLEDGEMENTS: National Health and Medical Research South African Research Foundations – Grant Number: 158166/V10.
Council, Australia. CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: Human Research Ethics Committees of ETHICS COMMITTEE: Medical Research Ethics Committee of the
Curtin University of Technology, Sir Charles Gairdner Hospital and University of Cape Town
Royal Perth Hospital.

718 Tuesday 5 June 10:45 VCEC Meeting Rooms 19-20
VCEC Meeting Room 18 ALTERED MOTOR CONTROL OF TRAPEZIUS IN THOSE WITH
ENVIRONMENTAL BARRIERS EXPERIENCED BY URBAN AND NON TRAUMATIC SHOULDER INSTABILITY
RURAL DISABLED PEOPLE IN SOUTH AFRICA Alexander C1,2 , Harrison P2 ; 1 Hammersmith Hospitals NHS Trust,
Maart S1 , Eide A2 , Jelsma J1 , Loeb M2 , kaToni M3 ; 1 University of London, UK; 2 University College London, London, UK
Cape Town, South Africa; 2 Sintef Research Organisation, Norway;
3 Disabled People Organisation, South Africa PURPOSE: If the scapula fails to be anchored to the chest,
the glenoid can move away from the humeral head leading to
PURPOSE: The aim of the study was to investigate the experience instability. Trapezius is one muscle that assists in this stability. The
of disabled people with regard to environmental barriers in an urban purpose of this investigation was to examine whether the control of
as opposed to rural setting. The specific objectives were to identify trapezius in subjects with non-traumatic shoulder instability (NTSI)
which items within the ICF (International Classification of Functioning, differs to that of healthy subjects. RELEVANCE: Patients with NTSI
Disability and Health) checklist of environmental factors presented complain of pain and recurrent dislocations, which lead to significant
people with disability with the most barriers and to see whether problems with every day activities. At present, little is understood
the barriers were different for those living in a rural opposed to about the underlying causes of this condition. Without a better
urban setting. RELEVANCE: Despite the fact that the disabling understanding, targeted treatment programmes are difficult to design.
effect of environmental factors is acknowledged, little research has PARTICIPANTS: With local ethics approval, 11 subjects with NTSI
been done to explore the impact of the environment on varying and 15 healthy subjects were recruited and gave informed consent.
degrees of disability and different impairments. Physiotherapists METHODS: Group I muscle afferents of the forearm and hand
must be aware of the barriers posed by the specific environments evoke facilitatory reflexes in trapezius, which assist in stabilising
people with disabilities will be returning to post rehabilitation. The the shoulder girdle during use of the hand. These reflexes were
International Classification of Functioning, Disability and Health (ICF) evoked using electrical stimulation of the ulna nerve at elbow level
provide the framework for describing and analysing the interaction (with a Digitimer and CED system). Surface EMG was recorded
between a person’s health condition and the context in which they from upper (UTr) and lower trapezius (LTr). The conduction velocity
find themselves. PARTICIPANTS: The study was conducted amongst of the effective afferents was recorded by additional stimulation of
isi- Xhosa speaking people in the Eastern and Western Cape of the ulna nerve at the level of the wrist. Secondly, the descending
South Africa which respectively have a 5.8% and 4.1% disability control of trapezius was investigated using magnetic stimulation of
prevalence. The sample was a convenience sample and was the contralateral motor cortex to record the latency and threshold
identified through a “snowballing” process initiated by enumerators of the motor evoked potential (MEP) of trapezius. Finally, the M
who were all members of Disabled People South Africa. METHODS: response and H reflex of trapezius was recorded by electrically
A descriptive, analytical, cross-sectional study was used to gather stimulating the spinal accessory nerve and the cervical nerve of
the data. The primary data collection tool was the isi-Xhosa version C3/4. ANALYSIS: The conduction velocity of the afferents, latency
of the ICF checklist. Ethical approval was obtained from the UCT and threshold of the evoked responses were compared to the data
Research Ethics Committee. ANALYSIS: The computer software from a healthy population using un-paired t tests. The frequency of
programme STATISTICA was used for data analysis. The chi-square occurrence of the reflex data was compared using the Mann Whitney
test was used to compare proportions between urban and rural areas. U Test. RESULTS: The control of LTr differed between the two groups.
RESULTS: The sample consisted of 468 respondents, with 375 living The long latency reflex occurred less frequently in LTr in those with
in the Eastern Cape, and 93 in the Western Cape. The prevalence of NTSI (27% v 87% (instability v healthy); p < 0.002). In addition, the
the different types of impairments between the two areas was similar latency of the MEP of LTr is longer (16.7ms ±4.7ms v 11.2ms
(Chi-square = 2.96, DF=5, p=NS). Specific barriers identified by 40% ±1.8ms; p < 0.006) and the threshold to evoke the LTr MEP is higher
or more of the urban respondents included climate e225 (55%), public (57% ±15.8% v 36% ±7.6% of the stimulator output; p < 0.003) in
buildings e150 (54%), labour e590 (47%), education e585 (46%) and people with NTSI. Although the latency of the M response of LTr was
housing e525 (43%). The two individual items that were reported the same (p < 0.52), the H reflex of LTr was longer (p < 0.03). However,
most frequently as barriers by the rural sample were labour e590 the control of UTr did not differ between these two groups. The long
(43%) and education e585 (35%).Respondents from the urban area latency reflex was evoked equally in UTr (82% v 87% (instability v
reported experiencing more barriers in the categories of Products healthy); p < 0.41) and the latency (9.4ms ±1.2ms) and threshold of
and technology (p= 0.046), and the Natural and built environment the UTr MEP (47% ±14.4%) were not different to that of a healthy
(p = 0.001) and the respondents from the rural area experienced population (p < 0.21 and p < 0.11 respectively). Finally, the average
more barriers with attitudes (p = 0.054). An equivalent number of conduction velocity of the arm afferents did not differ (p < 0.35).
people in the respective areas identified barriers in the Services CONCLUSIONS: The control of LTr differs in subjects with shoulder
category. CONCLUSIONS: It would appear to be more challenging instability. These factors may contribute to the prolongation of this
for a person with a disability to live in an informal settlement debilitating condition. IMPLICATIONS: Knowledge of a change to the
within an urban area, than in a rural area. The ICF did allow control of a particular part (LTr) of a muscle will assist in the design of
for the identification of the majo IMPLICATIONS: The information appropriate treatment strategies. KEYWORDS: Shoulder, instability,
regarding barriers gained through the use of the ICF can be used motor control. FUNDING ACKNOWLEDGEMENTS: Hammersmith
by disabled people’s organisations and the government in terms Hospitals NHS Trust Research Committee Grant number 40616.
of ensuring the equalisation of opportunities for disabled people CONTACT: [email protected]
in South Africa. KEYWORDS: Environmental barriers, Disability, ETHICS COMMITTEE: Hammersmith, Queen Charlotte’s and
ICF,. FUNDING ACKNOWLEDGEMENTS: The Norwegian and Chelsea Research Ethics Committee.
Research Report Platform Presentation ACKNOWLEDGEMENTS: Mr. Baltov was supported by scholarships
776 Tuesday 5 June 11:05 from the Faculty of Graduate Studies of the University of Montreal and
PP Crystal Pavilion A the Mentor program of the Canadian Institutes for Health Research.
PREDICTORS OF OUTCOMES IN PATIENTS WITH CHRONIC Dr. Feldman holds a salary award from The Arthritis Society of
WHIPLASH WHO UNDERGO INTENSIVE REHABILITATION: A Canada. Dr. Côté is funded by CFI, REPAR and NSERC grants and
PILOT STUDY holds a FRSQ junior 1 salary award. Dr. Truchon is funded by IRSST
Baltov P1 , Feldman D1 , Côté J2 , Truchon M3 , Beaton D4 ; and REPAR grants. Dr. Beaton is supported by a New Investigator’s
1 School of Rehabilitation, University of Montreal Montreal, Canada; award from CIHR. CONTACT: [email protected]
2 Department of Kinesiology and Physical Education, McGill ETHICS COMMITTEE: Ethics committee of the Centre for Interdis-
University Montreal, Canada; 3 Department of Industrial Relations, ciplinary Research in Rehabilitation of Greater Montreal (CRIR)
Laval University Quebec, Canada; 4 St. Michael’s Hospital, Mobility
Program Clinical Research Unit Toronto, Canada
PURPOSE: Fourteen to sixty-six percent of persons with whiplash Research Report Platform Presentation
associated disorders (WAD) develop chronic symptoms and psy- 1958 Tuesday 5 June 11:05
chosocial factors may play an important role in the development of PP Crystal Pavilion B & C
chronicity. Evidence suggests that multidisciplinary rehabilitation is OCCURRENCE AND TYPE OF NECK PAIN AMONG DRIVERS
beneficial for persons with chronic WAD. Despite this, little is known OF FOREST MACHINES AND THE ASSOCIATION WITH
regarding psychosocial and socio-demographic factors associated WHOLE-BODY VIBRATION EXPOSURE
with improved outcomes in those who undergo intensive multimodal
treatment. Our study objectives are: 1) to evaluate whether patients Rehn B; Physiotherapy, Dep. Community Medicine and
improved after intensive multidisciplinary rehabilitation, and 2) to Rehabilitation, Umeå University, Sweden
determine whether psychosocial and socio-demographic factors are PURPOSE: The purpose of this study was to investigate if
associated with outcomes. RELEVANCE: It is crucial to investigate musculoskeletal symptoms in the neck among forest machine drivers
factors which predict the prognosis of chronic WAD in order to identify were related to their whole-body vibration (WBV) exposure. It was
patients at risk of poor outcomes and guide treatment selection hypothesised that the occurrence of neck pain would be higher with
and patient counseling. PARTICIPANTS: Twenty-two persons with higher exposure to WBV and that existence of radiating symptoms
chronic WAD of grades I, II and III (Quebec Task Force classification) would be related to WBV exposure. RELEVANCE: The logging
who were undergoing an intensive interdisciplinary rehabilitation industry is important for many countries such as Sweden, Finland,
program were selected to participate in this study. They met the Germany and Canada. Drivers of forest machines frequently report
following inclusion criteria: 18-65 years of age, diagnosed with musculoskeletal problems from the neck, shoulders and lower back.
WAD by a doctor at least 12 weeks prior to their entrance into
These symptoms could be a result of a bad seated posture but
the program, no concurrent pathology in the cervical region, no
exposure to WBV has also been suggested as a likely risk factor.
prior whiplash episode and speak and understand English or
Type of musculoskeletal neck disorder important for decision of
French. Ethics approval was obtained and subjects signed an
treatment and prognosis and may be associated with the exposure
informed consent form. METHODS: Participants completed the
situation. More epidemiological research necessary to explore the
Neck Disability Index (NDI) documenting self-perceived pain and
association between WBV exposure and neck disorders among
disability and the General Health Questionnaire (GHQ) describing
drivers in general. PARTICIPANTS: 529 forest machine drivers
psychological distress, at entry to and completion of the rehabilitation
in northern Sweden participated, which comprises the census of
program. They also completed questionnaires on coping, social
the working group in the region. Cases were defined as subjects
support at work, kinesiophobia, life satisfaction, patient expectations,
reporting neck pain both previous 7 days and previous 12 months
agreement regarding responsibility for the accident, and general
socio-demographic information at the baseline interview. ANALYSIS: according to the Nordic Questionnaire on musculoskeletal symptoms.
Paired t tests were used to evaluate whether patients improved Non-cases were defined as subjects reporting no symptoms during
after rehabilitation. We investigated the effect of each one of the the previous 7 days or 12 months. Radiating neck pain was defined
predictor variables measured at baseline on the main outcome, radiating symptoms in arm or arms. METHODS: A self-administered
level of self-perceived pain and disability at follow-up, with simple questionnaire containing items on musculoskeletal symptoms and
linear regressions. Promising variables (p < 0.2) were entered into a self-reported exposure time was sent to the participants. The
backward multiple linear regression model and significant predictors final response rate was 63%. The magnitude of WBV exposure
(p < 0.05) were identified. The same process was repeated for the was measured in a representative sample of forest machines.
secondary outcome: level of psychological distress at follow-up. ANALYSIS: From exposure data and questionnaire 14 various WBV
RESULTS: Patients improved in terms of self-perceived pain and doses were calculated for each driver such as exposure time, root
disability post treatment (p < 0.01). A higher disability level at follow- mean square and vibration dose value etc and compared between
up was predicted by a higher baseline disability score (p < 0.001). cases and non-cases. RESULTS: The prevalence of neck pain
Greater psychological distress post-rehabilitation was associated was reported to be 35% and almost half of them (43%) reported
with: catastrophizing, a negative coping behavior (p < 0.001), fewer radiating symptoms in one or both arms. Univariate analysis showed
days since the accident occurred (p = 0.02) and less hours of work no relation between neck pain and WBV doses. Further, there
per week prior to the accident (p = 0.04). CONCLUSIONS: Patients were no relation between WBV doses and type of neck pain
improved in terms of self-perceived disability after the intensive (radiating vs non-radiating). CONCLUSIONS: The conclusion from
multidisciplinary treatment. The psychosocial factors measured here this study is that individual WBV doses can’t explain neither the
were not predictive of self-perceived pain and disability post- occurrence of neck pain nor the type of neck disorder among
rehabilitation in persons with chronic WAD, but were related to the group forest machine drivers. IMPLICATIONS: It seems as if
the level of psychological distress. IMPLICATIONS: Counseling characteristics of WBV can’t predict occurrence or type of neck
on coping strategies with an adverse prognostic effect should be pain. However, prevalence among this group should be compared to
implemented in the rehabilitation of persons with chronic WAD. other driver categories and with other seated jobs not involving WBV
Physiotherapists and other rehabilitation professionals may need exposure (e.g. office work). KEYWORDS: Musculoskeletal, vibration,
to provide more services to patients with higher baseline self- neck. FUNDING ACKNOWLEDGEMENTS: Vibrisks – Risks of
perceived pain and disability, and to those whose accident occurred occupational exposure. CONTACT: [email protected]
more recently. KEYWORDS: chronic, whiplash, prognosis. FUNDING ETHICS COMMITTEE: Umeå University
HOME EXERCISE PROGRAM FOR PATIENTS WITH EXPLORING PHYSIOTHERAPISTS’ PARTICIPATION IN PEER
PARKINSON’S DISEASE: IMPROVEMENT IN MOTOR REVIEW IN NEW ZEALAND. EVALUATION OR DEVELOPMENT
PERFORMANCE AND QUALITY OF LIFE OF PRACTICE?
Pimentel Piemonte M, Almeida D, Melo M, Burgi K, Morimoto M, Rolland T, Hocking C, Jones M; Auckland University of Technology,
Barbosa E; Department of Physical Therapy of Medical School, Auckland, New Zealand
University of Sao Paulo
PURPOSE: The aim of this qualitative study was to explore
PURPOSE: The purpose of this study was to verify the long term physiotherapists’ experience of participating in peer review, in order
effectiveness of a physiotherapeutic program, based on a weekly to stimulate debate about the benefits and costs of peer review for
home-exercise schedule and supervised through fortnightly check- individual practitioners and the profession as a whole. RELEVANCE:
ups, for patients with Parkinson’s disease (PD) in early and advanced Peer review has become accepted practice for physiotherapists
stages, on both motor performance and quality of life. RELEVANCE: in New Zealand. Accordingly, much professional effort has been
PD is a progressive and degenerative condition of the nervous expended on developing peer review systems and implementing
system that causes impaired movement leading to varying degrees review processes in both public health services and private practices,
of functional incapacity. Physical Therapy in PD seeks to minimize yet the benefits of peer review are uncertain. In addition, while the
the motors difficulties arising from symptoms, and improve the literature identifies competing focuses on professional development
quality of life of patients. Physiotherapeutic studies on PD have and accountability, there is lack of clarity about which model of
already discussed the necessity of practicing daily exercises and the peer review is being implemented in this country, and which might
continuity of these exercises throughout the patients life to achieve serve the profession better. This study is a first step in clarifying the
favorable and persistent results. As the costs of physiotherapeutic issues, by identifying the personal, professional and organisational
programs fulfilling these characteristics are high. Home exercise factors that influence how health professionals participate in peer
programs specifically developed for PD are very important in that review. PARTICIPANTS: The participants were 7 physiotherapists
they allow the number of visits of patients to assistance health working in the public or private health system in New Zealand,
centers to be reduced, thereby lowering costs for patients and who had participated in a peer review process within the last 3
health services. PARTICIPANTS: Sixty patients with idiopathic PD, years as either a reviewer or as the practitioner being reviewed.
comprising 24 females and 36 males with an mean age of 66.6 They were recruited following brief presentations of the nature and
years, 30 in early evolution stages (EPD) according to the Hoehn intent of the study given to professional meetings in the greater
and Yahr (HY)and 30 in advanced evolution stages (APD). EPD and Auckland region. METHODS: A qualitative descriptive approach
APD patients were randomly divided into an Experimental Group within a post-positivist paradigm was the methodology used. After
(EG) and a Control Group (CG). METHODS: Patients from the EG ethical approval was granted by the AUT ethics committee, semi-
were assessed individually by UPDRS and PDQL scales, before structured interviews of 40-60 minutes in duration were conducted,
and after 3, 6 and 12 months on the home exercise program. guided by broad questions relating to central themes identified
The program consisted of 50 exercises, developed specifically for during an extensive literature review. Interviews were audiotaped and
motor problems of PD, and was divided into 5 blocks (one for transcribed verbatim to form the data. ANALYSIS: Transcripts were
each day of the working week). Exercises were demonstrated analysed using thematic analysis and qualitative descriptive tech-
individually to all patients. The exercises were performed at home niques. This involved identifying themes from the text that seemed
and corrected every 15 days by a physiotherapist. Patients from the to represent one complete thought or idea. The labelled groups
CG were assessed periodically and received only general guidance were analysed into sub-themes. Finally, the general themes that
on PD. ANALYSIS: The data obtained was compared employing the arose were described. RESULTS: The findings indicate that while
ANOVA variance analysis model for repeated measurements. Those peer review systems have been developed, and are carried out as
factors yielding category differences on mean comparison then prescribed, therapists lack clarity about the intended outcomes. While
underwent the Scheffé post-hoc test to verify level of significance, recognising the benefits of receiving feedback on practice, many
two by two. RESULTS: There was a progressive increase in both manage the review process to maintain positive working relationships
the number of remembered exercises (p < 0.005) and the number with reviewers and ensure their practice is favourably reviewed.
of correct exercises (p < 0.0005), as number of visits grew for The strategies they employ and the consequences of managing
patients, indicating good adhesion of patients to the program. peer review in these ways are described. CONCLUSIONS: Current
Comparison of the initial evaluation vs. final evaluation scores peer review processes in New Zealand may not provide trustworthy
in sections II and III UPDRS, and PDQL showed a significant information about competence to practice. Neither do they fully
difference in the EG only (p < 0.0001). Additionally, there was a achieve their potential as a professional development tool. Therefore,
significant difference in the end scores on the PDQL between the professional emphasis and effort expended on peer review
the groups (p < 0.0005). CONCLUSIONS: Home exercise programs needs to be revisited. IMPLICATIONS: The findings highlight the
specifically developed for PD can help patients to improve their motor need for consultation amongst physiotherapy managers, professional
performance and consequently their quality of life. IMPLICATIONS: associations, colleges and the Physiotherapy Registration Board, to
As the study progressed, motor improvements presented by the negotiate whether regulatory or professional development needs will
patients at initial and advance stages of PD were seen to be drive the development of peer review processes in New Zealand.
maintained, showing that the daily practice of exercises, set against KEYWORDS: Peer Review Quality Assurance Continuing Profes-
the inactive state that the patients were hitherto submitted to, can sional Development (CPD). FUNDING ACKNOWLEDGEMENTS:
minimize the consequences of disease evolution. KEYWORDS: Auckland University of Technology (AUT) Waitemata District Health
Parkinson’s disease, exercises program, quality of life. FUNDING Board. CONTACT: [email protected]
ACKNOWLEDGEMENTS: HCFMUSP. CONTACT: [email protected] ETHICS COMMITTEE: Auckland University of Technology Ethics
ETHICS COMMITTEE: All patients signed the term of consent Committee (AUTEC)
approved by the Hospital das Clinicas da FMUSP Ethical Committee
Research Report Platform Presentation targeted physical therapy intervention in older people at risk of falling.
2599 Tuesday 5 June 11:05 KEYWORDS: Fear of falling. FUNDING ACKNOWLEDGEMENTS:
VCEC Meeting Room 16 This study was part of PROFANE and supported by an EC
RELATIONSHIP BETWEEN FALLS EFFICACY SCALE grant under the Fifth Framework Program QLK6-CT-2002-02705
INTERNATIONAL (FES-I), PHYSICAL PERFORMANCE, (www.profane.eu.org). CONTACT: [email protected]
PHYSICAL ACTIVITY AND AVOIDANCE OF ACTIVITIES IN
OLDER PERSONS AT RISK Research Report Platform Presentation
Beyer N1 , Hauer K2 , Piot-Ziegler C3 , Todd C4 , Yardley L5 , 1318 Tuesday 5 June 11:05
Kempen G6 ; 1 Institute of Sports Medicine – Copenhagen & Dept. VCEC Meeting Room 17
Physical Therapy, Copenhagen University Hospital Bispebjerg,
AN EXPLORATION OF BARRIERS AND ENABLERS TO
Copenhagen, Denmark; 2 Robert-Bosch-Krankenhaus, Stuttgart
PARTICIPATE IN CARDIAC REHABILITATION IN RURAL
and Bethanien-Krankenhaus, University of Heidelberg, Germany;
3 Institut de Psychologie, Université de Lausanne, Switzerland; VICTORIA, AUSTRALIA
4 School of Nursing, Midwifery and Social Work, University of De Angelis C1 , Bunker S2 , Schoo A2 ; 1 Physiotherapy Department,
Manchester, United Kingdom; 5 School of Psychology, University Western District Health Services; 2 Greater Green Triangle University
of Southampton, United Kingdom; 6 Department of Health Care Department of Rural Health, Flinders and Deakin Universities
Studies, Maastricht University, The Netherlands
PURPOSE: The objectives of this study were to identify (i) local barri-
PURPOSE: Fear of falling is a common concern of older people ers and enablers to participation in hospital-based cardiac rehabilita-
and can lead to decline in physical function, activity restriction, and tion (CR) programs, and (ii) preferred options for the delivery of CR.
greater falling risk. The Falls Efficacy Scale International (FES-I) a RELEVANCE: Coronary heart disease (CHD) is the largest single
modified version of the Falls Efficacy Scale was developed to assess cause of years of life lost and disability life adjusted years in Victoria.
both easy and difficult physical and social activities. FES-I has shown In rural Victoria rates of CHD deaths and hospital admissions are
to be acceptable with respect to reliability and construct validity in significantly higher than in the metropolis. CR program participation
different samples in different countries. The aim of this study was is associated with a 35% survival advantage at 5 years compared with
to investigate whether a significant relationship exist between FES-I non-participators. Unfortunately, only 24% of eligible Victorians begin
and measures of functional ability, physical activity and avoidance of CR. PARTICIPANTS: Ninety seven patients (27 females, 70 males)
activities in older persons treated in a falls clinic. RELEVANCE: There with CHD who were referred to CR, and their carers; health profes-
is a need for measures that can determine the degree of fear of falling sionals working within the local CR programs at six regional hospitals
and indicate which activities are most feared and should therefore in south west Victoria. METHODS: A questionnaire administered
be targeted for physical therapy rehabilitation. PARTICIPANTS: 57 by CR coordinators, and focus groups to obtain participant and
consecutive falls clinic patients referred to exercise training as part health professional views on current CR programs and to explore the
of a targeted individualized intervention. METHODS: Following a receptiveness of various delivery options. The focus group sessions
medical examination the participants went through assessments also allowed further exploration of issues identified in the question-
carried out by a trained physical therapist. These consisted of a) a naires. ANALYSIS: Data analysis was conducted using descriptive
structured interview with filling in questionnaires including the FES- statistics and Mann-Whitney U-Test for quantitative data. A qualitative
I (scores 16-64) to measure fear of falling, the Modified Survey of approach was utilised to report on key themes identified in the focus
Activities and Fear of Falling in the Elderly scale (SAFFE, scores groups and questionnaires. RESULTS: Distance to travel was the
16-64) to determine avoidance of activities due to fear of falling, the only statistically significant factor in determining commencement of
Composite Physical Function scale (CPF, scores 12-36) to assess CR (p = 0.008, 2-tailed). Enablers to CR participation were easy
functional ability, and additionally self-reported balance, and physical access to transport (63%), family support (49%) and work flexibility
activity level, and b) measurement of functional ability including the (43%). More than one third (38%) of participants was receptive to
Berg Balance Scale (BBS, scores 0-56), standing balance from the alternative methods of CR, for example, evening-based programs,
Short Physical Performance Test (standing balance, 0-30s) and 30- programs in outlying communities, home-based programs with or
s chair stand test (Chair stand, # in 30s). ANALYSIS: Because without a handbook, or telephone support. Family responsibilities,
data were skewed they are presented as median (interquartile inability to drive self, and self-consciousness were put forward as
range). The relationship between the FES-I and the other measures potential barriers by decliners. Focus groups identified CR decliners
were analysed with bivariate correlations using Spearman’s rho. as being less motivated to attend. The stoicism and gender related
RESULTS: The participants were 85(9)yr and 70% were women. barriers were proposed as influencing a person’s decision to reject
74% had fallen at least twice during the previous year and 96% hospital-based CR. Females were more likely to support partners with
reported that they had balance problems. 74% used walking aid and cardiac problems to attend sessions, although less likely to attend CR
46-58% had problems walking 400m, climbing stairs and carrying 5 due to lack of home support. It was noted that depression and anxiety
kg. 84% performed light physical activity at least 2 h/w. The median may influence a person’s decision to attend or decline CR. Both
and interquartile ranges were FES-I: 22(12.5); SAFFE: 25(12); CPF: patient and health professional focus group participants reported
22(7); BBS: 44(12); standing balance: 23(8)s. There was a strong that dealing with psychological health care is a key component of
relationship between FES-I and SAFFE (rs = 0.712, p < 0.001) and CR. CONCLUSIONS: Distance to travel was a significant factor
a moderate relationship between FES-I and self-reported balance influencing attendance at current hospital-based CR. Strategies have
(rs = 0.538, p < 0.001). The relationship between FES-I and self- been identified that have the potential to increase utilisation of
reported functional ability and physical activity level was weaker and improve patient satisfaction with rural CR. IMPLICATIONS:
(rs = 0.382, p = 0.004; rs = −0.359, p = 0.006; rs = 0.307, p = 0.020) as Home-based CR combined with a handbook and telephone support,
was the relationship between FES-I and BBS, standing balance and intensive short courses or CR after business hours may offer viable
Chair stand (rs = −0.385, p = 0.003; rs = −0.375, p = 0.004; rs = −0.368, alternatives to current hospital-based programs during day time. The
p = 0.006). CONCLUSIONS: There were significant relationships need for hospital-based CR will remain, particularly for those who
between FES-I and measures of functional ability, physical activity prefer a higher level of supervision. The provision of different types
level and avoidance of activities. Particularly the association between of CR delivery will have implications for resources such as staffing.
FES-I and SAFFE was strong indicating that concern about falling Psychosocial factors are currently the focus of much CR attendance
potentially leads to activity restrictions. However, studies on the research. KEYWORDS: Cardiac rehabilitation, rural, attendance.
responsiveness of FES-I are needed. IMPLICATIONS: Information FUNDING ACKNOWLEDGEMENTS: Primary Health Care Research
from FES-I could potentially be a useful when planning an individually and Development. CONTACT: [email protected]
ASSESSMENT OF FUNCTIONING IN THE ACUTE HOSPITAL: ULTRASOUND ASSISTED EXAMINATION OF HUMERAL TOR-
OPERATIONALIZATION AND RELIABILITY TESTING OF ICF SION: IMPLICATIONS FOR PHYSIOTHERAPY MANAGEMENT
CATEGORIES RELEVANT FOR PHYSICAL THERAPISTS’ OF THROWING-RELATED SHOULDER DISORDERS
INTERVENTIONS
Whiteley R1 , Ginn K2 , Nicholson L1 , Adams R1 ; 1 University of
Gloor-Juzi T1,2 ,
Grill MPH E3 ,
Huber E1,4 ,
Stucki G3,5 ; 1 Department Sydney, Faculty of Health Sciences, Discipline of Physiotherapy;
2 University of Sydney, Faculty of Medicine, School of Medical
of Rheumatology and Institute of Physical Medicine, University
Hospital Zurich, Switzerland; 2 Physiotherapy Science Studies, Sciences
Department of Rheumatology and Institute of Physical Medicine,
PURPOSE: The aim of this study was to ascertain the extent of side-
University Hospital Zurich, Switzerland and Faculty of Health
to-side differences in humeral torsion in throwing athletes compared
Sciences, Maastricht University, the Netherlands; 3 ICF Research
to a non-throwing sample. Athletes included mature males who began
Branch of the WHO FIC Collaborating Centre (DIMDI), IHRS,
their participation in throwing sports either before or after skeletal
Ludwig-Maximilian University, Munich, Germany; 4 Swiss Association
maturity and skeletally immature male throwers. RELEVANCE:
of Physiotherapy, Sursee, Switzerland; 5 Department of Physical
Altered rotational range of motion is increasingly implicated in the
Medicine and Rehabilitation, Ludwig-Maximilian-University, Munich,
aetiology of shoulder injuries. As the degree of torsion in the humerus
Germany
influences the measurement of shoulder rotational range, athletes
who present with reduced range need to be assessed in light of
PURPOSE: Up to date there is no proof whether specific categories
this torsion. Knowing the contribution of humeral torsion to shoulder
of the International Classification of Functioning, Disability and rotational range indicates whether a shift in range is structural or
Health (ICF) can be operationalized in a way that the resulting injury-related and thereby guides treatment. There is debate as to
items are useful and reliable when applied by physical therapists. the contribution activity plays in the genesis of humeral torsion so its
The objective of this study was to write items based on the ICF measurement and relation to pre-pubertal activity are of interest. The
relevant to physiotherapeutic interventions and to test their reliability development of a reliable, safe clinical measure of humeral torsion
in the hand of physical therapists. RELEVANCE: Interventions makes this possible without the use of expensive potentially danger-
from physical therapists are focused on the patient’s loss of ous ionising radiation methods such as CT. PARTICIPANTS: Sixteen
functioning. For identification and classification of these problems adult subjects without a history of participation in throwing sports,
in the acute hospital and for efficient communication between 70 mature male throwing athletes who commenced participation in
health professionals, the International Classification of Functioning, throwing sports prior and subsequent to skeletal maturity and 35
Disability and Health (ICF) arguably is the appropriate basis for adolescent male throwers were recruited for this study. METHODS:
assessment in an interdisciplinary environment. PARTICIPANTS: Humeral torsion was measured bilaterally using a method which has
28 patients (16 women) mean age 59.6 years (range 27 to 88) previously shown excellent reliability. Each of the subjects completed
with diverse acute health conditions requiring physical therapy a questionnaire describing their history of participation in throwing
treatment in the acute hospital. METHODS: Items were written in and other overhead sports. ANALYSIS: Comparisons of side-to-
side differences in humeral torsion between the populations of
a formal experts’ decision-making and consensus process based
throwing athletes and non-throwing normal subjects were made using
on 124 ICF categories relevant to physiotherapeutic interventions.
descriptive statistics. RESULTS: Athletes participating in throwing
Inter-rater reliability of operationalized ICF categories was tested
sports had greater humeral retrotorsion in their dominant arms than
with repeated measurement by two independent observers in a did non-athletic adult subjects. The average (± S.E.M.) side-to-side
convenience sample of patients. ANALYSIS: The inter-rater reliability differences were: non-athletic adults 1.3º (8.9º); adolescent throwers:
was analyzed using the percentage of raw agreement and Cohen’s 11.2º (1.2º); adult males throwers: 12.8º (1.4º). Very few of the
kappa for nominal scales. RESULTS: All of the 49 ICF categories 121 subjects examined in this study demonstrated symmetry in
of the component of Body Functions and Structures (100%) showed the degree of humeral torsion in their dominant/throwing and non-
a raw agreement of 0.7 or above, 73% of the categories showed a dominant shoulders. The largest variation in individual side-to-side
kappa value 0.7 or above. 59% of the categories of the component difference in humeral torsion was 38 degrees in the adult throwing
Activities and Participation showed a raw agreement 0.7 or above, subjects, 29 degrees in the adolescent throwers and 15 degrees
17% of the categories showed a kappa of 0.7 or above. 39% of the in the non-throwing control subjects. CONCLUSIONS: Almost all of
categories of the component Environmental Factors showed a raw the subjects examined displayed a side-to-side difference in humeral
agreement 0.7 or above, none of the categories showed a kappa torsion implying physiotherapists cannot use the contralateral arm
value 0.7 or above. CONCLUSIONS: This study shows that it is for comparison when measuring shoulder rotational range of motion.
possible to adapt the ICF to individual profession and setting specific Humeral torsion displays an activity-related effect: those participating
needs. Physical therapists may use the ICF as a checklist and tool in throwing-related sports displayed a greater degree of humeral
to assess patients and monitor the results of interventions. Further retrotorsion in their dominant arm, while non-athletic adults showed
research is needed on the development of reliable instruments for no systematic dominance effect. IMPLICATIONS: Humeral torsion
should be routinely measured in the clinical setting because the
physical therapists based on the ICF. IMPLICATIONS: Using the
apparent rotational range of motion measured with a goniome-
ICF as a unifying framework to communicate patients’ needs to
ter/inclinometer will be significantly affected by this torsion. Physio-
other health professionals is very important for physical therapists.
therapists cannot assume shoulder rotational symmetry with humeral
Additionally, this standardized instrument can be implemented in torsional symmetry only displayed in less than 10% of subjects.
management studies to describe the goals of physical therapy Accordingly treatment aimed at restoring shoulder rotational range of
and highlighting aspects of quality. KEYWORDS: Assessment, motion must take humeral torsion into consideration. KEYWORDS:
Reproducibility of Results. FUNDING ACKNOWLEDGEMENTS: We Humeral torsion; Ultrasound; Throwing injuries; Shoulder. FUNDING
gratefully acknowledge the Swiss Physiotherapy Association, Sursee, ACKNOWLEDGEMENTS: Funding was received through a PhD
Switzerland for financial support of the operationalization conference scholarship from the Faculty of Health Sciences, University of Sydney.
in Ermatingen (CH). CONTACT: [email protected] ETHICS COMMITTEE: Human Research Ethics Committee of the
ETHICS COMMITTEE: ethic committee of Zurich University of Sydney.
DO THE ATTITUDES AND BELIEFS OF HEALTH CARE TRANSLATING NECK PAIN AND DISABILITY QUESTIONNAIRES
PRACTITIONERS INFLUENCE THEIR MANAGEMENT OF INTO THE KOREAN LANGUAGE: CROSS-CULTURAL
PATIENTS WITH LBP? ADAPTATION AND PSYCHOMETRIC TESTING
Bishop A, Foster N, Thomas E, Hay E; Primary Care Musculoskeletal Lee H1 , Nicholson L2 , Adams R2 , Maher C2 , Halaki M3 , Bae S4 ;
Research Centre, Keele University, Keele, Staffs. UK. ST5 5BG 1 Dept of Physical Therapy, College of Medical Life Science, Silla
PURPOSE: The aim of this study was to describe the attitudes, University, Busan, Korea; 2 School of Physiotherapy, Faculty of
beliefs and practice behaviour of UK physiotherapists (PTs) about Health Sciences, University of Sydney, Sydney, Australia; 3 School of
low back pain (LBP) and to explore the relationship between their Exercise and Sport Science, Faculty of Health Science, University
attitudes and beliefs and their practice behaviour. RELEVANCE: of Sydney, Sydney, Australia; 4 Dept of Physical Therapy, College
Guidelines for the management of LBP have been in existence for of Rehabilitation Science, Daegu University, Daegu, Korea
many years, but adherence to these by health care practitioners PURPOSE: To translate three neck and spinal pain disability
(HCPs) remains sub-optimal. The attitudes and beliefs that HCPs questionnaires – the NDI, NPDS, and FRI – into the Korean
hold about LBP have been shown to influence the advice given to language, and evaluate reliability, face validity and item response
patients and may be a barrier to uptake of guideline recommenda- patterns to achieve a good cross-cultural adaptation. RELEVANCE:
tions. PARTICIPANTS: A simple random sample of 2000 UK based Although measuring health status is important for research and
PTs identified from the professional register of the Chartered Society clinical practice, few validated neck pain and disability scales exist.
of Physiotherapy. METHODS: A postal cross-sectional survey using Further, non-English speakers are often excluded from clinical
a questionnaire consisting of an attitudes and beliefs measure, the trials and epidemiological studies due to the lack of valid and
Pain Attitudes and Beliefs Scale (PABS.PT), which differentiates reliable cross cultural measurements. There are no Korean language
between biomedical (range 10–60) and behavioural (range 9–54) neck pain and disability measures. Direct translations may fail
orientations of HCPs towards back pain and a vignette describing to achieve questions comparable to the meaning of the original
a patient with non-specific LBP with questions relating to clinical English, so it is important to consider conceptual matters and
management of the described patient. ANALYSIS: Descriptive and cultural relevance. PARTICIPANTS: Forty (23 males, 17 females)
inferential analyses were carried out using SPSS. RESULTS: The subjects, aged from 15 to 64 years old, participated to examine test-
response rate was 55% (n = 1091) of which 580 were currently retest reliability. One hundred and eighty (76 males, 104 females)
involved in the management of patients with LBP and were used subjects with a primary diagnosis of non-specific neck pain and 81
in the analysis. Of these applicable responders, 81% were female, healthy volunteers were recruited to examine internal consistency,
52% worked exclusively in the National Health Service and 70% discriminative validity and longitudinal construct validity. METHODS:
reported having received specific postgraduate training in back Versions of each questionnaire in idiomatic modern Korean were
pain. On the PABS.PT subscales, the mean biomedical score developed with a process involving initial independent translation,
was 31.1 (SD 7.2) and the mean behavioural score was 32.5 synthesis of the translations, independent back translation and review
(SD 4.8). For the clinical management items, 16% of respondents by an expert committee to achieve equivalence with the original
reported they would advise the patient described in the vignette English. Psychometric testing of the questionnaires was undertaken
to ‘return to normal work’ and 22% reported they would advise to examine test-retest reliability, internal consistency, discriminative
avoiding bedrest entirely as a form of treatment. A large majority validity and longitudinal construct validity. The questionnaires were
(82%) reported they would advise the described patient to ‘perform administered twice to the clinical subjects; on their first treatment
activities within the patient’s tolerance’ with 10% recommending (baseline) and the last treatment day (post treatment). A 7-point
‘perform usual activities’. The PABS.PT scores and work advice global perceived effect scale was also completed at the last treatment
show a significant linear trend with higher biomedical [F(1,561) = 51.7, and served as the external criterion of clinically important change.
p < 0.001] and lower behavioural [F(1,559) = 25.65, p = 0.001] scores The healthy group completed the questionnaires once only. Prior
being associated with advice to not return to work. CONCLUSIONS: to testing, ethical approval was obtained from the University of
PTs hold a wide variety of attitudes and beliefs about back pain. Sydney, and each subject gave informed consent. ANALYSIS: To
We have shown an association between PTs’ attitudes and beliefs assess reliability, the intraclass correlation coefficient [ICC(2,1)] was
and their reported practice behaviour. PTs’ operating within a calculated. Internal consistency was evaluated by Cronbach’s alpha.
predominantly biomedical framework were less likely to adhere to Discriminative validity was examined with independent-groups t -
current guideline recommendations regarding advising a patient tests. Internal responsiveness was tested by calculating the effect
with back pain about early return to work. Future research needs size and standardized response mean for each questionnaire, and
to focus on approaches to help implement best practice and external responsiveness was measured using Pearson’s r and ROC
guideline recommendations into clinical practice. IMPLICATIONS: analysis. RESULTS: Test-retest reliability of the translated versions
Guideline dissemination methods are having only limited success of the three disability questionnaires was excellent [ICC(2,1) = 0.86-
in encouraging best practice in physiotherapy for back pain. The 0.90]. High internal consistency was found in the three disability
attitudes and beliefs held by PTs are related to what they do questionnaires (Cronbach’s alpha was 0.88 for the FRI, 0.96 for
in practice. KEYWORDS: Physiotherapists, attitudes, guidelines. the NPDS and 0.82 for the SFMPQ). The VAS subscale of the
FUNDING ACKNOWLEDGEMENTS: This study was funded by the SFMPQ was found to be the most responsive subscales (ES=1.44,
Arthritis Research Campaign. Nadine Foster is funded by a Primary SRM=1.37). The VAS was also the most responsive pain and
Care Career Scientist Award from the Department of Health and NHS disability index in internal responsiveness analysis, although disability
Research and Development. CONTACT: [email protected] indices showed marginally better responsiveness when compared
ETHICS COMMITTEE: West Midlands Multi-Centre Research Ethics with external standards. CONCLUSIONS: We conclude that the
Committee questionnaires were successfully translated and exhibit acceptable
measurement properties, and as such are suitable for use in clinical
and research applications. IMPLICATIONS: The results of the current
study may suggest that Korean versions of four common neck
pain and disability questionnaires are suitable for use in clinical
and research applications. KEYWORDS: Responsiveness, Neck
disability questionnaires, Short Form McGill Pain Questionnaire.
FUNDING ACKNOWLEDGEMENTS: None of authors have any Research Report Platform Presentation
financial support for the current study that may lead to a conflict 1610 Tuesday 5 June 11:25
of interest. CONTACT: [email protected] VCEC Meeting Rooms 1-3
ETHICS COMMITTEE: University of Sydney PATIENT SATISFACTION AMONG MINORITY GROUPS. WHICH
FACTORS ARE IMPORTANT? PART II OF A QUALITY SURVEY
STUDY
Andreassen G, Graver V, Eriksdotter A; Ullevaal University Hospital,
Oslo, Norway
VCEC Ballroom A
GROUP EXERCISE THERAPY FOR MOBILITY AND BALANCE PURPOSE: Patient satisfaction and participation have become
IN PEOPLE WITH MULTIPLE SCLEROSIS:A RANDOMISED important issues in health care. This is due to legislation and
CONTROLLED PILOT STUDY consumer awareness.In 2003 we carried out a survey on patients
with muscular skeletal disorders in our outpatient clinic. One of the
Lennon S1 , MacAuley S2 , Hill C3 , Lowe-Strong A1 ; 1 University
results was that patients not having a Scandinavian language as
of Ulster, Newtownabbey, Northern Ireland; 2 Belfast City Hospital,
their mother tongue were overall significantly less satisfied than
Belfast, Northern Ireland; 3 Musgrave Park Hopsital, Belfast,
the other patients. The purpose of this study is to find out why
Northern Ireland
this was so, and to assess with which factors the patients were
PURPOSE: The purpose of this study was to evaluate the effect most dissastisfied. RELEVANCE: There is an increasing number of
of group exercise therapy on mobility and balance and in people patients with a minority background in our country. An essential factor
with multiple sclerosis (MS). RELEVANCE: Restrictions in mobility in health care is equality in services. The way in which health care is
and balance are common in people with MS. A recent Cochrane delivered and puts patients at the centre is essential in physiotherapy.
review (Rietberg et al, 2005) suggests that exercise therapy can PARTICIPANTS: From Part I of this study we included the 30 patients
improve strength, fitness, mobility and balance in individuals with MS, with a non-Scandinavian mother tongue (16 woman and 14 men,
with no evidence of deleterious effects, yet access to such therapy mean age 46.6, SD 10.6), who had completed their physiotherapy
remains limited. Outpatient based group exercise therapy would thus treatment. Another group of patients, with a non-Scandinavian mother
appear to be a realistic service delivery option to ensure that exercise tongue, participated in focus group interviews. METHODS: We
therapy becomes more readily available. PARTICIPANTS: Ethical analysed data from the questionnaire the 30 patients had filled out in
approval was obtained from the University of Ulster’s Research Part I of the study.The questionnaire consisted of three global effect
Ethical Committee. Inclusion criteria were that all participants had variables: overall satisfaction, improved condition following treatment,
a definite diagnosis of MS, were over 18 years of age with an and whether the patients would reccomend our clinic. In addition it
Expanded Disability Status Scale (EDSS) of 7 or less. Participants included 22 variables in the following quality dimensions; professional
were excluded if they were currently experiencing a relapse of conduct, accessibility, physical environment and expectations. We did
MS, had received steroids within the last month, were due to qualitative focus group interviews to get access to the experiences
receive them during the period of the study, or relapsed during patients had and the meaning or value these had for them. In this
the study requiring hospitalisation. METHODS: 14 participants were way we used a triangulation of methods – both quantitative and
randomised, stratified by walking ability, into an Exercise or Control qualitative. ANALYSIS: In the quantitative analyses, the significance
group for twice-weekly sessions of exercise therapy over a four- of association between the global effect variable, overall satisfied
week period. A blinded assessor measured the Rivermead Mobility and the other variables were investigated by means of univariate
Index (RMI-the primary outcome measure), and the Step Test and regression analyses. The results of the quantitative analyses were
10m Timed Walk (the secondary outcome measures) at baseline used as background material for an interview guide. The qualitative
and weeks 5, 10 and 16 post intervention. The Barthel Index (BI) interviews were analysed by the methods of phenomenograpy.
and the Multiple Sclerosis Quality of Life-54 instrument (MSQoL- RESULTS: We found a significant association between age and
54) were measured at baseline and week 16. A focus group satisfaction (p < 0.04) older patients were more satisfied. There was
was undertaken at the end of the intervention period to obtain no significant association between gender and satisfaction. The main
the users’ perspective. ANALYSIS: Data were analysed on an dissatisfaction factors were: no improvement following treatment, high
intention to treat basis using independent-samples T-tests on the parking fees and poor follow up. Questions that had significant impact
differences of the means of each outcome measure at each time point on the overall satisfaction score were: competence/professional skills
compared to the baseline. RESULTS: Differences between groups (p < 0.0001), information (p < 0.0001),communication (p < 0.0006).
were not statistically significant for any of the outcome measures The focus group interviews supported these findings to a certain
(p > 0.05). However, there was a positive effect in terms of walking extent. However the patients appeared to be more satisfied in
speed following intervention; in addition, participants reported an the interviews than in the quantitative survey. CONCLUSIONS:
improvement in functional activity as well as psychosocial benefits. Although many patients reported that there were no improvement,
CONCLUSIONS: Findings from this pilot study would suggest they were satisfied on overall basis. Patient satisfaction among
that outpatient based group exercise therapy has beneficial effects minority groups is an issue that should be given more attention –
on mobility and balance, and thus warrants further investigation. by identifying areas of dissatisfaction and finding ways of measuring
IMPLICATIONS: This small randomised controlled pilot study is one this. IMPLICATIONS: We must adress the issue on how to improve
of the first to evaluate the effect of group exercise therapy on mobility treatment service to people from minority groups in order to better
and balance in people with multiple sclerosis. The clinical importance meet their needs. Qualititive methodology should be used more in
of this study is that the group format may be an effective approach patient surveys. KEYWORDS: Patient satisfaction, minority health-
to ensure that exercise therapy is available to a greater number care. FUNDING ACKNOWLEDGEMENTS: No external funding.
of patients, and may be more resource efficient. KEYWORDS: CONTACT: [email protected]
multiple sclerosis, mobility, balance, exercise therapy. FUNDING
ACKNOWLEDGEMENTS:: Siobhan MacAuley was sponsored by
the Research and Development Office (Northern Ireland). Dr
Andrea Lowe-Strong was funded by a research grant from the MS
Society (Northern Ireland) during this study. Additional funding was
also received from the Association of Chartered Physiotherapists
Interested in Neurology (ACPIN). CONTACT: [email protected]
ETHICS COMMITTEE: University of Ulster Ethics Comiittee
CARDIORESPIRATORY RESPONSES OF INDIVIDUALS WITH REFERENCE VALUES AND EFFECTIVENESS OF SEVEN
SPINAL CORD INJURY DURING UPPER AND LOWER COMMONLY USED BALANCE AND FALL RISK SCREENING
EXTREMITY EXERCISE TESTS FOR COMMUNITY DWELLING OLDER ADULTS
Pollack S1 , Moffat M2 , Dijkers M1 ; 1 Department of Rehabilitation Boulgarides L1 , Yali B, Edward B1 ; 1 California State University,
Medicine, Mount Sinai Hospital, New York, NY, USA; 2 Department Sacramento, CA, USA
of Physical Therapy, New York University, New York, NY, USA
PURPOSE: The purpose of the study was to determine whether
PURPOSE: To analyze the cardiorespiratory responses of adults with
scores on seven balance tests were related to fall status in community
paraplegia at the spinal cord levels T6-T12 and adults with tetraplegia
dwelling older adults and how mean scores compared to those found
at the spinal cord levels C4-C6 following three different exercise
in the literature. RELEVANCE: Falls in older adults are a major cause
training phases: voluntary upper extremity armcrank ergometry;
of fracture, disability, and death in addition to costing millions of
electrically induced lower extremity ergometry; and voluntary upper
health care dollars. The ability to effectively determine whether older
extremity armcrank ergometry combined with electrically induced
adults have decreased balance and/or increased fall risk important
lower extremity ergometry. RELEVANCE: Exercise capability in
for identifying at-risk seniors and offering timely intervention in the
adults with spinal cord injury (SCI) has not been been adequately
researched. It is unclear whether they can develop the physiological clinical and community wellness settings. The data from this study
capacities required to perform differing degrees of work. The assists in interpretation of common tests currently used in the
limited literature available leads to the prediction that the exercise clinical and community settings. PARTICIPANTS: Subjects included
capacity of adults with SCI, specifically those with lesions above 255 community dwelling adults 65 years and older (82 male and
the fifth thoracic nerve, is limited due to autonomic nervous system 173 female) who attended health fairs between 2001 and 2004.
interruption. However, this issue has not been directly examined, METHODS: Data collected included sex, age, history of falls, and
and the exercise capacity of adults with SCI remains virtually scores on seven different balance tests: the Functional Reach Tests
unknown. PARTICIPANTS: Nine adults with SCI participated in a (FRT), Tandem Stand (TS), Single Leg Balance (SLB), Timed Up and
three phase exercise training and testing program. Six of these Go Test (TUGT), Composite Test for Sensory Interaction with Balance
individuals had a spinal cord level of injury between T6 and T12 (CTSIB), the Four Square Step Test (FSST), and the 30 second chair
(Group 1) and three were between C4 and C6 (Group 2). All three stand (TSCS). ANALYSIS: Correlations determined relationships
individuals in Group 2 but only two individuals in Group 1 (T6-T7) between test scores and demographic variables (age, sex, location.
completed the entire protocol. METHODS: The exercise program Mean test values were compared to those reported in the literature,
consisted of 12 sessions of upper extremity armcrank ergometry, univariate analysis determined relationship between test scores and
12 sessions of electrically induced lower extremity ergometry and fall status, and logistic regression was done to determine whether
12 sessions of upper extremity armcrank ergometry combined with any tests or combined tests predicted fall status. RESULTS: Scores
electrically induced lower extremity ergometry. The cardiorespiratory on the following tests were related to fall status: TUGT (P = 0.02),
capability of the participants was assessed before and after each FSST (P = 0.007), TS ability (P = 0.0003), SLB (P = 0.0008), eyes
phase of exercise training. Peak oxygen consumption (VO2 ) and closed component of the CTSIB (P = 0.0.02), and TSCS (P = 0.0.02).
exercise run times were calculated for each participant. ANALYSIS: Logistic regression analysis revealed the TSCS (more repetitions
Independent samples t-tests were used to determine whether there per 30 second period predicted less liklihood of falls) and location
was a significant difference between the groups. Additionally, all (the location with primarily African American sujects predicted less
participants’ cardiorespiratory parameters were plotted to loof for liklihood of falls) as the only combination of variables significantly
appearance of trends. RESULTS: There may have been a difference predictive of falls (P = 0.02). Means of the tests (TUGT for fallers =
between the groups in peak VO2 and run time, however, statistical 9.8, non-fallers = 8.3; FSST for fallers = 14.7, non-fallers = 10.8;
significance was not always found. Analysis of each individual’s data TSCS for fallers = 10.3, non-fallers = 12.9; SLB for fallers = 8.8,
over time revealed that as peak VO2 increased, carbon dioxide non-fallers = 15.2) were similar in the current investigation to those
production (VCO2 ) increased as well, indicating corresponding of some studies. Variations in sample characteristics and methods
increases in peak cardiorespiratory performance and physical work
of reporting prevented statistical comparison. CONCLUSIONS: Five
capacity. These increases in peak VO2 and VCO2 were accompanied
of the seven tests (TUGT, FSST, TS time and ability, SLB, eyes
by increases in minute ventilation (VE) which indicated that ventilation
closed component of the CTSIB,and TSCS) are related to fall
probably did not limit oxygen uptake. CONCLUSIONS: The small
status. Some similarities exits in mean values of balance tests
sample size may explain the lack of statistically significant differences
compared to comparative studies, though there is considerable
between the groups. Furthermore, the participants with thoracic
variability between mean values reported in the literature for the
injuries at T6 and T7 may have had autonomic nervous system
interruption. Therefore, statistically significant differences between different tests. IMPLICATIONS: Mean values reported here and in
the means may not have occurred because the two groups were related literature are useful for the practitioner to be able to compare
more similar than dissimilar. Reviewing each individual’s data individual performance to a larger active community dwelling older
over time revealed interesting trends with regard to VO2 , VCO2 population. As most of these tests are found to be related to fall
and VE. IMPLICATIONS: Thoracic injuries at T6 or T7 are just status, performance that falls a standard deviation below the mean
below the cutoff for autonomic nervous system interruption. This for these tests will allow clinicians and participants to identify potential
cut off may not be precise. Additional tests may need to be problems related to balance, function, and possible future falls.
employed in future research to truly segregate individuals with SCI Further research should focus on establishing norms for different age
that have an intact autonomic nervous system from individuals groups and levels of disability. KEYWORDS: Fall Prediction; Older
who do not. KEYWORDS: spinal cord injury, cardiorespiratory, Adults; Balance. FUNDING ACKNOWLEDGEMENTS: This research
exercise. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: was funded in part by the department of Research and Sponsored
[email protected] Projects at California State University, Sacramento. CONTACT:
ETHICS COMMITTEE: 1. New York University Committee on [email protected]
Activities Involving Human Subjects. 2. Mount Sinai Institutional ETHICS COMMITTEE: Committee for the Protection of Human
Review Board Subjects, California State University, Sacramento
EDUCATION IN PULMONARY REHABILITATION: THE PATIENTS’ PATIENT CONCERNS IN THE FIRST SIX WEEKS FOLLOWING
PERSPECTIVE PRIMARY TOTAL KNEE ARTHROPLASTY
Wilson J1 , O’Neill B2 , Reilly J3 , MacMahon J1 , Hall M2 , Bradley J1,2 ; Rastogi R1 , Davis A2 , Chesworth B1 ; 1 University Of Western
1 Department of Respiratory Medicine, Belfast City Hospital Trust,
Ontario, London, Canada; 2 Toronto Western Research Institute,
N. Ireland; 2 Health and Rehabilitation Sciences Research Institute, Toronto, Canada
University of Ulster, N. Ireland; 3 UNESCO Centre, University of
Ulster, N. Ireland PURPOSE: The primary objective of this study was to identify
PURPOSE: To ascertain from the patients’ perspective what should what patients believe is important during their recovery in the first
be included in the educational component of pulmonary rehabilitation six weeks following primary total knee arthroplasty (TKA). These
(PR) and how this should be delivered. RELEVANCE: There is patient-reported important items were linked to components of the
limited research to direct the content and delivery of the educational International Classification of Functioning, Disability and Health
component of pulmonary rehabilitation. Current guidelines give no (ICF) and then mapped to commonly used outcome measures.
indication about which, of many topics, are essential for inclusion, RELEVANCE: To date, no researchers have investigated what is
nor of the specific content and method of delivery. Importantly important to patients in the first six weeks following primary TKA.
these proposed topics are not based on the patients’ perspective. An understanding of what is important to patients at a time when
PARTICIPANTS: A purposive sample of 32 (25 male) patients with physical therapists are involved in the treatment of these patients will
COPD were recruited from the regional respiratory centre at the aid clinicians in providing patient-centered care. Linking of patient-
Belfast City Hospital (8 mild, 20 moderate, 4 severe). METHODS: reported important items to the ICF allows for comparison and
Six focus groups were conducted (2 groups had attended PR, 2 non-
sharing of data amongst researchers, as the ICF is the accepted
PR groups and 2 mixed groups). A structured schedule of topics
framework for evaluating disability in rehabilitation. PARTICIPANTS:
was used to guide the discussion, which was led by an experienced
moderator. All focus groups were videotaped and field notes taken The sample comprised of thirty patients (18 females) from a tertiary
by an assistant moderator. Debriefing followed each focus group and care hospital who were in the first six weeks of recovery following
a transcript was prepared. ANALYSIS: Data was analysed using primary TKA. METHODS: Individual interviews were conducted to
a grounded approach. Data was coded and sorted into categories identify what patients believe is important during their recovery
and subcategories. Results were summarised and verified by means following primary TKA. ANALYSIS: Items identified by patients were
of a follow up report which elicited participants’ comments on analyzed for content and linked to the components of the ICF using
the findings. RESULTS: The physical and psychosocial impact of the operational definitions of the ICF components. These items were
COPD was described extensively. Patients reported considerable mapped to the Western Ontario McMaster Universities Osteoarthritis
lifestyle adjustments and frustration as a result of their symptoms. Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score
Key topics identified by participants were: disease education (what (KOOS) and Oxford knee scale by manually comparing the content of
is COPD and causes); management of breathlessness and of each patient-reported item to each item on these outcome measures.
the physical impact of COPD (practical strategies for activities of Items that linked to the ICF and those that matched with the outcome
daily living and walking, pacing and panic reduction); medication measures were counted. Frequencies of matching items were then
(how, when and why to use medications); welfare and benefits generated for each ICF component, each outcome measure and
system (disability entitlements, access to home aids and appliances);
their cross-tabulation. RESULTS: Thirty-two items were identified
exacerbation management (recognition of worsening of symptoms,
as being important by patients. Forty-seven percent (n=15) of the
when and where to seek help). There was ambivalence concerning
items linked to the Activity component, 22% (n=7)to Body Function,
the importance of disease progression and end of life issues.
The majority of patients felt these along with a range of other 13% (n=4) to Participation, and 13% (n =4) to the Environmental
topics should be included in supplementary information, which factors component of the ICF. Six percent(n=2) of the items did not
they could choose to access. Patients preferred a group format link to the ICF. Of the 32 items identified by patients 14 mapped
as practical demonstrations and peer support were considered to the KOOS, 11 to the WOMAC and, 4 to the Oxford knee scale.
important aspects of learning. The location could be hospital CONCLUSIONS: Items important to patients linked to four different
based or otherwise, as long as the sessions were delivered by components of the ICF indicating that patients are involved in or are
a knowledgeable/credible individual. CONCLUSIONS: This study thinking of multiple aspects of life even in this early phase of recovery.
has identified deficits in patients’ knowledge, understanding and The KOOS was found to be the most appropriate for use based on
management of their COPD. IMPLICATIONS: Physiotherapists the patients’ perspective. However, less than half of the importance
should ensure that educational components are included in PR items identified by patients were covered by the KOOS, WOMAC
programmes which meet the needs of patients, and in a format that or Oxford Knee Scale indicating that further investigations need to
is acceptable to patients. KEYWORDS: Pulmonary rehabilitation, be conducted to either develop new measures or modify existing
Education. FUNDING ACKNOWLEDGEMENTS: This research is measures to evaluate outcome during this early phase of recovery
funded by the Northern Ireland Chest, Heart and Stroke Association. following primary TKA. IMPLICATIONS: Currently, we recommend
using the KOOS as well as evaluating additional concerns of
ETHICS COMMITTEE: Research Ethics Committee, Queens Univer-
individual patients using the patient-specific scale or other alternative
sity Belfast, Northern Ireland
methods. KEYWORDS: Arthroplasty, knee, concerns. FUNDING
ACKNOWLEDGEMENTS: This work was supported by a Premier’s
Research Excellence Award from the Ontario Ministry of Health and
Longterm Care to Dr. Davis and by the Dr. Jal Tata Research Award
from the London district of the Ontario Physiotherapy Association to
Ravi Rastogi. CONTACT: [email protected]
ETHICS COMMITTEE: University of Western Ontario Research
Ethics Board for Health Sciences Research Involving Human
Subjects
PRE-ACTIVATION OF MUSCLES DURING SHOULDER PREVALENCE OF BACK PAIN AND THE RELATION TO
ABDUCTION IN NORMALS PSYCHOSOCIAL AND SOCIOECONOMIC FACTORS AMONG
Pizzari T1 , Wickham J2 , Stansfeld K1 , Djoneff M1 ; 1 School of 45-69 YEAR OLDS IN A GENERAL POPULATION
Physiotherapy, La Trobe University, Melbourne, Australia; 2 School Skargren E1 , Larsson M1 , Kristensson M2 ; 1 Department of Health
of Human Biosciences, La Trobe University, Melbourne, Australia and Society Physiotherapy, Linköpings universitet; 2 Department of
Health and Society Social Medicine and Public Health, Linköpings
PURPOSE: Current shoulder electromyography (EMG) studies that
universitet
attempt to quantify shoulder muscle activity in planar movements
typically have small subject numbers, analyse limited muscle activity PURPOSE: To describe the prevalence of back pain at present and
characteristics and lack reproducibility. In particular, the temporal over the past five years, and to compare persons reporting back pain
characteristic of muscle onset has not been fully explored in shoulder with those without such pain in relation to health-related quality of
movements. The purpose of this experiment was to identify invariant life, co morbidity, psychosocial and socioeconomic factors, a further
temporal and intensity muscle EMG characteristics in a sample of purpose was to examine whether there were any differences between
healthy shoulders to allow a reference database to be developed. men and women with back pain in this regard. RELEVANCE: Recent
This database will be used for comparison with pathological research has shown that back pain is a complex phenomenon
shoulders in the future. RELEVANCE: The identification of impaired related to many factors. Psychosocial- and socioeconomic factors,
muscle activity in various shoulder pathologies will allow the devel- and co morbidity seem to be of importance for the perception of
opment of truly evidence-based rehabilitation programs to restore back pain. PARTICIPANTS: The study comprised 1007 persons
shoulder muscle function. PARTICIPANTS: 24 participants (13 male, between 45-69 years of age listed at 10 primary care centers.
11 female) with healthy shoulders aged between 18 and 37 years The persons were selected at random. METHODS: The study was
(Mean ±SD = 23.8yrs ±5.2) were included. METHODS: Surface a cross-sectional, general population study, part of the LSH (Life
and intramuscular fine wire electrodes recorded EMG activity from 15 circumstances, stress and health study) studying self-rated health,
shoulder muscles segments (deltoid x 3, trapezius x 3, subscapularis back pain, heart disease and premature death. The data in this study
x 2, latissimus dorsi, pectoralis major and minor, supraspinatus, was based on questionnaires. ANALYSIS: Comparisons between
infraspinatus, serratus anterior and rhomboids). Each participant groups and regression analysis. Data were standardized for age.
performed 10 dynamic coronal plane abduction movements from 0 RESULTS: The point prevalence of back pain was 44%. The five-
to 180º with a light dumbbell. ANALYSIS: A linear envelope (6Hz year prevalence was 69%. Prevalence was slightly higher among
low pass Butterworth 4th Order filter) enabled onset determination, women (49% and 79%). Persons with back pain at present and over
time of peak amplitude, termination and % MVC determination of the past five years were more often on sick-leave and reported a
the activation period for each muscle. The average and standard worse financial situation than people without back pain. Those with
deviation of each muscle characteristic for the 24 subjects was back pain at present also reported lower education level, poorer
calculated. RESULTS: Three muscles were activated before the health-related quality of life (SF-36), self-esteem and coping ability,
movement onset. Supraspinatus (−0.102 sec before movement together with a higher degree of perceived stress, vital exhaustion
onset), middle trapezius (−0.019 sec) and middle deltoid (−0.014 and depression than people without back pain. Women with back
sec) demonstrated consistent pre-emptive activation. Analysis of the pain at present reported less well-being than the men with back pain
time to peak amplitude, termination and %MVC showed a pattern at present. CONCLUSIONS: Back pain was common among 45-69
emerging where the prime movers (supraspinatus and middle deltoid) year olds in a general population and more frequent among women.
were among the first to reach peak amplitude, turn off last or display A relation was seen between reported back pain and reported
the highest % MVC values. CONCLUSIONS: Patterns of activation worse socioeconomic situation, less well-being, lower psychosocial
are apparent in the normal shoulder with the most reproducible status as well as being a women. IMPLICATIONS: The results need
patterns of activation arising from the more prime mover muscle to be taken into account in public health promotion programmes.
sites in all EMG variables analysed. It is these characteristics This study is aimed to form a basis for further analysis of the
(muscle onset, peak EMG and deactivation sequencing between prognosis for back pain in relation to psychosocial, stress and
several of the muscles investigated) that will provide the robust socioeconomic factors. Relation to biological stress markers will
data upon which to compare the EMG waveforms between this also be analyzed. KEYWORDS: neck and/or low back pain, SF-
normative database and that of the pathological shoulder. The pre- 36, gender. FUNDING ACKNOWLEDGEMENTS: The LSH study is
activation of supraspinatus, middle trapezius and middle deltoid supported by the Swedish Research Council and Swedish Heart-
could potentially be the most significant contribution to a pain-free Lung Foundation. CONTACT: [email protected]
shoulder considering the evidence of the importance of muscle pre- ETHICS COMMITTEE: The Research Ethics Committee at Linköping
activation in other joints of the body (e.g. transversus abdominis University
and the lower back, vastus medialis and the knee). IMPLICATIONS:
The identification of invariant muscle characteristics in normal
shoulders allows for a comparison with pathological shoulders and
for rehabilitation programs to incorporate any deficits that may 2729 Tuesday 5 June 11:45
exist. KEYWORDS: Electromyography, shoulder joint, muscle activity. VCEC Ballroom A
FUNDING ACKNOWLEDGEMENTS: A small grant was received CAN EXTERNAL CUES IMPROVE THE BALANCE OF PATIENTS
from the Faculty of Health Sciences, La Trobe University, Melbourne, WITH PARKINSON’S DISEASE?
Australia. CONTACT: [email protected]
Capato T, Mathias M, Piemonte M; Universidade de São Paulo
ETHICS COMMITTEE: Faculty Human Ethics Committee, La Trobe
University, Melbourne, Australia. PURPOSE: To verify the efficiency of motor training associated
with visual and auditory cues on the balance of patients with
Parkinson’s Disease (PD). RELEVANCE: Balance disturbances are
an important symptom of Parkinson’s Disease (PD) which contribute
significantly to loss of independence and functionality. As PD evolves,
disturbances worsen and compromise the quality of life (QL) of
patients. Physiotherapy is an important resource for treating balance
in PD since the pharmaco approach brings little benefits to these with manual assistance (TM), 2) treadmill training with peroneal
motor alterations. A number of studies have shown that external nerve stimulation (TS), 3) treadmill training with robotic assistance
cues associated to motor treatment may yield important benefits (Lokomat robotic orthosis; LR), and 4) overground training with
to the gait of PD patients, yet few have investigated the effect of peroneal nerve stimulation (using a Walkaide2 stimulator; OG).
these cues on balance. DESCRIPTION: Forty two patients with Prior to and following participation we assessed soleus H-reflex
idiopathic PD took part in this study, with a mean age of 65.91+ excitability, reciprocal Ia inhibition, presynaptic (D1) inhibition, post-
6.51 years, at stages 2 to 3 of the Hoehn and Yahr Classification activation depression, flexor reflex excitability and responsiveness
(HY), randomly assigned into one of 3 groups: one group receiving to mechanical stretch. To assess motor control of limb movement
motor training associated to visual and auditory cues (ET), one group during walking, we quantified intra- and interlimb coordination and
performing motor training only (MT) and a third group receiving step symmetry. We also evaluated muscle strength and function-
no treatment. Performance in gait and balance were assessed by related parameters. ANALYSIS: Vector coding techniques were used
a blinded examiner, before and after 10 training sessions (two to quantify the degree of interlimb (hip-hip) and intralimb (hip-knee)
45-minute sessions per week) for the ET and MT groups, and coordination. Repeated measures analysis of variance (ANOVA)
before and after 5 weeks for the CG, using the BERG test (BT) was used to assess changes in coordination values and change
and Postural Stress test (PST). Patients were also assessed for in reflex activity following training. Pearson correlation was used
independence in daily life activities and motor performance using to assess the association between measures of coordination and
section II and III of the Unified Parkinson’s Disease Rating Scale reflex activity. RESULTS: In the TS and TM training groups there
(UPDRS); for Quality of Life using the Parkinson’s Disease Quality of was a statistically significant improvement in the efficacy of tibialis
Life (PDQL), and for emotional state by Beck’s Depression Inventory anterior-to-soleus reciprocal Ia inhibition. This measure was highly
(BDI). The data obtained was compared employing the ANOVA variable in the TS group and the LR group. There was a trend toward
variance analysis model for repeated measurements. Those factors decreased flexor reflex excitability, decreased H-reflex excitability,
yielding category differences on mean comparison then underwent and a decrease in the responsive of the quadriceps to mechanical
the Scheffé post-hoc test to verify level of significance, two by stretch (with greatest change observed in the TS group). There
two. EVALUATION: Results obtained differed amongst groups where were no changes or trends noted in presynaptic (D1) inhibition or
ET and MT groups presented significant improvement in scores post-activation depression. The consistency of intralimb coordination
after training on the BT p < 0.006007), PST (P = 0.034311), UPDRS improved across all groups as did step symmetry. There was a
(P = 0.000640), PDQL(P = 0.000001) and BDI (P = 0.001446), in moderate correlation between change in response to mechanical
contrast to the CG which presented no improvement. However, the stretch and change in intralimb coordination, there was also a fair
ET group presented a significantly greater improvement in scores on correlation between change in intralimb coordination and change in
the BT (P = 0.021562) and the PST (P = 0.036423). CONCLUSIONS: reciprocal Ia inhibition. CONCLUSIONS: In individuals with motor-
Training associated to visual and auditory cues proved beneficial incomplete SCI, task-related practice appears to be associated
to balance performance in PD patients, in comparison to motor with changes in efficacy of selected spinal reflex circuits, with few
training only. IMPLICATIONS: Visual and auditory cues can enhance differences among the different training approaches. Further, there
results achieved through physiotherapeutic treatment of dysfunctions may be relationships between control of gait-related limb movement
in balance of PD patients, might consider as additional resources and some aspects of spinal reflex activity. IMPLICATIONS: These
in the physical therapy practice for PD KEYWORDS: Parkinson’s results suggest that locomotor training is associated with alterations
Disease,balance,gait. FUNDING ACKNOWLEDGEMENTS: None. in the control of walking function which is reflected in improved
CONTACT: [email protected] limb coordination and more typical reflex activity. KEYWORDS:
ETHICS COMMITTEE: Ethical Committee of Hospital das Clinicas Locomotion, activity-dependent plasticity, task-specific, practice.
da Faculdade de Medicina da USP FUNDING ACKNOWLEDGEMENTS: Support Contributed By: NIH
grant HD41487, the Schumann Foundation and The Miami Project
to Cure Paralysis. CONTACT: [email protected]
ETHICS COMMITTEE: University of Miami School of Medicine
1888 Tuesday 5 June 11:45 Human Subjects Institutional Review Board
LOCOMOTOR TRAINING IN INDIVIDUALS WITH SPINAL CORD
INJURY IS ASSOCIATED WITH MORE TYPICAL SPINAL
REFLEX ACTIVITY AND IMPROVED LIMB COORDINATION 2790 Tuesday 5 June 11:45
Field-Fote E1,2 ,
Khan M2 ,
Lindley S2 ; 1 University
of Miami Miller
School of Medicine, Department of Physical Therapy; 2 The Miami SPATIO-TEMPORAL RISK FACTORS FOR FALLS AND
Project to Cure Paralysis FRACTURE FALLS IN RESIDENTIAL AGED CARE
Barker A1 , Haines T1,2 , Nitz J1 , Low Choy N1 ; 1 The Division of
PURPOSE: In animal models of spinal cord injury (SCI), locomotor
Physiotherapy, School of Health and Rehabilitation Sciences, The
training has been shown to be associated with plasticity of spinal
University of Queensland, Brisbane, Australia; 2 Princess Alexandra
reflex activity and improved limb coordination. However, little is known
Hospital, Brisbane, Australia
about the effects of training on spinal reflexes in individuals with
SCI. The purpose of this investigation was to assess the changes in PURPOSE: To identify spatio-temporal characteristics of falls and
spinal reflex activity and inter- and intralimb coordination associated fracture falls in residential aged care. RELEVANCE: Falls remain a
with locomotor training in individuals with chronic, incomplete SCI. major source of disability and accident related mortality for people
RELEVANCE: Disordered neural control following spinal cord injury living in residential aged care. Physiotherapists are at the forefront
is associated with movement dyscoordination and bothersome of designing and delivering falls prevention interventions. Information
involuntary motor output such (e.g., spasticity, clonus, flexor spasms, on falls characteristics offers insight into high risk, locations, activities
and etc). Repeated practice of locomotor activities is associated and times in residential aged care. Knowledge of these factors
with improved neural control, this should be reflected in measures facilitates development of risk management strategies which are
of coordination and reflex activity. PARTICIPANTS: Forty-three (43) evidence-based, and likely to offer reductions in falls and fracture
individuals with chronic (>1 year) motor-incomplete SCI participated falls. PARTICIPANTS: Information from the charts of 98 people
in this study. METHODS: Subjects were trained 5 days/week for 3 living in 4 residential aged care facilities in Australia was collected.
months following assignment to one of four different body-weight METHODS: A retrospective chart audit was conducted. ANALYSIS:
supported (BWS) locomotor training protocols: 1) treadmill training Event rates for falls and fracture falls were calculated. Descriptive
statistics were used to describe circumstances and frequencies carried out within the framework of Interpretative Phenomenological
of falls and fracture falls. To explore the relationships between Analysis. Semi-structured interviews (50-90 minutes) were carried
circumstances and fracture falls, a logistic regression was performed out in participants’ homes. A topic guide was developed to focus
with fracture fall as the dependent variable and location, precipitating on experiences of COPD and views regarding future attendance
activity and fall time as the independent variables. As multiple events at pulmonary rehabilitation. Ethical approval was granted by the
per person were possible, the model was adjusted to cluster by Multi-Region Ethics Committee in Scotland. ANALYSIS: Transcribed
resident. RESULTS: The mean age of residents was 81.47 years interviews were analysed using the QSR N6 computer package.
(SD = 9.35). Data on 362 falls and 20 fractures from falls were Two researchers were involved in developing themes, iteratively
obtained. The mean observation period was 2.40 years (SD =1.44). developing a classification or typology of views and experiences, pro-
The most common location for both falls and fracture falls was the gressing to locate relationships between themes. Three overarching
bedroom, where 228 (64.41%) falls and 11(57.89%) fracture falls master themes emerged. RESULTS: Master themes are labelled to
occurred. Outside was the location associated with the highest risk reflect views or needs described by interviewees. The first describes
of sustaining a fracture from a fall OR 5.50 (95% CI: 1.85-16.35). Falls contrasting experiences and attitudes: ‘Exercise will kill me’ versus ‘I
and fracture falls whist walking were the most common, accounting can’t let it beat me.’ Some individuals developed fear and avoidance
for 153 (42.38%) falls and 13 (68.42%) fracture falls. Walking was the of exercise, translating into wariness about attending pulmonary
activity with the highest risk of sustaining a fracture from a fall OR rehabilitation. Others refused to dwell on negative experiences,
8.94 (95% CI: 1.27-62.76). Fracture falls most commonly occurred were determined to overcome symptoms, and expressed willingness
while walking in the bedroom, between midday and 4pm. Fracture to attend rehabilitation. The second master theme is called: ‘A
falls while walking outside were most common between midday and waste of my time’ versus ‘Doctors know best.’ Participants with
4pm. CONCLUSIONS: A profile of spatio-temporal characteristics of previous negative experiences of management often described low
falls and fracture falls was established. The bedroom is the most expectations of pulmonary rehabilitation. Others expressed faith in
common location for falls and fracture falls. Outside is the location health professionals as a result of positive experiences, and were
with the highest risk of sustaining a fracture from a fall. Walking willing to follow their recommendations. The last theme was labelled:
is the most common precipitating activity for falls and fracture falls, ‘I want to walk and breathe better.’ This reflects individuals’ desire for
and is also the activity with the highest risk of sustaining a fracture professional advice and support in coping better with their condition.
from a fall. IMPLICATIONS: Further investigation should be directed CONCLUSIONS: Individuals frequently recognise that they could
towards identifying environmental factors that contribute to increased be helped to cope better with their COPD symptoms. However,
fracture rates in the afternoon, in the bedroom and outside such some fear that the burden of attending pulmonary rehabilitation
as levels of staff supervision and floor surfaces. Falls prevention will outweigh the benefits. IMPLICATIONS: It is important that
interventions should target residents who are ambulant and spend the aims and content of pulmonary rehabilitation are carefully
periods of time unsupervised in their bedroom or outside in the explained on referral in order to motivate patients and allay any
afternoon. KEYWORDS: Accidental falls, risk factors and residential fears. Positive and informative communications about pulmonary
aged care. FUNDING ACKNOWLEDGEMENTS: Nill. CONTACT: rehabilitation are likely to lead to increased uptake and benefit to
[email protected] more patients. KEYWORDS: Pulmonary; rehabilitation; participation.
ETHICS COMMITTEE: The University of Queensland, Medical FUNDING ACKNOWLEDGEMENTS: Queen Margaret University
Research Ethics Committee. College. CONTACT: [email protected]
ETHICS COMMITTEE: Multi-Region Ethics Committee in Scotland
2031 Tuesday 5 June 11:45 Research Report Platform Presentation
VCEC Meeting Room 17 2486 Tuesday 5 June 11:45
ENCOURAGING ATTENDANCE AT PULMONARY VCEC Meeting Room 18
REHABILITATION: A QUALITATIVE EXPLORATION FACTORS ASSOCIATED WITH THE AMOUNT OF
Bulley C1 , Salisbury L2 , Whiteford S3 , Donaghy M1 , Mackay E3 ; INTERVENTIONS PROVIDED BY PHYSICAL THERAPISTS IN
1 Queen Margaret University College, Edinburgh, Scotland; THE ACUTE HOSPITAL
2 Edinburgh University, Centre for Integrated Healthcare Research,
Grill E1 , Huber E2,3 , Strobl R1 , Gloor-Juzi T2,4 , Stucki G1,5 ; 1 ICF
Edinburgh, Scotland; 3 NHS Greater Glasgow and Clyde, Glasgow, Research Branch of the WHO FIC Collaborating Centre (DIMDI),
Scotland IHRS, Ludwig-Maximilian University, Munich, Germany; 2 Department
of Rheumatology and Institute of Physical Medicine, University
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is
Hospital Zurich, Switzerland; 3 Swiss Association of Physiotherapy,
a limitation of airflow that leads to reduced participation in life.
Sursee, Switzerland; 4 Physiotherapy Science Studies, Department of
Pulmonary rehabilitation uses individually-tailored exercise and
Rheumatology and Institute of Physical Medicine, University Hospital
multidisciplinary education to help people manage their symptoms
Zurich, Switzerland and Faculty of Health Sciences, Maastricht
optimally and be as independent as possible. However, not all
University, the Netherlands; 5 Department of Physical Medicine and
individuals referred to pulmonary rehabilitation participate. This
Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
qualitative study aimed to analyse patient views regarding attendance
at pulmonary rehabilitation to explore influences on their decisions. PURPOSE: To identify the factors associated with intervention
RELEVANCE: Better understanding of influences on attendance time provided by physical therapists RELEVANCE: Common to all
at pulmonary rehabilitation will enable health professionals to take hospitalized patients are a number of risks including complications
actions that increase the likelihood of participation; this will increase of diagnostic procedures and interventions, thrombosis, ulcer and
the numbers of individuals with COPD who take the opportunity hospital infections, to name just a few. Consequently, patients
to learn better ways of managing their condition. PARTICIPANTS: are at risk of experiencing a significant loss of functioning. Early
Individuals with COPD who were referred to a pulmonary rehabili- identification of risks and decrements in functioning and consequently
tation service were invited to participate in a single interview prior early physiotherapeutic interventions should thus complement med-
to joining the programme. It was emphasised that their decision ical and surgical care in the acute hospital. The goals of these
would not impact on any future treatment. Purposive selection of interventions are to minimize the loss of functioning, to facilitate
men and women ensured a variety of experiences. Five women recovery and to promote early independence. The recognition of
and four men aged 59 to 82 completed interviews. All were white mechanisms and the origin of patients’ problems are an essential
Caucasians living in Glasgow, Scotland. METHODS: The study was part of the daily work of physical therapists. Physical therapists
decide about how frequent and how long they treat individual RESULTS: Seven studies examining the accuracy of SIS clinical
patients based on a number of considerations. However, there are tests met the criteria for inclusion. Of these seven studies, eight
no studies that have examined the factors that influence decision clinical tests were described and many of the study results were
making and consequently the amount of resources provided. A better heterogenous. Among all clinical tests, the Hawkins-Kennedy test
understanding of decision making and consequently the amount of demonstrated the highest pooled sensitivity of 83% for assessing
interventions given would provide us with an important basis for a Stage I (95% CI, 74-89) and 74% Stage III (95% CI, 68-79). For
more rational decision making, the allocation of resources in services assessing Stage II, the Hawkins-Kennedy and the Neer test had
provision and the reimbursement of physiotherapeutic interventions. pooled sensitivities of 80% (95% CI, 74-89) and 82% (95% CI, 74-
PARTICIPANTS: Patients with musculoskeletal conditions from a 88), respectively. The Drop Arm test showed the highest specificity for
representative sample of 23 primary, secondary and tertiary care Stage I, II, and III (82%, 87%, 94%, respectively). Pooled DOR data
hospitals in different regions of Switzerland METHODS: The following was similar to sensitivities for Stage I and II, but Stage III pathology
data were collected prospectively on functioning at admission was best detected with tests containing an active component and
to hospital: socio-demographic characteristics, comorbidities, and this included the Supraspinatus test (4.8, 95% CI: 2.3-9.7), Drop
hospital characteristics. The outcome was measured as total time Arm (4.7, 95% CI: 1.7-12.9), and Painful Arc (4.5, 95% CI: 2.8-7.1).
of physiotherapeutic (PT) intervention during the inpatient stay. CONCLUSIONS: Based on the results from this meta-analysis, either
ANALYSIS: Generalized linear mixed models were used to identify the Hawkins-Kennedy or Neer tests had the highest sensitivities
the factors associated with PT intervention time. RESULTS: On for all stages of SIS. The Drop Arm test consistently had the
average, 234 patients (mean age 56.1 years, 50.0% female) had highest pooled specificities across all impingement stages. DOR data
364.2 hours of PT intervention time (median 272.5, 95% CI 320.9- supports the pooled sensitivities findings except in Stage III pathology
407.5). There was significant variation in intervention time across where the Supraspinatus, Painful Arc, and Drop Arm tests were
hospital sites. About 30% of variation in the total sample could best. IMPLICATIONS: This study provides new information about the
be explained by site. Type of hospital (primary and secondary diagnostic accuracy of various clinical tests across the various stages
care) and specialty (physical medicine and rehabilitation) were of SIS pathology. Passive maneuver tests such as the Hawkins-
variables associated with increased intervention time on the hospital Kennedy and Neer test are best for detecting Stage I or II pathology,
level. Single body function, body structure and activity categories whereas tests with an active component are superior for Stage
accounted for 36% of variation in intervention time within hospitals. III. KEYWORDS: Shoulder, impingement, examination. FUNDING
CONCLUSIONS: The amount of PT resources provided to patients ACKNOWLEDGEMENTS: No external funding was received for this
with musculoskeletal conditions is associated with several functioning project.
parameters at admission to the hospital. IMPLICATIONS: Any
prospective payment system should take patients’ functioning into
consideration when developing standards for PT resource funding. It
may be worthwhile to study the influence of distinct components of 3326 Tuesday 5 June 12:05
functioning instead of relying on summary scores. KEYWORDS: ICF, PP Crystal Pavilion B & C
International Classification of Functioning, Allocation of resources, ASSESSMENT OF MECHANICAL NECK FUNCTION IN A
Intervention time. FUNDING ACKNOWLEDGEMENTS: We gratefully VIRTUAL ENVIRONMENT: RELIABILITY STUDY
acknowledge the Swiss Physiotherapy Association for its financial Sarig-Bahat H1 , Laufer Y2 , Weiss T3 ; 1 School of Physical Therapy,
support and the cooperation of all participants in this study. University of Haifa, Israel; 2 School of Physical Therapy, University
ETHICS COMMITTEE: ethic committee of Zurich of Haifa, Israel; 3 School of Occupational Therapy, University of
Haifa, Israel
Research Report Platform Presentation PURPOSE: To assess the test-retest and inter-rater reliability of a
2609 Tuesday 5 June 11:45 novel virtual reality (VR) assessment tool, and to evaluate the effect
VCEC Meeting Rooms 19-20 of a single VR training session on cervical range of motion (ROM).
DIAGNOSTIC ACCURACY OF CLINICAL DIAGNOSTIC TESTS RELEVANCE: Mechanical Neck Disorders (MND) such as Whiplash
FOR SHOULDER IMPINGEMENT SYNDROME Associated Disorders (WAD) constitute a major cause of disability.
Dale R, Bounds M, Crager K, Merkel B, Moore K; Department There is a need for an objective evaluation of the impairments
of Physical Therapy, University of South Alabama, Mobile, AL, USA and disabilities associated with these injuries, in particular for
WAD, where secondary gains may have a significant effect on
PURPOSE: To determine the diagnostic accuracies of clinical tests assessment results. PARTICIPANTS: Fifteen subjects, aged 22-55
for assessing shoulder impingement syndrome (SIS) across the years, with no known neuromuscular pathology, history of spinal
Neer stages of impingement. RELEVANCE: Shoulder impingement disorders, visual or vestibular complaints. METHODS: The study
syndrome is one of the most common conditions of the shoulder, was approved by the Institutional Review Board. A three-dimensional
resulting in pain and loss of function. Several clinical tests are fre- (3D) game-like virtual environment was developed to assess neck
quently utilized in diagnosing SIS, but little evidence exists describing function. A light-weight Head Mounted Display was worn by subjects
their diagnostic accuracy. Pooling sensitivity, specificity, and likelihood to view the game. A 3D two-sensor tracking system was used
ratios are indicators of diagnostic accuracy but their interpretation to collect head motion data which controlled the game cursor.
is difficult when heterogeneity is present. Diagnostic odds ratios Subjects were assessed twice during one session by two different
(DOR), however, are relatively robust to heterogeneity. We therefore assessors, and then again during a second session, 3-7 days later.
performed a meta-analysis of the literature describing the diagnostic ANALYSIS: ANOVAs were used to determine test-retest and inter-
accuracy of various clinical tests for SIS. PARTICIPANTS: Meta- rater reliability, and to determine the effect of a VR training session
analysis of peer-reviewed investigations. METHODS: MEDLINE, on cervical ROM. Significance was set at p0.05. RESULTS: Tests
CINAHL, EMBASE, and SPORTDiscus were searched and the for inter-rater reliability showed no significant difference between
references of various studies were subsequently reviewed to identify raters in all movement directions with 95% repeatability ranging
other potential investigations. Studies included in the meta-analysis between 13-16 degrees. Test-retest analysis of flexion-extension
were selected on the basis of comparing at least one clinical test and side flexion (right and left) movements showed no significant
to arthroscopy. Studies were excluded if data were undeterminable differences with 95% repeatability ranging between 17-18 degrees.
for extraction or it was the only study validating a particular test. However, for rotational movements there were significant differences
ANALYSIS: Data were extracted and pooled for various indicators of between testing sessions. A significant increase of cervical ROM was
diagnostic accuracy using Meta-disc for Windows (Barcelona, Spain). demonstrated in all movements following a single VR training session.
CONCLUSIONS: This novel paradigm has been demonstrated to Disease, Balance, attention. FUNDING ACKNOWLEDGEMENTS:
have good test-retest and inter-rater reliability in the assessment of None. CONTACT: [email protected]
all neck movements except for rotation which failed to support test- ETHICS COMMITTEE: ETHICAL COMMITIE OF HOSPITAL DAS
retest reliability. The single VR session training had a significant CLINICAS DA FACULDADE DE MEDICINA DA USP
effect on increasing neck ROM. IMPLICATIONS: The developed
neck assessment tool uses a virtual environment to reliably measure Research Report Platform Presentation
spontaneous cervical movements while subjects are involved in a
game-like scenario. This may prove particularly important in the
assessment of patients with MND whose movement limitations are
affected by fear of pain, anxiety, or awareness of secondary gain. PATIENT SATISFACTION WITH PRIVATE PHYSIOTHERAPY IN
A study of the ability of this VR paradigm to reveal functional IRELAND
neck disability in patients with MND is now underway. This may Casserley-Feeney S1 , Phelan M2 , Duffy F1 , Roush S3 , Cairns M2 ,
also contribute to a greater understanding of normal and abnormal Hurley D1 ; 1 School of Physiotherapy & Performance Science,
cervical kinematics. The ultimate goal is to adapt the system for University College Dublin, Ireland; 2 School of Health & Emergency
the treatment of patients with MND. KEYWORDS: neck, reliability, Professions,University of Herfordshire, Herts, UK; 3 Physical
virtual reality. FUNDING ACKNOWLEDGEMENTS: Dean’s Research Therapy Department, University of Rhode Island, Kingston, USA
Grant from the Faculty of Social Welfare and Health Studies at the
PURPOSE: To establish patient satisfaction with private physiother-
University of Haifa. Caesarea-Rothschild Institute at the University of
apy in Ireland using the Physical Therapy Outpatient Satisfaction
Haifa. CONTACT: [email protected]
Survey (PTOPS), a valid and reliable measure of patient satisfaction
ETHICS COMMITTEE: Ethics committee at University of Haifa, Israel
with four dimensions (i.e. enhancer, detractor, location, cost).
RELEVANCE: Patient satisfaction is a key indicator of the quality
and effectiveness of healthcare from the patient’s perspective, and
an important determinant of patient adherence. However, it is rarely
Research Report Platform Presentation measured within clinical settings, and there is no universally accepted
2949 Tuesday 5 June 12:05 measure of patient satisfaction in physiotherapy. PARTICIPANTS:
VCEC Ballroom A Participants & Methods: The study comprised two stages: (1) A cross-
RAPID IMPROVEMENT IN BALANCE AND GAIT OF PATIENTS cultural translation/adaptation of the original PTOPS (developed in
WITH PARKINSON’S DISEASE THROUGH TRAINING ON USA) was undertaken by three Irish physiotherapists experienced in
BALANCE AND DIVIDED ATTENTION musculoskeletal management, collated by the Ireland team leader
(DH), sent to the US team leader (SR) for retranslation by three
Capato T, Silva J, Lanzillo J, Piemonte M; Universidade de São Paulo comparable American physical therapists. The retranslated US
PURPOSE: The aim of this study was to assess the efficiency version was found to be equivalent to the original PTOPS and
of balance training carried out simultaneously with a cognitive was used in this study. (2) A cross-sectional survey of patients
task, on balance and gait in patients with Parkinsons Disease attending private physiotherapy clinics in Ireland was undertaken.
(PD patients). RELEVANCE: Of all PD motor symptoms, postural A sample of convenience of 40 private physiotherapy clinics were
selected, of which 24 agreed to participate. METHODS: Between
instability is one of the most incapacitating, where loss of motor
Sept 2005-April 2006 each clinic was sent 10 questionnaire
independence by patients marks a significant stage of disease onset.
packages to be distributed to patients for anonymous completion
Physiotherapy, in conjunction with medication, plays an important
and return to the research team. ANALYSIS: Descriptive data
role in the treatment of this symptom, although no consensus has
analysis was conducted using the Statistical Package for the Social
been reached on the best approach to the problem. Recently, several
Sciences (SPSS, v.11). RESULTS: There was a 55% response
studies have proposed that deficiency in dividing attention associated
rate (n=131/240). Respondents were predominantly male (53.4%,
to the disease, may be one of the factors responsible for this
n=70), married (56.5%, n=74), employed (74.8%, n=98), with a
postural instability. Therefore, studies exploring the clinical potential
higher degree or professional qualification (54.2%, n=71), who
of treatment of divided attention are important for rehabilitation in
had attended physiotherapy for back pain (37.4%; n=49), and had
these patients. DESCRIPTION: A total of 14 PD patients participated previous experience of physiotherapy (65.6%, n=86). Their mean
in this study, 8 men and 6 women, with a mean age of 70.5 age (SD) was 37.69 years (12.44). The mean (SD) number and
years, and between stages 2 and 3 of disease evolution according total cost of treatments were 9 (8.67) and €352.86 (€322.86)
to the Hoehn and Yahr Classification. Results obtained through respectively, at an average cost per treatment of €40. The mean
the Berg Balance test, Time up go and Postural Stress test were (SD), optimum scores and scoring range for each PTOPS dimension
compared by paired test-t, before and after six individual 30-minute were:‘Enhancer’ 41.24 (3.78), 50, 10-50; ‘Detractor’ 19.38 (4.38), 10,
training sessions. Training comprised 3 series of exercises, with 8 10-50; ‘Location’ 27.95 (4.11), 35, 7-35; ‘Cost’ 18.92 (2.82), 7, 7-35].
repetitions, performed in different situations of imbalance and in The results for, i) enhancers(i.e. satisfactory physical environment
parallel to a cognitive task, in which patients had to discriminate and therapist-client interaction) and ii) clinic location were comparable
random auditive signals. All patients agreed to and signed the to the ‘ideal’ scores, whilst respondents were very dissatisfied with
term of consent, approved by the ethics committee. EVALUATION: the cost of private physiotherapy, and somewhat dissatisfied with
Following training, significant improvements were seen in anticipatory detractors (i.e. issues that, if not present, create negative feelings, but
(Berg test: 49.57–53.57; T-value= 6.54; p-value= 0.0001), and if present, are not necessarily associated with positive feelings e.g.
compensatory balance responses (Postural Stress test – 5.28–7.0; T- the clinic being too crowded). The modal responses for the following
value= 3.24; p-value=0.006), as well as in gait performance (Up to Go statements, which were scored on a five point scale from “excellent to
Test: 8.80–7.80; T-value=4.93; p-value=0.0001). CONCLUSIONS: poor”, were: Overall rate of improvement: Very Good (40.5%; n=53).
The balance training carried out simultaneously with a cognitive Chance of recommending practice to a friend: Excellent (60.2%;
task was efficient to improve the balance and gait in PD patients. n=80). Overall Satisfaction: Very Good (42%; n=55). Chances of
IMPLICATIONS: Motor training, in conjunction with cognitive tasks returning to this clinic: Excellent (62.6%; n=82). CONCLUSIONS:
requiring division of attention, may improve balance and gait in Conclusions & Implications: This study confirmed the feasibility of
PD patients, stimulating the automatic motor control fundamental measuring patient satisfaction and has provided values for private
for these tasks and should be consider in the elaboration of physiotherapy in Ireland. IMPLICATIONS: A national comparative
physical therapy treatment for PD patients. KEYWORDS: Parkinson’s survey of patient satisfaction with publicly-funded physiotherapy is
underway. KEYWORDS: Private Physiotherapy, Patient Satisfaction. Research Report Platform Presentation
FUNDING ACKNOWLEDGEMENTS: Health Research Board, Ire- 3132 Tuesday 5 June 12:05
land for Research Project Grant. CONTACT: [email protected] VCEC Meeting Room 16
ETHICS COMMITTEE: The study was approved by the University of RISK FACTORS OF FRACTURES AMONG OLDER PERSONS IN
Hertfordshire Faculty Of Health And Human Sciences Radiography A FINNISH MUNICIPALITY – A POPULATION-BASED 12-YEAR
And Physiotherapy Ethics Committee. FOLLOW-UP
Piirtola M1,2 , Vahlberg T3 , Isoaho R1,4 , Aarnio P5 , Kivelä S1,5,6 ;
1 Department of Family Medicine, University of Turku, Turku,
Research Report Platform Presentation Finland; 2 Härkätie Health Centre, Lieto, Finland; 3 Department
968 Tuesday 5 June 12:05 of Biostatistics, University of Turku, Turku Finland; 4 Pori Health
VCEC Meeting Rooms 11-12 Centre, Pori, Finland; 5 Satakunta Central Hospital, Pori, Finland;
6 Unit of Family Medicine, Turku University Hospital, Turku, Finland
OUTCOMES OF CYCLING AND/OR ELECTRICAL STIMULATION
FOR CHILDREN WITH SPINAL CORD INJURY PURPOSE: The purpose of this study was to analyse gender
Johnston T, Lauer R, Smith B, Mulcahey M, Betz R; Shriners specific risk factors of fractures among persons 65 years or older
Hospitals for Children, Philadelphia, PA, USA during the follow-up of 6 and 12 years. RELEVANCE: Long-term
risk factors of fractures should been identified and screened in
PURPOSE: Determine the effects of cycling and/or electrical
physiotherapy practice in order to reduce falls and fractures among
stimulation on the musculoskeletal, respiratory, and cardiovascular
systems of children with spinal cord injury (SCI). RELEVANCE: older persons. PARTICIPANTS: 1177 subjects aged 65 years or
Children with SCI are at risk for secondary complications. Cycling older (482 men, 695 women), mean age 73 years (range 65-97),
with functional electrical stimulation (FES) has led to improvements living in the municipality of Lieto, located in South-Western Finland.
in adults with SCI, but no studies have examined these effects METHODS: A true population-based cohort study started in October
in children or have compared the effects of FES cycling to those 1990. Information about fractures among 1177 participants was
of passive cycling or electrical stimulation alone. PARTICIPANTS: collected individually from health care registers during 1991-2002.
Seventeen subjects, ages 9.1 ±2.4 years, with American Spinal Injury The mean follow-up period was 8.5 years. ANALYSIS: Subjects
Association A or B SCI of 5.2 ±2.3 years duration participated. having sustained at least one fracture during 6 or 12 year follow-
Fifteen subjects sustained an SCI due to motor vehicle accidents, up period were compared with subject with no fractures at the
one sustained an intrauterine SCI, and one subject’s SCI resulted same follow-up period. Risk factors of fractures were analyzed using
from chemotherapy. METHODS: Subjects were randomly assigned Poisson regression model. All analyses were done separately for men
to one of three interventions: functional electrical stimulation (FES) and women. RESULTS: In multivariate Poisson regression analyses
cycling, passive cycling (PC), and electrically stimulated exercise the independent risk factors among women during six years of
(ES). Children exercised one hour three times per week for 6 follow-up were weak hand grip strength (Relative Risk (RR) 2.2,
months at home. Data collected included stimulated quadriceps and 95% confidence intervals (95% CI) 1.2-4.0) low BMI (body mass
hamstrings strength, hip and knee bone mineral density (BMD), index) (RR 2.1, 95% CI: 1.3-3.4), poor cognitive ability (RR 2.4,
lipid profiles, and heart rate (HR) and oxygen consumption (VO2/kg) 95% CI: 1.1-5.7), and in a chest radiogram observed compression
during arm ergometry. ANALYSIS: 2 x 2 ANOVAs (group x time) were fracture in one or more thoracic vertebras (RR 2.3, 95% CI: 1.4-
performed. RESULTS: Differences (p < 0.05) were seen between 3.8). In 12 years of follow-up the risk factors were weak hand grip
groups over time for BMD at Ward’s triangle (hip) and the distal strength (RR 2.2, 95% CI: 1.4-3.4), low BMI (RR 2.0, 95% CI: 1.3-
femur with the FES groups having increases of 65.1 ±100% and 2.8), and in the chest radiogram observed compression fracture
16.3 ±24.4% respectively. The PC group had increases at Ward’s in one or more thoracic vertebras at base line (RR 2.0, 95% CI:
triangle (45.4 ±104.4%). The ES group had decreases at both 1.4-3.0). Among men a high amount of depressive symptoms (RR
locations. Similar trends were seen at the femoral neck, overall hip, 3.6, 95% CI: 1.7-7.6), (RR 2.0, 95% CI: 1.2-3.4), and in the chest
and tibia with the FES group having increases in all areas, and radiogram observed compression fracture in one or more thoracic
BMD in the PC group increasing only around the hip. There were no vertebras (RR 4.1, 95% CI: 1.8-9.6), (RR 3.4, 95% CI: 1.8-6.2) were
significant differences between groups over time for other variables; related to the risk of sustaining at least one fracture during both
however trends were present. Stimulated strength improved in all six and 12 years of follow-ups, respectively. CONCLUSIONS: The
groups for the quadriceps by 126.3 ±88.6% (FES), 34.8 ±89.5%
Risk factors of sustaining fractures among persons 65 years or older
(PC), and 49.6 ±87.1% (ES) and for the hamstrings by 45 ±49%
varied by gender. In the chest radiogram observed compression
(FES), 52.2 ±44% (PC), and 16.4 ±27.8% (ES). All groups showed
fracture in one or more thoracic vertebras at base line was an
decreases in triglyceride levels (FES: −15.7 ±22.2%, PC: −12.2
independent risk factor in both genders. IMPLICATIONS: This
±10.2%, ES: −4.9 ±48.2%), but there were no changes in other
new information about predictive, independent, and gender specific
lipid measures. During arm ergometry, the FES group’s peak VO2/kg
risk factors provides new possibilities in prevention of falls and
increased (43.1 ±7.5%), but the other groups experienced declines
(PC: −18.6 ±28.2%, ES: −15.8 ±25.4%). Peak HR declined in all fractures in clinical everyday work. More education for physiotherapist
groups (FES: −7.5 ±8.6%, PC: −4.5 ±21.9%, ES: −8.5 ±16.6%), and all health care professionals is needed. KEYWORDS: Risk
and resting HR declined in the FES (−11.2 ±10.8%) and PC factors, fractures, older people. FUNDING ACKNOWLEDGEMENTS:
(−3.6 ±19.3%) groups, but not in the ES group (3.2 ±10.5%). The baseline study was supported by The Academy of Finland,
CONCLUSIONS: The FES group showed trends for having the The Yrjö Jahnsson Foundation, and The Finnish Anti-Tuberculosis
greatest overall changes; however improvements were seen in Association. The follow-up study of fractures was supported by The
the PC and ES groups, indicating that all 3 interventions may La Carita Foundation, The Finnish Cultural Foundation; The Regional
provide benefits to children with SCI. IMPLICATIONS: Cycling and/or Fund of Varsinais-Suomi – The Laina and Aarne Alitalo, The Juho
electrical stimulation can improve health outcomes in children with Vainio Foundation, grants from Satakunta Hospital District and Lieto
SCI and may lead to longer term musculoskeletal, respiratory, and Health Centre, and the scholarship fund of the Ageing, Wellbeing and
cardiovascular benefits. KEYWORDS: Spinal cord injury, pediatrics, Technology graduate school. CONTACT: maarit.piirtola@utu.fi
cycling. FUNDING ACKNOWLEDGEMENTS: Shriners Hospitals for ETHICS COMMITTEE: The Joint Ethics Committee of the Turku
Children, Grant #8540. CONTACT: [email protected] University and Central Hospital and the Finnish Ministry of Social
ETHICS COMMITTEE: Temple University Institutional Review Board Affairs and Health.
A SINGLE CASE STUDY IN THE IMPLEMENTATION OF A MAPPING THE STROKE IMPACT SCALE TO THE INTERNA-
BEHAVIOURAL MODIFICATION MANUAL IN A CARDIAC TIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND
REHABILITATION CENTRE HEALTH: USING A STANDARDIZED PROTOCOL
Hopkins-Rosseel D; School of Rehabilitation Therapy, Faculty of Moriello C1 , Mayo N1 , Stolee P2 , Byrne K3 , Cieza A4 ; 1 School
Health Sciences, Queen’s University, Kingston, Ontario, Canada of Physical and Occupational Therapy, McGill University,
PURPOSE: To pilot a behavioural modification manual (BMM) Montreal, Quebec, Canada; 2 Lawson health Research Institute,
developed for use in cardiac rehabilitation (CR) with a focus on St. Joseph’s Health Care London Ontario Canada; 3 Rehabilitation
enhancing the adoption of healthy exercise behaviours using a single Sciences, University of Western Ontario, London Ontario Canada;
4 Department of Physical Medicine and Rehabilitation, University
case study. RELEVANCE: The effectiveness of adopting exercise
regimes depends on the individual being able to initiate and maintain of Munich, Germany
the change over time yet, we may be limiting our effectiveness by PURPOSE: The purpose of this study was to create coded functional
not evaluating individual’s readiness for change, their ability to make status indicators for the items of the SIS-16 using the ICF as a coding
change or continue that change over time. In the Transtheoretical framework. The specific aim is to describe the mapping protocol.
Model Model of Behaviour Change (TTM), or ‘Stages of Change’ RELEVANCE: Electronic Health Records (EHR) are able to provide
(SOC), Prochaska and DiClemente (DiClemente, 82, 85, 90, 91; a substantial amount of data for research in the clinical, population
Prochaska, 79, 82, 83, 85, 87, 88, 91, 92, 94, 97) proposed 5 SOC: and health related services. However, there is some valuable
pre-contemplation, contemplation, action, maintenance and relapse. information missing, such as a patients’ functional status (such as
An additional stage, preparation, was proposed in 1991. Subsequent the ability to perform activities of daily living). This information would
research lead to the development and validation of questionnaires have great value for care planning and outcome measurement,
to measure and document patient’s their (1) stage of change, (2) and in planning for service needs, but these data are typically
processes of change, (3) decisional balance and (4) degree of self- not being captured electronically in this new technological era.
efficacy. DESCRIPTION: A BMM in CR was developed based on the PARTICIPANTS: Nineteen professionals from various disciplines.
TTM to enhance patient outcomes. The BMM includes an introduction METHODS: All participants received a training package prior to
to the SOC model, the questionnaires and sections addressing this mapping exercise. It included a Power Point presentation that
behaviours linked to cardiovascular risk: (i) smoking, (ii) nutrition, explains the terminology of the ICF along with rules for mapping,
(iii) exercise and (iv) stress. There is also a clinician instructional an article describing the rules for mapping existing items to the
component. A 58 year old female with known coronary artery disease ICF coding system, and the SIS-16 questionnaire. They were then
and one month post-myocardial infarction (MI), who was admitted to asked to assign alphanumeric codes to each item of the SIS-16
an ambulatory multidisciplinary CR centre was recruited to the trial. questionnaire. A Delphi technique was used to obtain consensus. In
This patient was selected due to the patient’s history of a previous MI addition, cognitive debriefing sessions were conducted with persons
with unsuccessful rehabilitation, no co-morbidities and an extensive with a stroke living in the community. The purpose of the sessions
risk factor profile. She was a never smoker. The patient provided was to determine the meaning of the chosen items to the individual.
her informed consent. The subject went through the 1st section of ANALYSIS: The percentage of agreement was calculated for all
the manual with the PT and then completed the questionnaires with suggested codes. A percentage of agreement of greater than or
exercise as the primary outcome. The exercise section was used as equal to 70% was selected a priori as a threshold that needed
the primary intervention and the BMM was revisited monthly over 4 to be met in order for a code to be endorsed. RESULTS: There
months. EVALUATION: The subject was in the contemplation SOC were 7 items that reached a 4 digit level consensus with agreement
on admission, rated ‘dramatic relief’ and ‘self-reevaluation’ as her ranging from 70 to 100%. At the 3 digit level, consensus was
primary processes of change, demonstrated a precarious decisional reached for 5 items with agreement ranging from 89 to 100%. A
balance [DB] (cons 22: pros 15) and low self-efficacy [SE] (36 of total of 3 items did not reach consensus therefore these items do
a possible 90). The subject was compliant (attendance at exercise not have functional status indicators. Cognitive debriefing sessions
sessions 2x/week, education sessions 1x/week and counseling demonstrated some inconsistency between interpretation among
sessions 1x/month). She also documented her daily walk in her different respondents and the developers of the questionnaire. Also
logbook but was sporadic at completing and recording her weekly uncovered was gaps in the ICF relating to common constructs in
independent exercise session. BMI decreased from 31.6 to 29.1 physical therapy. For example, balance is not represented in the
kg/m2 and waist circumference decreased by 4.1 cm. At discharge ICF, but equilibrium is coded under dizziness. CONCLUSIONS:
she rated her SOC as ‘action’, her DB was 10: 16 and her SE had There exists a degree of conceptual ambiguity between terminology
increased to 59. CONCLUSIONS: The BMM was user friendly and commonly used in physical therapy and its outcome measures and
its application with this subject appeared to improve her outcomes in the ICF. Communication is facilitated by having a common language
cardiac rehabilitation compared to her previous attempt. Although the and the ICF framework should be adopted. On a practical level it
subject did move successfully forward, the measures suggested her makes more sense to develop a measure based on the ICF. This
status would remain precarious until she entered the maintenance would reduce ambiguity in terminology. Items should then also be
stage, reported lower temptation and a higher SE. IMPLICATIONS: written in a manner that the respondents will interpret the items as
The use of BMM with objective outcome measures may enhance they are defined by the ICF. IMPLICATIONS: This demonstrates the
rehabilitation outcomes. Future study should randomize individuals added benefit of using the ICF to map existing measures, its value
entering cardiac rehabilitation into a group using the manual and for the electronic health era and also to use as a foundation to the
a matched control group using usual interventions. KEYWORDS: future developed measures. KEYWORDS: electronic health records;
Behavioural modification, stages of change, rehabilitation practice mapping; ICF; SIS-16. FUNDING ACKNOWLEDGEMENTS: CIHR.
model. FUNDING ACKNOWLEDGEMENTS: Not applicable.
ETHICS COMMITTEE: Queen’s University Research Ethics Board
Research Report Platform Presentation is routinely taught on short post-graduate Mulligan Concept and
3098 Tuesday 5 June 12:05 other courses. It is therefore important that physiotherapists using
VCEC Meeting Rooms 19-20 this approach must be able to accurately identify the presence
WHAT IS THE BEST CLINICAL TEST FOR IDENTIFYING SLAP and degree of FRT dysfunction. PARTICIPANTS: This study was
LESIONS OF THE SHOULDER? RESULTS OF A SYSTEMATIC staged in two parts. In the first, two experienced examiners
REVIEW independently evaluated 20 subjects with CGH of C1/2 origin, 10
asymptomatic subjects and 10 CGH subjects not of C1/2 origin, for
Walton D, Sadi J; The University of Western Ontario
FRT dysfunction and agreement determined. CGH was based on
PURPOSE: To identify the best clinical test for identifying SLAP published guidelines for headache classification. Cervical segmental
lesions of the shoulder, based on critical evaluation of available level of involvement was based on manual diagnosis. In the second
evidence using pre-defined criteria. RELEVANCE: SLAP lesions part, two inexperienced and one experienced examiners evaluated
are difficult to manage conservatively. Arthroscopic repair is the the FRT in 12 CGH and 12 asymptomatic subjects and agreement
management approach of choice. Gold standard evaluation, including determined. Subjects were a sample of convenience. METHODS:
MR arthrography and arthroscopic investigation are not always Ethical approval was granted for this study. The rights of individuals
feasible. Clinicians would benefit from the ability to screen for these were respected at all times and all subjects provided written informed
conditions prior to referral for more invasive work-up. There are a host consent. An index of headache severity and demographic data
of tests described in the literature, many of which report diagnostic was determined by questionnaire. FRT range was measured to
accuracy which is not repeated in subsequent investigations. A the left and right using a goniometer placed on the apex of
new critical appraisal of this literature is needed. PARTICIPANTS: the skull. Examiners were blind to each other and independently
N/A METHODS: Key databases were searched and articles that measured FRT range and were required to classify the FRT as
fit our inclusion criteria were retained for evaluation. Articles were positive if there was a greater than 10 degree reduction in range.
graded based on the presence of 4 criteria for methodologic ANALYSIS: ANOVA and planned orthogonal comparisons were
validity, diagnostic accuracy, risk of flaring an irritable condition, and used to analyze FRT range. Bland-Altman and linear regression
difficulty in learning the technique and interpreting the results of the plots were produced for each comparison between examiners.
test. ANALYSIS: N/A RESULTS: A total of 12 published articles Sensitivity, specificity and agreement of the FRT were analyzed
describing 14 different tests for SLAP lesions were retained for review. using cross tabulation and a receiver operating curve. RESULTS:
As expected, the findings of high sensitivity and specificity reported Mean sensitivity and specificity of the FRT was 90% and 88%
in the initial development report of many tests were not repeated with 92% agreement for experienced examiners (p < 0.001). Overall
by subsequent investigations. Critical review reveals methodologic diagnostic accuracy was 89% (p < 0.001) and kappa 0.85. For
problems in many articles. The Resisted Supination/External Rotation inexperienced examiners, FRT range was significantly greater than
test received the highest grade in this review. CONCLUSIONS: for experienced examiners, but sensitivity, specificity, agreement and
Clinicians should be prepared to critically evaluate reports of kappa values were all within acceptable levels for clinical tests.
new clinical tests as we discovered many methodologic limitations Accuracy of the FRT is not diminished in CGH diagnosis when the
in currently-available literature. The Resisted Supination/External sample comprises mixed levels of symptomatic cervical segments.
Rotation test appears to be the best available clinical test for CONCLUSIONS: The FRT can be used accurately and reliably by
identifying SLAP lesions, although this test has yet to be investigated experienced and inexperienced examiners and is a useful aid in CGH
in groups other than the initial validation report. IMPLICATIONS: evaluation. IMPLICATIONS: This study should give inexperienced
The Resisted Supination/External Rotation test appears to be a examiners increased confidence in their ability to diagnose FRT
useful screening tool for identification of patients who would benefit dysfunction. KEYWORDS: Headache, manual diagnosis. FUNDING
from more invasive diagnostic exploration. KEYWORDS: SLAP, ACKNOWLEDGEMENTS: This study was unfunded. CONTACT:
systematic review, clinical test. FUNDING ACKNOWLEDGEMENTS: [email protected]
The authors received no funding in support of this project. CONTACT: ETHICS COMMITTEE: Curtin University Human Research Ethics
[email protected] Committee

THE INFLUENCE OF EXAMINER EXPERIENCE ON ACCURACY DISTINCTION BETWEEN PARESIS AND DEXTERITY: A
AND INTERPRETATION OF THE CERVICAL FLEXION-ROTATION CLINICAL CHALLENGE IN SCI
TEST IN CERVICOGENIC HEADACHE EVALUATION Wirth B1,2 , van Hedel H1 , Curt A3 ; 1 Spinal Cord Injury Center,
Hall T1 , Robinson K1 , Fujinawa O2 , Akasaka K3 ; 1 Curtin University, Balgrist University Hospital, Zurich, Switzerland; 2 Swiss Federal
Perth, Western Australia; 2 Saitama Prefectural University, Saitama, Institute of Technology, Zurich, Switzerland; 3 ICORD, University
Japan; 3 Saitama Medical University College, Saitama, Japan of British Columbia, Vancouver, Canada
PURPOSE: The cervical flexion-rotation test (FRT) is used to PURPOSE: Motor performance after a lesion of the central nervous
identify C1/2 segmental dysfunction in cervicogenic headache system can be affected by both muscle weakness (paresis) and
(CGH). Previous research has provided preliminary evidence of dexterity (the ability for coordinating muscle activity to meet
agreement, sensitivity and specificity for this test for experienced environmental demands).The aims of this study were (1) to develop
examiners, but no studies have investigated these characteristics a simple foot motor test that gives deeper insight into motor recovery
for inexperienced/naive testers. Therefore the purpose of this study after incomplete spinal cord injury (iSCI) (by being applicable from the
was to determine whether inexperienced examiners have the same acute stage after iSCI throughout rehabilitation and by distinguishing
accuracy and agreement, when using the FRT, as experienced between paresis and impaired dexterity) and (2) to link its results to
examiners. A secondary objective was to establish the accuracy of ambulatory capacity. RELEVANCE: At present, motor assessments
the FRT at identifying C1/2 dysfunction in a mixed sample, with CGH after iSCI are limited to isometric muscle tests and gait tests.
arising from varied cervical symptomatic segments. RELEVANCE: However, in addition to isometric muscle strength, dynamic muscle
CGH is a common condition frequently managed by physiotherapy. A performance is of particular importance for safe locomotion and
novel exercise approach has been developed by Mulligan to manage walking tests are of limited value in monitoring the early stage of
CGH in subjects with identified FRT dysfunction. This approach recovery after iSCI. Regarding new treatment strategies in SCI,
there is a need for precise assessment of motor recovery after of randomisation. The implementation group underwent education
iSCI. PARTICIPANTS: For the first study, 16 in- and outpatients by opinion leaders about whiplash guidelines and the dissemination
(5 females; mainly ASIA C and D; mean age 53.6±17.0 years) group had the guidelines mailed to them. The primary outcome
with iSCI were recruited at an SCI center in Zurich, Switzerland. was patient disability, measured using the Functional Rating Index,
16 healthy subjects (mean age 51.9±14.4 years) were matched for collected on admission to the trial and at 1.5, 3, 6 and 12 months.
gender and age. Gait capacity was tested in 20 iSCI patients (6 Physiotherapist knowledge about the guidelines was measured using
females; ASIA C and D; mean age 55.8±14.3 years). METHODS: a custom made questionnaire. Physiotherapist practice and cost of
The subjects had to perform auditory-paced repetitive ankle dorsi- care were measured by audit of patient notes. ANALYSIS: Patient
and plantarflexion movements (0.8 to 3.2 Hz at intervals of 0.4 outcomes were analysed using an independent t test and adjusted
Hz) in supine position as accurately in timing and with the largest for the cluster effect using the ACLUSTER software developed by
range of motion (ROM) possible. Ankle movements were measured Pinol and Piaggio (2000). Physiotherapist knowledge and practice
by an electric goniometer. Walking speed was assessed by a 10 outcomes were analysed using linear regression for continuous
meter walk test at preferred and maximal speed. ANALYSIS: ROM data (eg total questionnaire score and cost of care) adjusted for
and peak velocity of dorsi- and plantarflexion was determined per the before trial score, Mann Whitney test for ordinal data and Chi
movement cycle and averaged for each frequency. Accuracy of timing Square test for categorical data. RESULTS: There were no significant
was calculated by determining the duration of each movement cycle. differences between groups for any of the patient outcomes at any
The average was then converted to a frequency and compared to time. The implementation patients had 0.6 (95% CI −7.8 to 6.6)
the target frequency. RESULTS: 1. The iSCI subjects were able less disability than the dissemination patients at 12 months. 44%
to follow the target frequency with high accuracy (up to 1.6 Hz, more physiotherapists in the implementation group reported that
healthy subjects to 2.4 Hz). The difference in accuracy between they prescribed the two endorsed treatments of reassurance and
the two subject groups was not significant prior to 3.2 Hz. However, advice to act as usual, and 32% more actually prescribed them.
ROM and peak velocity for dorsi- and plantarflexion were significantly The cost of care for patients in the implementation group was $255
reduced at all frequencies in the patient group. 2. The peak (95% CI −1505 to 966) less than for patients in the dissemination
velocity in dorsiflexion at 2.4 Hz (=frequency, where absolute peak group. CONCLUSIONS: Although the active implementation program
velocity was reached on average) of the more affected leg highly increased guideline-consistent practice, patient outcomes and cost
correlated to maximal (Spearman correlation coefficient rS=0.86) and of care were not affected. IMPLICATIONS: Future implementation
preferred gait speed (rS=0.85). CONCLUSIONS: Foot dorsal- and strategies for clinical guidelines in physiotherapy may be guided
plantarflexion movements allow for distinguishing between paresis by our results, given an active implementation strategy including
and reduced dexterity. In longitudinal studies, the quantification education successfully changed physiotherapy practice. However, in
of these movement components is thought to give insight into order to change patient health outcomes, we suggest implementation
the mechanisms of motor recovery after iSCI. IMPLICATIONS: strategies in the future may need to target practitioners whose
Deeper understanding of the mechanisms underlying motor recovery baseline practice deviates more substantially from the guidelines,
after iSCI might contribute to focusing rehabilitation strategies after and suggest that some elements of the guideline content may not
iSCI. KEYWORDS: Incomplete spinal cord injury, paresis, dexterity. be essential. KEYWORDS: health plan implementation, practice
FUNDING ACKNOWLEDGEMENTS: This study was supported by guidelines, whiplash injuries. FUNDING ACKNOWLEDGEMENTS:
the International Spinal Research Trust (ISRT), Clinical Initiative This study was funded by the Motor Accidents Authority of New
Stage II. CONTACT: [email protected] South Wales, who also provided administrative assistance. This
ETHICS COMMITTEE: Kantonale Ethikkommission des Kantons organisation, which is the regulator of compulsory third party
Zurich, Zurich, Switzerland insurance companies had no part in the analysis of the data or
reporting of this study. CONTACT: [email protected]
Research Report Platform Presentation ETHICS COMMITTEE: University of Sydney Human Research Ethics
Committee
EVALUATING TWO IMPLEMENTATION STRATEGIES FOR Research Report Platform Presentation
WHIPLASH GUIDELINES IN PHYSIOTHERAPY: A CLUSTER 1513 Tuesday 5 June 13:05
RANDOMISED TRIAL PP Crystal Pavilion B & C
Rebbeck T; School of Physiotherapy, University of Sydney CERVICAL RANGE OF MOTION IN WHIPLASH
Woodhouse A, Vasseljen O; NTNU – Norwegian University
PURPOSE: The purpose of this cluster randomised trial was to of Science and Technology, Faculty of Medicine, Dep of Community
evaluate two implementation strategies for whiplash guidelines. Medicine and General Practice, Trondheim, Norway
RELEVANCE: This study is relevant to the education and research
tracks of the conference. The clinical guidelines that are implemented PURPOSE: The aim of this study was to investigate group differences
are based on best evidence, as obtained from a systematic review. in cervical range of motion (ROM) between persons with persistent
Increasingly, clinical guidelines are used as a method to facilitate whiplash-associated disorders (WAD), persons with chronic non-
evidence based practice, and this study is one of only 3 studies traumatic neck pain and asymptomatic volunteers. Primary and
published on implementing clinical guidelines in physiotherapy. conjunct ranges of motion were measured. RELEVANCE: Evidence
PARTICIPANTS: 100 physiotherapy clinics in two states of Australia suggests that cervical ROM can be an indicator of physical
(NSW and ACT) that had seen at least five whiplash cases in impairment in the cervical spine. Cervical ROM has also been
the previous year were identified from an insurer database. They found capable of discriminating between asymptomatic persons
were ranked by median cost per whiplash claim by the insurer. and persons with persistent WAD. There is however inconclusive
Invitations to participate in the study were sent to 24 physiotherapy evidence on differences between persons with persistent WAD and
clinics in the highest, and 24 clinics in the lowest quartiles. persons with persistent non-traumatic neck pain. In the diagnosis
Twenty-seven physiotherapy clinics agreed to participate and were and treatment of persons with persistent WAD there is still a need to
randomised into an implementation group (n=14) or a dissemination explore ROM in this group PARTICIPANTS: The study participants
group (n=13). One hundred and three patients presenting to the were divided into three groups: A “WAD group” of 56 persons with
physiotherapists with acute whiplash participated (implementation persistent WAD (22 men, 34 women, mean age 38.0 years), a
group n=72, dissemination group n= 31). METHODS: We conducted “neck group” of 53 persons with chronic non-traumatic neck pain
a cluster-randomised controlled trial, with physiotherapists the unit (19 men, 34 women, mean age 43.9 years) and a control group
of 57 asymptomatic volunteers (29 men, 28 women, mean age would be appropriate for research and clinical use in the assessment
38.2 years). METHODS: Three dimensional cervical motion ranges of unsupported sitting balance in people with SCI. KEYWORDS:
were measured using a 3Space Fastrak™ device (Polhemus, Inc, SCI, Balance, Measurement. FUNDING ACKNOWLEDGEMENTS:
Colchester, Vermont, USA). All measurements were done in a Supported by the NSW Premier’s Spinal Cord Injury Grant Program
seated position with shoulders fixed to a backrest. Movements were and the National Health and Medical Research Council of Australia.
assessed in the full range of the three primary motion planes. Three ETHICS COMMITTEE: Royal Rehabilitation Centre Sydney Ethics
repetitions of each movement were performed. ANALYSIS: Mean Committee and South East Health Human Research Ethics Commit-
values of ROM and conjunct motion for each subject were computed tee
in all planes. General linear modelling was used to compare ROM
and conjunct motion between groups. ROM was adjusted for group
differences in age and sex. Compound motion was additionally
adjusted for the primary plane ROM. RESULTS: Cervical ROM in 1976 Tuesday 5 June 13:05
all primary motion planes was significantly different between the VCEC Meeting Room 18
three groups, sagittal plane being most affected. Conjunct motions THE DEVELOPMENT AND EVALUATION OF A MULTIFACETED
were significantly different between groups in some motion planes. IMPLEMENTATION STRATEGY TO IMPLEMENT THE DUTCH
CONCLUSIONS: Cervical ROM differentiated between the three GUIDELINES FOR PHYSICAL THERAPY IN PARKINSON’S
groups in all planes. IMPLICATIONS: The relevance of Cervical ROM DISEASE
and conjunct motion in the diagnosis and treatment of WAD should Munneke M1 , Keus S2 , Nijkrake M1 , Kwakkel G3 , Bloem B1 ;
be acknowledged. KEYWORDS: WAD, neck pain, Fastrak, Cervical 1 Radboud University Nijmegen Medical Centre, Netherlands;
Range of Motion. FUNDING ACKNOWLEDGEMENTS: The project 2 Leiden University Medical Center, Netherlands; 3 VU Medical
received financial support from The Norwegian Fund for Postgraduate Center, Amsterdam, Netherlands
Training in Physiotherapy. CONTACT: [email protected]
ETHICS COMMITTEE: Regional ethichs committe in Trondheim, PURPOSE: To develop a multifaceted implementation strategy in
Norway. order to implement the Dutch guidelines for physical therapy in
Parkinson’s Disease (PD) and to set up a cluster randomised
study to evaluate this implementation strategy. RELEVANCE: In PD,
Research Report Platform Presentation physical therapy is often prescribed. In the Netherlands more than
2220 Tuesday 5 June 13:05 60% of PD patients are referred to an physiotherapist. In 2004
VCEC Meeting Rooms 11-12 an evidence-based clinical practice guideline for physical therapy
RELIABILITY OF ASSESSMENT TOOLS TO MEASURE in PD was distributed to all physical therapists in the Netherlands
UNSUPPORTED SITTING BALANCE IN PEOPLE WITH SPINAL (available via www.kngf.nl and www.cebp.nl). However, distribution
CORD INJURIES hardly ever results in implementation. Therefore, we developed an
implementation strategy and evaluated this strategy. DESCRIPTION:
Boswell-Ruys C1 , Sturnieks D1 , Lord S1 , Harvey L2 , Sherrington C1 ,
The implementation strategy consists of six steps: 1) selection of
Middleton J2 ; 1 Prince of Wales Medical Research Institute and
therapists who applied to participate in a small PD expert network;
University of New South Wales, Sydney, Australia; 2 Rehabilitation
2) a 4.5 day, competence oriented basic course in covering PD in
Studies Unit and University of Sydney, Sydney, Australia
general, and correct use of the guideline for physical therapy in
PURPOSE: The ability to maintain balance in sitting is an important PD; 3) a web-based learning management system which facilitates
determinant of independence in people with spinal cord injuries (SCI). continuous education (e.g. completing tasks, sharing knowledge,
However, there are as yet no standardised measures of seated exchanging experiences) combined with feedback from coaches;
balance. The aim of this study was to develop simple and reliable 4) two-monthly seminars in which PD related topics will be discussed;
measurements of unsupported sitting balance in people with SCI. 5) a decision supporting, web-based electronic patient record which
RELEVANCE: Physiotherapists spend a large percentage of reha- guides the therapist through the guideline; 6) involvement of referring
bilitation time training seated balance, yet the lack of measurement physicians. EVALUATION: The multifaceted implementation strategy
tools leaves therapists unsure of the effectiveness of their treatment. has started in eight regions in the Netherlands. Willingness to enrol in
PARTICIPANTS: 30 people with SCI participated in this study. Sub- a PD network was high. Forty-three therapists are selected to enroll
jects were recruited from the community and the local hospital. Each in the PD expert network. These therapists are continuous educated
subject’s level of injury was between C6 and L1 and the classification through the PD basic course, the web-based learning management
varied from complete (AISA A) to incomplete (AISA B, C or D). system, and the electronic patient record. To evaluate the effective-
METHODS: Subjects performed a battery of tests, which were modi- ness of the implementation strategy, we have started a large cluster
fications of balance tests used in other populations. Each subject was Randomised trial, the ParkNet Trial. Sixteen clusters (departments
assessed on two different occasions to determine the test-retest relia- of neurology of general hospitals), localized around three university
bility. These included a test of fast alternating arm reaching; timed un- medical centers, are randomly allocated to an experimental group
supported sitting; a maximal torso leaning test; a test of co-ordinated (network care lusters) or a usual care group (unchanged care). In the
stability; a seated upper body/arm reach test; and the donning/doffing network care clusters, the implementation strategy is implemented.
of a T-shirt. ANALYSIS: Intraclass correlation coeffients (ICC3,1 ) were We intend to include at least 800 eligible patients in the 16 clusters.
calculated for each outcome measure. The Mann Whitney U test was All medical records of participating centres (n=3403) are screened
applied to detect differences in chronicity and injury level. RESULTS: and more than 700 patients enrolled already in our study. All patients
All the tests showed good to excellent reliability scores (ICC3,1 will be followed for six months. Primary outcome measures are a
0.719 to 0.912). The most repeatable tests were donning a T-shirt patient preference outcome scale for limitations in activities, a Dutch
(ICC3,1 0.912) and the test of unsupported maximal torso leaning validated version of the Dutch Parkinson’s Disease Questionnaire-
(ICC3,1 0.904). The fast alternating reach and T-shirt tests appeared 39 (PDQ-39) Mobility domain, and costs. CONCLUSIONS: A
to discriminate between subject injury level (p = 0.005 and 0.003 multifaceted implementation strategy aimed at implementation of the
respectively). The torso leaning, co-ordinated stability and seated Dutch guidelines of Physical Therapy in Parkinson’s Disease has
reach tests appeared to discriminate chronicity (p = 0.002, 0.008 and been developed and will be evaluated within a cluster randomised
0.002 respectively). CONCLUSIONS: The tests were simple, quick trial. IMPLICATIONS: If our multifaced implementation strategy
to administer, and reliable. The battery of tests will be utilised in proves to be effective it can be used for the implementation of other
a randomised controlled trial to evaluate the effectiveness of sitting guidelines in order to improve the quality of Physical Therapy Care.
balance training in the SCI population. IMPLICATIONS: The tests KEYWORDS: Guidelines; Parkinson’s Disease; Implementation.
FUNDING ACKNOWLEDGEMENTS: The ParkNet trial is financial determine whether self-efficacy and fear of movement were related
supported by the Netherlands Organisation for Health Research and to outcome in patients with CNP. Furthermore, the study explored
Development (ZonMW). CONTACT: [email protected] the extent to which self-efficacy mediated the relation between fear of
ETHICS COMMITTEE: The ethics commitee of the UMC st Radboud, movement and outcome. RELEVANCE: Physical therapists are often
Nijmegen, the Netherlands required to treat patients with CNP. To optimize the treatment of these
patients it is imperative to identify those factors that contribute to
their disability. This study will highlight whether two cognitive factors
Research Report Platform Presentation contribute to the disability levels of patients with CNP. If these factors
3244 Tuesday 5 June 13:25 contribute to disability then strategies that explicitly target these
PP Crystal Pavilion A cognitive factors could be utilised during treatment. PARTICIPANTS:
HERITABILITY OF LOW BACK PAIN AND THE ROLE OF DISC Data were collected from 64 patients with non-specific chronic neck
DEGENERATION pain who had been referred to a physical therapy department. All of
the patients exhibited an elevated fear of movement (TSK > 39). Fifty-
Battié M1 , Videman T, Levalahti E, Gill K, Kaprio J; 1 Department
six percent were female, the mean age was 43.3 years (SD=14.3)
of Physical Therapy, University of Alberta, Canada
and the mean duration of symptoms was 3.6 years (SD=6.5). Thirty-
PURPOSE: Twin studies suggest that both disc degeneration and seven percent reported that their pain had started following a motor
back pain have a genetic component. We were interested in vehicle accident, 18% were not working because of their neck pain,
estimating the heritability of low back pain in men and examining and 32% were pursuing medico-legal compensation. METHODS:
whether genetic influences on back pain are mediated through Prior to treatment patients completed the Neck Disability Index
genetic influences on disc degeneration. RELEVANCE: Understand- along with the Tampa Scale for Kinesiophobia and the Chronic
ing possible conditions underlying back pain are critical for the Pain Self-Efficacy Scale. ANALYSIS: Multi-step linear regression
development of rational treatment interventions. PARTICIPANTS: analysis (Baron & Kenny, J Pers Soc Psychol 1986; 51:1173-82)
Subjects included 147 monozygotic and 153 dizygotic male twin pairs was performed to determine whether self-efficacy mediated the
(N=600 subjects) from the population-based Finnish Twin Cohort. relation between fear of movement and outcome. In Analysis 1,
METHODS: All subjects underwent lumbar magnetic resonance age, sex, pain duration and fear of movement were the independent
imaging and completed an extensive interview, including back pain variables and total NDI score was the dependent variable. In Analysis
history and exposure to suspected risk factors. Disc height narrowing 2, self-efficacy was entered as the dependent variable and the
was the degenerative finding most associated with pain history, and independent variables were the same as those entered in Analysis
was used to index disc degeneration in the models. ANALYSIS: 1. In Analysis 3, total NDI score was the dependent variable but
We conducted a classic twin study with multivariate quantitative self-efficacy was added to the set of independent variables. For
genetic models to estimate the degree to which genetic (or a mediational effect to exist, fear of movement should significantly
environmental) effects on back pain were correlated with genetic (or contribute to the prediction of outcome in Analysis 1 and 2, but
environmental) effects on disc degeneration. RESULTS: Statistically not in Analysis 3 after the introduction of self-efficacy. RESULTS: In
significant genetic correlations were found for disc height narrowing Analysis 1, fear of movement predicted outcome (b = 0.32; P < 0.01).
and different definitions of back pain, such as duration of the In analysis 2, fear of movement predicted self-efficacy (b = −0.42;
worst back pain episode (rg=0.46) and hospitalization for back P < 0.01). In the third analysis, total NDI score was entered as
problems (rg=0.49), as well as disability in the previous year from the dependent variable (same as Analysis 1) and self-efficacy was
back pain (rg=0.33). The heritability estimates for these back pain entered as an additional independent variable. The model explained
variables ranged from 30% to 46%. There also were statistically 25% of the variance in outcome. Following the introduction of self-
significant, but weaker environmental correlations for disc height efficacy, fear of movement no longer predicted outcome (b = 0.15;
narrowing with back symptoms over the prior year. CONCLUSIONS: P > 0.05) whereas self-efficacy emerged as a strong predictor (b
A substantial minority of the genetic influences on pain was due = −0.42; P < 0.01). CONCLUSIONS: Functional self-efficacy and
to the same genetic influences affecting disc degeneration. This fear of movement were related to outcome in patients with CNP.
suggests that disc degeneration is one pathway through which genes Furthermore, functional self-efficacy mediated the relation between
influence back pain. IMPLICATIONS: These results add to our fear of movement and outcome. IMPLICATIONS: Physical therapists
understanding of genetic influences on low back pain and possible should employ techniques that reduce fear of movement and
mechanisms through which genes and environment influence increase functional self-efficacy when treating patients with CNP.
symptoms. KEYWORDS: low back pain, disc degeneration, genetics. KEYWORDS: Fear of Movement, Self-Efficacy, Neck Pain. FUNDING
FUNDING ACKNOWLEDGEMENTS: Funding was received from ACKNOWLEDGEMENTS: This study was funded by Pennine Acute
the Alberta Foundation for Medical Research, the NIH, the Finnish NHS Trust. CONTACT: [email protected]
Academy and the Canada Research Chairs Program. ETHICS COMMITTEE: North Manchester Local Research Ethics
ETHICS COMMITTEE: The study was approved by the University of Committee
Alberta Health Ethics Review Board.
1689 Tuesday 5 June 13:25 VCEC Meeting Rooms 11-12
PP Crystal Pavilion B & C DEVELOPMENT OF A SITTING BALANCE SCALE FOR
FUNCTIONAL SELF-EFFICACY MEDIATES THE RELATION PATIENTS WITH SPINAL CORD INJURIES
BETWEEN FEAR OF MOVEMENT AND OUTCOME IN PATIENTS Eksteen C1 , Bührs D2 , Van der Bon L, Maritz L, Motsi V,
WITH CHRONIC NECK PAIN Tieleman E; 1 University of Pretoria South Africa; 2 Netcare
Woby S1,2 , Urmston M1,2 , Thompson D1,2 ; 1 Department of Rehabilitation Hospital (S I T Lab)
Physiotherapy, North Manchester General Hospital, Manchester,
PURPOSE: The need for an objective outcomes measure to
United KIngdom; 2 Centre for Rehabilitation Science, University
quantify patients with spinal cord injuries’ (SCI) balance (stability)
of Manchester, Manchester, United Kingdom
in sitting on a low plinth as well as in their wheelchairs was
PURPOSE: There is a paucity of data relating to whether self efficacy identified during consultation sessions on the recommendation of
and fear of movement predict outcome in patients with chronic suitable seating equipment. Such an objective outcomes measure
neck pain (CNP). Consequently, the purpose of this study was to specifically for patients with SCI could not be found in the literature.
This study therefore focused on the development of an objective guideline implementation and to improve quality of physiotherapeutic
outcomes measure for quantifying the patient’s siting balance. care in PD. PARTICIPANTS: Questionnaires were sent to 18
RELEVANCE: A balance scale for SCI patients in sitting would physiotherapists who participate in the ParkNet program (ParkNet
provide physiotherapists (rehabilitation therapists) with an objective therapists), and to 86 physiotherapists who do not participate in the
tool to quantify a patient’s progress during rehabilitation, give program. Only questionnaires of physiotherapists who had treated
feedback to health care providers, patients’ care-givers and health at least one PD patients during the preceding six months were
care funders about the patient’s progress. PARTICIPANTS: Six included in the analysis. METHODS: The ParkNet implementation
participants with complete C5-L2 spinal cord injuries were recruited strategy consists of six steps: 1) selection of therapists who applied
from a private spinal unit. The participants ranged from one week to to participate in a small PD expert network; 2) a 4.5 day basic course
fifteen (15) months post injury. All the subjects were male, between in covering PD in general, and correct use of the guideline for Physical
17 and 38 years of age: mean age being 28.17 years (SD = 6.91). Therapy in PD; 3) a web-based learning management system
None of the participants had pressure sores and their spasticity did which facilitates continuous education (e.g. completing tasks, sharing
not prevent them from performing the activities of the balance scale. knowledge, exchanging experiences) combined with feedback from
All of the subjects were permanent wheelchair users. An expert coaches; 4) two-monthly seminars in which PD related topics are
panel consisting of 5 members and a special interest in neurological be discussed, or skills are trained; 5) a decision supporting, web-
and spinal rehabilitation, were recruited. Each of the members had based electronic patient record which guides the therapist through
ten or more years of clinical experience. METHODS: A descriptive, the guideline; 6) involvement of referring physicians. A questionnaire
analytical exploratory research methodology was implemented. All was developed to evaluate the quality of physiotherapeutic care in
participants signed an informed consent form and the study was PD. The questionnaire was based on fifteen recommendations of
approved by the Ethics Committee of the University of Pretoria. the evidence-based guideline physiotherapy in PD. These fifteen
The study was conducted in four phases. (1) Conceptualization and recommendations were selected by an expert-panel for being most
development of a concept balance scale; (2) Testing the balance crucial to the quality of PT care provided to PD patients. For the
scale on patients while being video-recorded during the performance selection a Delphi technique was applied. The recommendations
of the activities of the balance scale. The procedure was repeated were transformed into guideline driven quality indicators. As part
twice but participants were differently clothed differently during the of the questionnaire, physiotherapists were asked to rate on a five-
second time to give the impression of being tested on the scale point scale how frequently they followed these recommendations of
on different occasions; (3) Evaluation of the balance scale as an the guideline. ANALYSIS: Descriptive statistics and non-parametric
evidence based outcomes measuring tool by a panel of expert tests for two independent groups were carried out to compare
physiotherapists in the rehabilitation of patients with SCI. (4) Phase ParkNet therapists with non-ParkNet therapists. For the level of
4: Analysis and categorization of the comments of the expert panel. significance p < 0.05 was applied. A recommendation was considered
ANALYSIS: Coding and categorisation of the comments made by to be sufficiently implemented if at least 70% of therapists followed
the expert panel members. Intraclass Correlation Coefficients (ICC) that recommendation frequently. RESULTS: Of the 45 returned
was used to determine the inter and intrarater reliability of the questionnaires, 22 met the inclusion criteria (14 ‘ParkNet’; 8 ‘non-
numerical values given to each patient’s performance of the activities. ParkNet’). ParkNet therapists were significantly more familiar with the
RESULTS: Intrarater as well as interrater reliability of the panel guideline and used the guideline significantly more when they were
members varied between excellent (a score of 1) and poor (a score of faced with PD patients with difficult problems. Furthermore, ParkNet
0.12). On the whole the intra and interrater reliability of the assesment therapists more frequently followed recommendations of the guideline
of activities in sitting in the wheelchair were better than in sitting in comparison to non-ParkNet therapists. These differences were
on the low plinth. Comments of the expert panel were implemented significant for eight of the 15 recommendations. ParkNet therapists
to enhance the user-friendliness of balance scale. CONCLUSIONS: had sufficiently implemented 14 of the 15 recommendations, while
The final balance scale is a valuable outcomes measure to assess non-ParkNet therapists only had implemented five recommendations.
a patients with SCI’s balance in sitting. It should be refined through CONCLUSIONS: Our results indicate that ParkNet program is
testing in a variety of clinical environments. IMPLICATIONS: The a feasible and promising, multifaceted implementation strategy.
balance scale contribute towards evidence based rehabilitation This strategy might therefore be used to enhance the quality of
of patients with SCI. KEYWORDS: Balance scale, Spinal Cord physiotherapy in PD. IMPLICATIONS: The ParkNet program will be
Injury, Outcomes measure. FUNDING ACKNOWLEDGEMENTS: evaluated in a large cluster randomised trial (the ParkNet Trial).
Unfunded. CONTACT: [email protected] In this trial also costs, and the eventual effects for PD patients
ETHICS COMMITTEE: Ethics Committee of the University of Pretoria in terms of improvement of daily functioning will be evaluated.
KEYWORDS: Parkinson’s disease; Guideline; Quality Indicators.
FUNDING ACKNOWLEDGEMENTS: This study is financial sup-
ported by the Netherlands Organisation for Health Research and
3186 Tuesday 5 June 13:25 Development (ZonMW).
EVALUATION OF A MULTIFACETED IMPLEMENTATION
STRATEGY FOR PHYSIOTHERAPY GUIDELINES IN Research Report Platform Presentation
PARKINSON’S DISEASE: THE PARKNET-PILOT 2719 Tuesday 5 June 14:00
Nijkrake M1 , Keus S2 , Lanson S1 , Fijen A1 , Braspenning J1 ,
Hendriks E3 , Bloem B1 , Oostendorp R1 , Munneke M1 ; 1 Radboud CONSTRUCT VALIDITY OF THE COMPREHENSIVE
University Nijmegen Medical Centre, Nijmegen, The Netherlands; PROFESSIONAL BEHAVIOURS DEVELOPMENT LOG: A
2 Leiden University Medical Centre, Leiden, The Netherlands; SELF-ADMINISTERED INSTRUMENT TO INFORM ENTRY-TO-
3 Maastricht University, Maastricht, the Netherlands PRACTICE AND CONTINUING PROFESSIONAL COMPETENCY
Lucy S, Bartlett D, Bisbee L, Conti-Becker A; School of Physical
PURPOSE: To evaluate a multifaceted implementation strategy (the
Therapy, The University of Western Ontario, London ON, Canada
ParkNet program) which aims to improve the application of the
Dutch guidelines for physical therapy (PT) in Parkinson’s Disease PURPOSE: A self-administered Comprehensive Professional Be-
(PD). RELEVANCE: In 2004 an evidence-based clinical practice haviours Development Log (CPBDL), with 9 key professional
guideline for PT in PD is distributed to all physiotherapists in the behaviours, was developed and validated through a Delphi process
Netherlands (www.cebp.nl). However, distribution hardly ever results to refine the specific behavioural criteria for each of the identified key
in implementation. A multifaceted strategy is needed to facilitate behaviours. To gain a fuller understanding of the CPBDL validity, we
examined the convergent validity of the CPBDL and the Physical together aims to prepare students for the reality of being effective
Therapist Clinical Performance Instrument (CPI). RELEVANCE: team workers in practice. Previous research has recognised the
Clinical reasoning and a complex array of professional behaviours importance of preparing tutors for interprofessional education (IPE)
have been increasingly recognized as key attributes for both entry- and described how tutors of IPL can be effective role models for
to-practice and continuing competency, as has reflection. Explicit their students. PARTICIPANTS: 12 Faculty of Health tutors, working
formative self-evaluation of professional behaviours is an important in the IPL programme, were invited to volunteer for this study. Tutors
strategy for fostering further development and continued professional were from the pre-registration physiotherapy, nursing, occupational
growth. PARTICIPANTS: A cohort of forty-four students, 33 women therapy, speech therapy, dietetics and social work programmes.
and 11 men, mean (SD) program admission age 24.0 (3.0) y, METHODS: A qualitative approach utilised individual semi structured
enrolled in our entry-level physical therapy professional Master’s taped interviews to explore the tutors’ experiences of working
program provided data. METHODS: The CPBDL requires students together to plan the new programme. Both researchers carried
to reflect on and indicate the consistency of performance (‘not at out the interviews. ANALYSIS: Transcribed interviews underwent a
all’, ‘sometimes’, ‘always’) of specific criteria for the key behaviours thematic content analysis.Categories and themes were developed
of accountability, adherence to legal and ethical codes of practice, using the phrase as the unit of analysis. Member checking of
evidence-based practice, client-centered practice, communication, the transcripts was used to check for accuracy RESULTS: Four
critical thinking, sensitive/respectful practice, lifelong learning and key themes were identified: Communication issues (bilingualism),
professional image. For this study, the CPBDL was completed in professionally tribalistic behaviour, workplace geography and critical
the final academic term, following completion of senior clinical reflection. Participants described difficulties understanding other
placements. Student performance was evaluated during each clinical tutors’ profession-specific language and difficulties relinquishing
placement with the CPI, an instrument designed to evaluate clinical “power” by having to “give up” their profession specific module
performance relative to entry-level competency in 24 areas along content to the IPL programme. Participants also addressed difficulties
a continuum from ‘novice’ to ‘entry-level’, using a visual analogue in working interprofessionally when staff were located in different
scale. Each CPI performance and CPBDL professional behaviour buildings. Tutors discussed how reflecting informally on their own IP
score was normalized to yield a score between 0 and 100. practice helped them understand the parallel process they needed to
ANALYSIS: Selected CPI clinical performance scores matched engender in the students. Participants mentioned the lack of reflective
with the 9 CPBDL professional behaviours were compared using frameworks on which to structure their own critical reflection. Tutors
paired sample t-tests. A Bonferroni correction for multiple paired recognised the negotiation and bargaining that occurs in thier
comparisons (p0.006) was applied. RESULTS: The CPI and IPL planning meetings reflected the reality of IP working which
CPBDL scores were all high (>92), with tight 95% confidence students will have to face in future practice. CONCLUSIONS: The
intervals, and not significantly different for adherence to legal and new programme encourages tutors to view IPL not as an “add
ethical codes, client-centered practice, sensitive/respectful practice on” but as part of their core work.Tutors recognised that skills
and communication. Conversely, student self-evaluations (CPBDL they used in IP meetings were the very skills they needed to
scores) of accountability (CPBDL 90.1; CPI 97.0), critical thinking facilitate in their students. Tutors were encouraged to challenge
(CPBDL 87.5; CPI 96.1), life long learning (CPBDL 85.6; CPI other tutors who use profession specific jargon and encourage
96.7), professional image (CPBDL 78.2; CPI 96.8) and evidence- development of a shared plain language.If tutors can understand
based practice (CPDBL 87.9; CPI 94.2) were consistently lower and internalise the challenges of working interprofessionally they
(p0.004) than the Clinical Instructor evaluated CPI performance are in an optimal position themselves to support students and
scores. CONCLUSIONS: These results provided support in part be effective role models. Current and future work concentrates on
for the convergent validity of the CPBDL (4 key behaviours) and i) Generating a tutor training pack founded on this study’s findings
the CPI. Unlike the CPI, 5 CPBDL scores did not demonstrate ii) Developing a new model of critical reflection that provides a
a ‘ceiling effect’, likely reflecting the differing respective foci on framework for students and tutors to reflect on their IP experiences.
entry-level versus continuing professional competency. Limiting a There was recognition that the small sample limits the generalisbility
broader understanding of the CPBDL validity was its 3-level scaling. of findings. Issues of bias because the interviewers were not
IMPLICATIONS: The CPBDL has been modified to 6-level scaling in independent were reflected upon. IMPLICATIONS: Pre registration
support of future Rasch Analysis to clarify the typical professionalism physiotherapists need to be prepared for the realities of practice
developmental order, and enhance the instrument’s intended usage both at home and abroad. Effective physiotherapy practice is not
to provide formative feedback regarding individual development. just uniprofessional practice. Multiprofessional tutors with insight into
KEYWORDS: professional behaviours, development. FUNDING the challenges of IP working can catalyse this process in all their
ACKNOWLEDGEMENTS: Supported by The University of Western students KEYWORDS: Tutors; Interprofessional education; Interpro-
Ontario, School of Physical Therapy. CONTACT: [email protected] fessional learning. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: Faculty of Health Research Ethics Sub
Research Report Platform Presentation Committee
TUTOR EXPERIENCES OF DEVELOPING AN 975 Tuesday 5 June 14:00
INTERPROFESSIONAL LEARNING (IPL) PROGRAMME VCEC Ballroom A
IN HIGHER EDUCATION (HE):RECOGNISING A PARALLEL COMPARISON OF EVIDENCE BASED AND NON-
PROCESS IN TUTORS AND STUDENTS STANDARDISED PHYSIOTHERAPY FOLLOWING AUTOLOGOUS
Smith S1 , Kate K1 ; 1 Leeds Metropolitan University,Leeds,UK; BLOOD INJECTION FOR THE TREATMENT OF PATELLA
2 Leeds Metropolitan University,Leeds, UK TENDINOSIS
Robertson C1 , Walter J2 , James S3 , Connell D3 , Pocock C4 ,
PURPOSE: This exploratory study aimed to investigate the inter-
Bell J5 ; 1 Kingston University/St George’s, University of London,
professional experiences of tutors at Leeds Metropolitan University
London, UK; 2 Joy Walter Clinic, Wimbledon, London, UK; 3 RNOH
working together to develop a new IPL programme for pre-
Stanmore, UK; 4 Kingston Hosiptal, Kingston-upon-Thames, UK;
registration health and social care students.This new IPL programme 5 Wimbledon Knee Clinic, Wimbledon, London, UK
is assessed and integrated into the health and social care curricula
RELEVANCE: A major drive in the UK and internationally to educate PURPOSE: To evaluate the effect of an evidence based standardised
physiotherapists and other health and social care profesisonals physiotherapy programme compared to a non-standardised treatment
package following ultrasound guided autologous blood injection in the Research Report Platform Presentation
treatment of patellar tendinosis. RELEVANCE: Patellar tendinosis 1279 Tuesday 5 June 14:00
affects 13-20% of the athletic population, and poor treatment VCEC Meeting Rooms 8&15
outcomes are well documented. To date, Young et al.,(2005), have THE PROGRESSIVE ISOINERTIAL LIFTING EVALUATION
demonstrated the most effective physiotherapy protocol, and Bahr (PILE): RELIABILITY IN PATIENTS WITH LOW BACK PAIN
et al., (2006) suggests this is equal to open patellar tenotomy.
Autologous blood has previously been documented as a treatment Lygren H1 , Dragesund T2 , Joensen J3 , Ask T4 , Moe-Nilssen R5 ;
1 Department of physiotherapy, Bergen University College, and
for lateral epicondylitis in humans, and rabbit patella tendons.
No published evidence exists for the use of autologous blood Department of Physical Therapy, Haukeland Univesity Hospital,
with human patella tendons, and hence the outcomes of post- Bergen, Norway; 2 Department of Physiotherapy Science,
injection physiotherapy programmes are unknown. PARTICIPANTS: Department of Public Health and Primary Health Care, University
41 subjects, 3 with bilateral knee symptoms, 24 men, mean age of Bergen, Bergen, Norway; 3 Department of physiotherapy,
(range) 34.5 (17-54) years, with clinically diagnosed patella tendi- Bergen University College, Bergen, Norway; 4 Department of
nosis confirmed by sonographic examination agreed to participate. Physical Therapy, Haukeland Univesity Hospital, Bergen, Norway;
5 Department of Physiotherapy Science, Department of Public Health
Mean (SD) duration of symptoms 12.9 (9.4) months. All subjects
reported unsuccessful previous physiotherapy. All subjects gave and Primary Health Care, University of Bergen, Bergen, Norway
informed consent for their data to be collected and used to present PURPOSE: Tests of functional abilities are used for the clinical
the results of this treatment. METHODS: All subjects received 2 assessment of patients with low back pain (LBP). Therefore, such
treatments (4 weeks apart) of ultrasound guided dry needling and tests should be validated relative to the clinical populations in which
injection of autologous blood into the site of patellar tendinosis. the tests are intended to be used. Progressive Isoinertial Lifting
After the second injection, 22 subjects received an evidenced based Evaluation (PILE) is a commonly used isoinertial lifting test, and
standardised physiotherapy package. The programme comprised of; was developed to evaluate the effect of treatment as well as to
twice daily, 5X30 second quadriceps, hamstring and calf stretching, diagnose and classify low back pain. Satisfactory test-retest reliability
(Cook et al., 2004), daily 3x15 reps decline eccentric loading has been found in a sample of 10 healthy men. However, test-
with incrementally increased loading, (Purdam et al., 2004), and retest reliability for clinical populations needs to be established. We
activity modification, (Visnes et al., 2005). Physiotherapy continued therefore wanted to investigate test-retest reliability of PILE applied
until return to sport. 19 subjects chose to be treated at other to patients with LBP. RELEVANCE: Different lifting tests are among
sites for geographical convenience and received a non-standardised the function tests used in physical therapy practice. Lifting is a
programme, (general exercise and electrotherapy techniques). Pre function at the activity level, and is part of many job operations and
and post treatment Victorian Institute of Sport Assessment scores, activities of daily life. Studies show that patients with chronic back
(VISA), were collected on all subjects, (administered by a researcher, pain very often have reduced lifting capacity. PARTICIPANTS: A total
independent of the radiologist and physiotherapist). VISA is a self- of 31 patients (17 women and 14 men) with long-lasting low back
reported score, ranging from 0-100, (100 represents full pain-free pain participated in the study. The patients were tested twice at an
function). ANALYSIS: Data were normally distributed. Differences in interval of 2 days and at the same time of the day. METHODS: The
VISA scores between standardised and non-standardised treatment patients were tested and retested at an interval of 2 days and at
groups were compared using un-paired t tests. RESULTS: Mean the same time of the day. Sex, age, weight, height, and profession
difference (SD) in VISA score for the standardised physiotherapy were registered. The heaviest load in kilos, which the patient was
group, 40.1 (16.9), mean difference (SD) for non-standadised group, able to lift 4 times, was used as outcome measure ANALYSIS: To
28.4 (14.3), difference between groups 11.9 (2.17 to 21.3) p = 0.01. estimate the degree of agreement, we used an ICC (1,1) model. A
The mean follow-up period was (SD) 14.8 (4.9) months. Two subjects systematic change from the first to the second testing was shown by
from the standardised group, one from the non-standardised group a paired t test with a chosen level of significance of 0.05. Absolute
proceeded to surgical decompression. There were no complications agreement was calculated. From the within subject standard deviation
reported by any subject. CONCLUSIONS: Autologous blood injection (Sw), we calculated the error of measurement and the smallest
combined with an evidence based standardised physiotherapy detectable difference between 2 measurements RESULTS: ICC was
protocol incorporating stretching and eccentric decline loading is 0.91. The error of measurement indicates that the true result in
an effective treatment for patellar tendinosis. IMPLICATIONS: The 95% of cases will be within ±4.5 kg from the measured value,
findings of this study suggest that our package of evidence based while the difference between 2 measurements in 95% of cases will
standardised physiotherapy may have additional benefits to that of be less than 6.4 kg. CONCLUSIONS: Relative test-retest reliability
non-standardised physiotherapy with patients post autologous blood was high assessed by ICC, but absolute measurement variability
injection for patellar tendinosis. However, a limitation of our study reported as the smallest detectable difference has relevance for the
is that the location of physiotherapy packages differed between interpretation of clinical test results and should also be considered.
groups and our subjects were not randomly assigned to the treatment IMPLICATIONS: Measurement variability shown in this study has
protocols. Further work is planned for a large randomised controlled relevance for the interpretation of clinical test results, and indicates
trial in this area. KEYWORDS: Patellar tendinosis, evidence that a difference between 2 measurements for the same person
based, autologous blood. FUNDING ACKNOWLEDGEMENTS: should be more than approximately 6 kg for a woman and 7
none. CONTACT: [email protected] kg for a man before a true change is said to have occurred.
KEYWORDS: lifting evaluation, reliability, low back pain. FUNDING
ACKNOWLEDGEMENTS: No funds were received in support of this
work. CONTACT: [email protected]
ETHICS COMMITTEE: The study was approval by Re-
gional Committees for Medical Research Ethics in West-Norway
(http://www.etikkom.no/REK).
Research Report Platform Presentation would be required. KEYWORDS: discectomy, immediate, physiother-
1161 Tuesday 5 June 14:00 apy. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
VCEC Meeting Rooms 11-12 [email protected]
A PROSPECTIVE,RANDOMIZED TRIAL OF IMMEDIATE ETHICS COMMITTEE: South Sheffield NHS Local Research Ethics
PHYSIOTHERAPY FOLLOWING LUMBAR MICRO- Committee,
DISCECTOMY:A PILOT STUDY
Newsome R1−3 , Cole A1 , Chiverton N1 ; 1 Orthopaedic Spinal Unit Research Report Platform Presentation
Northern General Hospital Sheffield Teaching Hospitals NHS Trust 1053 Tuesday 5 June 14:00
United Kingdom; 2 Physiotherapy Department, Northern General VCEC Meeting Room 16
Hospital Sheffield Teaching Hospitals NHS Trust United Kingdom; ADEQUATE HEART RATE INTENSITIES DURING GAIT TRAINING
3 Faculty of Health and Wellbeing Sheffield Hallam University United
IMPROVES WALKING ABILITY IN NON-AMBULATORY PATIENTS
Kingdom AFTER STROKE
PURPOSE: To investigate whether immediate physiotherapy fol- Mehrholz J1,2 , Werner C3 , Hesse S3 , Pohl M1 ; 1 Department of Early
lowing lumbar micro-discectomy enabled patients to become in- Rehabilitation, Klinik Bavaria, Kreischa, Germany; 2 Department
dependently mobile more rapidly with no increased risk of com- of Public Health, Technical University, Dresden, Germany;
plications. RELEVANCE: Studies have demonstrated the efficacy 3 Department of Neurological Rehabilitation, Klinik Berlin, Germany
of rehabilitation following lumbar micro-discectomy although none

PURPOSE: The purpose of our study was to evaluate the relationship
have looked at physiotherapy commencing within two hours post-
between heart rate intensity during two different gait training
operatively.While there are reports of day case micro-discectomy
strategies and walking abilities of patients after stroke. RELEVANCE:
none of these discusses rehabilitation or physical intervention
Stroke and cardiovascular disease are closely associated and
following this. PARTICIPANTS: Thirty patients in total were recruited
limited exercise capacity is likely to immobilize stroke patients in
from one NHS hospital within the orthopaedic surgical spinal
their ability to carry out routine functional tasks and extended
unit.Inclusion criteria were first time single surgical level lumbar activities of daily living. However, recently it was demonstrated
micro-discectomy patients who had not responded to conservative that during rehabilitation of patients after stroke the intensity of
treatment and MRI revealed a disc prolapse consistent with routine physiotherapy did not appear to elicit adequate metabolic
symptoms. Exclusion criteria consisted of previous discectomy, more stress to induce any cardio-vascular training effect. PARTICIPANTS:
than one surgically indicated level and emergency cauda equina We included non-ambulatory patients within six weeks after first
syndrome. METHODS: The study was designed as a single blind ischaemic or hemorrhagic supratentorial stroke, aged between 18
quasi-experimental trial.Thirty patients were randomized either to an to 79 years, a duration of illness less than 60 days. METHODS:
immediate group commencing physiotherapy within two hours post- The local ethical committee of Saxony, Germany (EK-MPG-4/2002),
operatively or a control group receiving physiotherapy exercises the approved the present study. Patients received five times a week for
day after surgery. Outcome measures included the time taken for four weeks either 20 minutes of repetitive locomotor training (RLT)
the patient to become independently mobile post-surgery,Oswestry and 25 minutes physiotherapy (PT), or 45 minutes PT without RLT.
Disability,VAS back and leg and McGill pain scores.These were We calculated the rates of patients achieving a heart rate intensity of
collected pre-operatively, post-operatively at four weeks and three 15 minutes within the individual target zone (HRtargetzone) during
months.The two surgeons involved were blinded to group allocation gait training sessions (HRresponder). Additionally, we assessed
as were the physiotherapists collecting post-operative data.Patients the rate of independent walking (defined as Functional Ambulation
were also blinded to allocation although this would become apparent Category (FAC)>3) and the rate of independent ability to perform
following surgery. ANALYSIS: The data was analysed using the activities of daily life (defined as a Barthel-Index Score 75) at study
Statistical Package for the Social Sciences. The Mann Whitney U end, at six month, and at three years after study end. ANALYSIS:
test was used to compare independent mobility between the groups We used t-tests for independent variables and Fishers exact tests
as the results did not follow a normal distribution curve owing to to determine statistical differences between groups. Alpha was set
working hours and times of operation. Mann Whitney U test was as 0.05 for all comparisons. RESULTS: 30 patients were included
used to analyse the disability and pain scores. RESULTS: The in each study group and analyzed as intended to treat. Patients in
results indicated significantly reduced time to independent mobility RLT-PT-group exercised longer in HRtargetzone than in PT-group
(p = 0.009) and return to work (p = 0.002) in the immediate group. (16.1±11.8 minutes versus 5.3±5.6 minutes, p < 0.001). Rates of
In this study there was a trend towards lower pain and disability HRresponder of both groups were associated with higher rates of
scores in the immediate group at four weeks but not statistically independent walking after study end, at six month, and at three years
significant. At three months there was no difference between after study end (Fishers exact test, p= 0.014, p = 0.012 and p = 0.017,
the groups. CONCLUSIONS: Immediate physiotherapy following respectively), but not with independency in activities of daily life
first time single level lumbar micro-discectomy enables patients (p = 0.175, p = 0.111 and p = 0.081, respectively). CONCLUSIONS:
to become independently mobile more rapidly and return to work A repetitive locomotor training approach may lead to higher cardiac
sooner.Immediate physiotherapy may enable patients to experience intensities without overexertion during gait training. Adequate heart
earlier discharge with no detriment to their recovery with associated rate intensities during the inpatient physiotherapy gait training of non-
cost benefits to healthcare.In this study there was no increased risk in ambulatory patients after stroke may partly results in sustainable
re-prolapse,but future work in this area would require a larger sample independent walking. IMPLICATIONS: The emphasis physiotherapy
size to significantly determine this is the case.A larger study would be should not lay alone on motor rehabilitation goals. KEYWORDS:
required to detect significant differences in pain and disability scores Walking – Stroke – Training. FUNDING ACKNOWLEDGEMENTS:
between the groups following this pilot. IMPLICATIONS: Current None declared.
physiotherapy practice should change for patients undergoing first ETHICS COMMITTEE: The local ethical committee of Saxony, Ger-
time lumbar micro-discectomy, beginning specific exercises within many (Landesärztekammer Sachsen, EK-MPG-4/2002), approved
two hours of the operation and becoming independently mobile the the present study.
same day.This may ultimately lead to reduced length of hospital
stay,reduced costs to healthcare and reduced need for rehabilitation
brought about by specialist physiotherapy intervention.In order to
facilitate the possibility of same day discharge,collaboration with
spinal surgeons to perform this operation as a morning case
TEMPOROSPATIAL GAIT PARAMETERS UNDERLYING PHYSIO- CHANGES IN QUALITY OF FINE MOTOR PERFORMANCE IN
THERAPISTS SCORING OF THE 4-ITEM DYNAMIC GAIT INDEX CHILDREN AGED 6-12 YEARS
IN PERSONS WITH AND WITHOUT VESTIBULAR DISORDERS Watter P, Burns Y, Purcell C, Morton C, Pompei J, Nicholson V;
Whitney S1,2,6 , Marchetti G2,3 , Phillip B4,5 , Vance J5 , Morris L6 ; The University of Queensland, Australia
1 University of Pittsburgh, Department of Physical Therapy, Pittsburgh,
PURPOSE: This study aimed to measure changes in quality of
PA, USA; 2 University of Pittsburgh, Department of Otolaryngology, hand performance in children aged 6-12 years using a clinical
Pittsburgh, PA, USA; 3 Duquesne University, Department of Physical measure of movement quality. Gender and preferred/non-preferred
Therapy, Pittsburgh, PA, USA; 4 Lebanon Valley College, Annville, hand differences were also explored. RELEVANCE: Children with
PA, USA; 5 Lancaster General Hospital, Lancaster, PA, USA; poor fine motor performance often have immature or clumsy hand
6 Centers for Rehab Services, Pittsburgh, PA, USA
skills, which require the quality of performance to be evaluated.
This study used simple clinical criteria to assess children’s quality
PURPOSE: The purpose of this study was to describe the
of hand movement, and evaluated its change between 6 and 12
relationship between temporal and spatial gait characteristics and
years of age. This knowledge will provide a basis for comparison
the ordinal clinician ratings of patients and controls performing the 4- when assessing children with motor impairment, and evaluating
item Dynamic Gait Index (DGI). RELEVANCE: Persons with balance intervention outcomes. PARTICIPANTS: A sample of convenience,
and vestibular disorders often report difficulty walking. The 4-item 508 children (294 girls, 214 boys) was recruited from schools
DGI walking test consists of 4 walking skills. Clinicians provide an representing private and public sectors, city/ suburban, and higher/
ordinal score to quantify walking ability plus the impact of head and lower socioeconomic areas within the greater Brisbane area,
body movements on walking, yet little is known about how these Australia. Children were included if they: were 6 −12 yeas old
scores relate to underlying spatial and temporal gait characteristics. +/−3months, participated in a standard curriculum, were well at
PARTICIPANTS: Forty seven subjects (mean age: 59.2 years, s.d. testing, and provided consent. Children were excluded if they: had a
18.5, range 24-90) participated in a descriptive cross sectional diagnosis affecting performance, sensory loss, or a history of severe
study (26 control subjects and 21 persons with balance and/or sprain/ fracture. METHODS: Children performed three randomized
vestibular dysfunction). METHODS: Three trials of each of the 4 three tasks for 10 seconds, using preferred and non-preferred
gait items (level walking, walking with changes in gait speed, and hands, namely: finger drumming, index finger tapping, sequential
walking with head up/down and and walking with head right/left) finger/thumb opposition. They used standard positions, instructions
were administered to subjects as they ambulated on a 13.5 meter and rests. Synkinesis and quality of movement were rated using set
instrumented walkway (GAITRite). Three to five phyisotherapists criteria. Quantitative findings were reported elsewhere. ANALYSIS:
scored each subject on the 4-item DGI. Temporal and spatial gait Kruskall-Wallis tests evaluated changes in rating with age and gender
characteristics were measured using GAITRite software (Version and Wilcoxon Signed Rank tests compared differences between
3.4). Step length variability (coefficient of variation), gait velocity, hands. Reliability was evaluated using Cronbach’s alpha, and p was
stance width variability, and the gait stability ratio (steps per meter) set at 0.05. RESULTS: Synkinesis scores were highly reliable (r =
were calculated. ANALYSIS: Descriptive statistics were utilized to 0.78-0.89). Quality of movement was more variable. Best results were
describe subject demographics (age, gender, and disease status). for quality of drumming and opposition in the right hand (r = 0.72, 0.5
The median clinician rating was used to identify subjects as having respectively) and index finger tapping in the left hand (r = 0.7). Trends
either normal, mild, moderate or severe impairment for each 4- to improvement with increasing age need to be carefully considered.
item DGI task. Analysis of variance was performed to compare gait Quality of performance significantly improved with increased age in all
parameters (velocity, gait stability ratio, step length and stance width tasks (chi squares = 12.3-80.2, p’s = 0.0001-0.05), as did synkinesis
variability) between normal, mild, moderate and severely impaired (chi squares = 54.1- 85.2, p’s all =0.0001). Overall, girls outperformed
boys, with drumming in the non-preferred hand (chi square = 4.49,
subject groups. A Type I error rate of p < 0.05 was used for all
p= 0.034), and control of index finger tapping in preferred and non-
comparisons. RESULTS: Significant velocity and gait stability ratio
preferred hands reaching significance (chi squares = 7.57, 5.82,
differences across the ordinal scores were noted for all of the 4-
p’s =0.006, 0.016 respectively).Gender exerted a significant effect
item DGI gait tasks (p < 0.001). Step length variability differences
on synkinesis for most tasks, with girls again better than boys
across the ordinal scores were noted for each of the 4 walking
(chi squares = 5.83-14.2, p’s = 0.016-0.0001). Preferred hand had
tasks (p < 0.01). Stance width variability was also significant (p < 0.02)
significantly better performance quality and synkinesis than non-
for walking with head turns to the right and left. CONCLUSIONS: preferred hand for all tasks except opposition (Z’s = −2.8- −6.9,
Physiotherapists’ ratings of dynamic gait are underscored by changes p’s = 0.0001- 0.0005). CONCLUSIONS: Quality of performance
in velocity, increased variation in step length, and in the gait stability varied although synkinesis was consistent. Quality and synkinesis
ratio as measured by the GAITRite. Additionally, ratings of ambulating improved with age, and girls tended to outperform boys. Preferred
with horizontal head turns was associated with an increase in hands generally outperformed non-preferred hands IMPLICATIONS:
stance width variation. Phyiotherapists observations of impairments Qualitative aspects of fine motor performance provide insight into
of dynamic gait, as measured by the 4-item DGI, appear valid when movement difficulties.The study provides knowledge about motor
compared to temporal and spatial gait measures. IMPLICATIONS: performance in typical children, informing our ability to more
This study further validates the 4-item DGI as a time effective, adequately assess children with impairments, and to optimally direct
inexpensive, clinically feasible tool for use in clinical settings. The intervention programs. KEYWORDS: Paediatrics; fine motor skill;
responsiveness of this measure to changes in disease status requires quality of movement. FUNDING ACKNOWLEDGEMENTS: Financial
additional study. These findings may have implications for the Markets Foundation for CHildren. CONTACT: [email protected]
design of impairment specific interventions for persons with balance ETHICS COMMITTEE: Medical Research Ethics committee of The
and vestibular disorders. KEYWORDS: gait; vestibular; balance. University of Queensland
FUNDING ACKNOWLEDGEMENTS: This project was supported in
part by NIH grants DC 05384 (slw), Lebanon Valley College (pjb),
and Lancaster General Hospital (jv). CONTACT: [email protected]
ETHICS COMMITTEE: University of Pittsburgh Biomedical Review
Board, Lancaster General Hospital, and the Lebanon Valley College
A COMPARISON OF HIP STRENGTH AND FUNCTION COMPARISON OF THREE RELIABILITY ESTIMATION
IN PATIENTS WITH UNILATERAL AND BILATERAL STRATEGIES: AN EXAMPLE USING THREE COBB ANGLE
PATELLOFEMORAL PAIN SYNDROME AND HEALTHY MEASURES IN ADOLESCENT WITH IDIOPATHIC SCOLIOSIS
CONTROLS Parent E, Allen S, Hill D, Raso J; Glenrose Rehabilitation Hospital,
Huang J1,2 , Yang C1 , Guo L3 , Yu T4 , Liang C2 ; 1 Department Edmonton, Canada
of Physical Therapy, Tzu-Chi College of Technology, Hua-Lien,
Taiwan; 2 Department of Physical Medicine & Rehabilitation, Tzu-Chi PURPOSE: (1) To compare measurement error estimates obtained
General Hospital, Hua-Lien, Taiwan; 3 Faculty of Sports Medicine, using three reliability assessment strategies for three Cobb angle
School of Medicine, Kaohsiung Medical University, Kaohsiung, measurements methods in persons with adolescent idiopathic
Taiwan; 4 Department of Orthopedics, Tzu-Chi General Hospital, scoliosis (AIS). (2) To discuss the advantages and inconveniences of
Hua-Lien, Taiwan each reliability assessment strategy. RELEVANCE: The assessment
of reliability for outcome measures is essential for evidence-based
PURPOSE: Patellofemoral joint pain (PFP) is one of the most
physiotherapy. Cobb angles measurements were used to illustrate
common orthopedic complaints among adolescents and young
the pros and cons of three accepted reliability assessment strategies
adults, with particularly high incidence rate (>25%) in athletes.
to help physiotherapists select the most appropriate strategy for
Despite the wealth of literature focused on the knee joints, recent
their research needs. Cobb angles are routinely measured to make
evidence has reported weaker hip strength in young women athletes,
relative (comparing between subjects) and absolute (comparing
especially in the hip abductors and external rotators. It is postulated
that this could be a contributing factor for PFP. The purpose of this to a threshold) decisions in managing scoliosis. While manual
study is to examine whether hip weakness is present in individuals measurements are prone to evaluator errors, semi-automatic pro-
with PFP, and its relationship between functional scores, pain (VAS) cedures could improve reliability. PARTICIPANTS: Radiographs from
and hip strength. RELEVANCE: The research results can provide 22 adolescents with AIS, treated conservatively, with Cobb angles
inofrmation of hip strngth in individuals with chronic patellofemoral between 20º and 50º, were selected from our database for this study.
pain syndrome and the relationship of proximal joint strength and METHODS: Cobb angles were measured on the postero-anterior
functions. PARTICIPANTS: A total of 65 participants volunteered to radiographs by two raters on three occasions using manual, semi-
recruit in this study. 24 subjects with unilateral PFP and 17 with automated (evaluator identifying endplates corners) and “automated”
bilateral PFP were assessed based on a standardized screening (identifying four vertebrae) methods. Raters evaluated images at least
examination referred by an orthopedic physician. 24 age and body 2 days apart and were blind to the subject’s identity, their previous
mass index (BMI) matched healthy subjects were selected as the measures and those from the other rater. The semi-automated
control group. METHODS: A hand-held dynamometer (Lafayette method is usually offered as part of commercial digital X-Ray analysis
Manual Muscle Testing System, USA) was used to examine the software. The “automated” method software uses active shape
isometric strength of abduction, adduction, extension, flexion, internal models to determine in the radiograph the orientation of the endplates
and external rotations in randomized order. A functional assessment at the curve end-points by referring to a training set of digitized
tool (Kujala) was used to measure the self-reported functional status images representative of curves treated conservatively (47 images).
in injured subjects. ANALYSIS: One-way ANOVA and multivariate ANALYSIS: Reliability and measurement errors were assessed using
paired comparison were used to test any significant difference 95% confidence intervals for intraclass correlations, generalizability
between sides and groups. Pearson’s correlation coefficient was theory (G-Theory)coefficients and Bland and Altman’s limits of
used to examine the association between functional status, pain and agreement. RESULTS: Corresponding intra- and inter-evaluator error
hip strength. RESULTS: Significant less hip flexor (p = 0.027) and estimates obtained using all three reliability assessment strategies
abductor strength (p = 0.002) on the affected side were found in the were not found to differ significantly. The reliability of the manual
unilateral group compared to their non-injured sides. For the bilateral and semi-automated methods were not found to differ significantly
group, significantly less bilateral abductor (dominant p = 0.0004; non- and were significantly more reliable than the automated method.
dominant p = 0.002) and internal rotator strength (dominant p = 0.025; G-theory was the most flexible strategy allowing estimation of
non-dominant p = 0.033) were found compared to that of the control coefficients for measurements situations involving more than one
group. Decrease of hip strength in unilateral and bilateral PFP were source of error. Using G-Theory, for relative decisions, repeated
poorly associated with functional status and were not significant.
measurements obtained using interchangeable evaluators and/or
Pain had a negative and moderate association with functional status
occasions using either the manual or the semi-automated method
in unilateral (r= −0.511, p = 0.011) and bilateral groups (r= −0.497,
are expected to be within ±7.1º 95% of the time. In contrast, for
p = 0.042). CONCLUSIONS: Subjects with bilateral PFP showed
absolute clinical decisions with respect to a set threshold, Cobb
bilateral deficits in abductor and internal rotator strength compared
measurements would fall within ±10.0º 95% of the time. G-theory
to healthy controls, whereas unilateral flexor and abductor strength
was found in individuals with unilateral PFP. IMPLICATIONS: It is also allows quantification of the proportions of error attributable to
necessary to consider examination of hip strength and possible differences between method, evaluators and occasion. These were
treatment strategies for proximal hip muscle strength in individuals 40.4%, 7.3% and 5.6%, respectively. CONCLUSIONS: G-theory is
with unilateral and bilateral PFP. KEYWORDS: Patellofemoral pain, the most flexible assessment strategy. The Bland and Altman strategy
Muscle Strength, Function. FUNDING ACKNOWLEDGEMENTS: with its associated plots is useful in understanding where the error
Thanks for the internal grant(TZH93-21)support from Tzu-Chi lies in the range of measurement. However,both the Bland and
General Hospital and Tzu-Chi Foundation, TAIWAN. CONTACT: Altman strategy and intraclass correlations are tedious to use with
[email protected] multiple sources of error. Automation of Cobb angle measurement
ETHICS COMMITTEE: Ethical Clearance from the Ethical Committee using active shape model, although it showed high intra- and inter-
of Tzu-Chi Hospital adn Tzu-Chi Unversity evaluator reliability, did not produce measurements in agreement
with the other methods. IMPLICATIONS: G-theory is recommended
for future reliability studies involving multiple sources of error.
Cobb angle measurements using the manual and semi-automated
methods can be used interchangeably. KEYWORDS: Reliability,
Adolescent Idiopathic Scoliosis, measurement error. FUNDING
ACKNOWLEDGEMENTS: Edmonton Orthopaedic Research Com- Research Report Platform Presentation

mittee. CONTACT: [email protected] 1175 Tuesday 5 June 14:20
ETHICS COMMITTEE: Health Research Panel – Health Research VCEC Meeting Room 16
Ethics Board of the University of Alberta, Capital Health, and the DOES CLINIC MEASURED GAIT SPEED DIFFER FROM GAIT
Caritas Health Group. SPEED MEASURED IN THE COMMUNITY IN PEOPLE WITH
STROKE
Research Report Platform Presentation Taylor D1 , Stretton C2 , Mudge S3 , Garrett N4 ; 1 Physical
1205 Tuesday 5 June 14:20 Rehabilitation Research Centre, AUT University, Auckland, New
VCEC Meeting Rooms 11-12 Zealand; 2 School of Physiotherapy, AUT University, Auckland, New
Zealand; 3 Neuro Rehab Results, Auckland, New Zealand; 4 Faculty
COMPARATIVE STUDY BETWEEN CHEMICAL AND MECHAN-
of Health and Environmental Sciences, AUT University, Auckland,
ICAL TREATMENT OF LUMBOSACRAL RADICULOPATHY
New Zealand
Ali M1 , Balbaa A2 , Elhafez S1 ; 1 Department of Biomechanics,
Faculty of Physical Therapy, Cairo University, Egypt; 2 Department of PURPOSE: To compare the extent to which gait speed measured
Physical Therapy for Musculoskeletal Disorders, Faculty of Physical in the clinic setting differs from that measured in the community.
Therapy, Cairo University, Egypt RELEVANCE: Community walking ability is often assumed from
clinical gait measures, such as the 10m walk test. It is important
PURPOSE: This study was designed to compare the chemical, to determine if tests taken in a clinic setting predict performance in
mechanical and their combination in treatment of sciatica in subjects a real life setting. PARTICIPANTS: Twenty-eight people with chronic
with lumbar disc prolapse. RELEVANCE: This may establish the stroke who regularly accessed the community were divided into 2
best treatment or combination of treatments in relieving the radicular groups based on gait velocity as measured in the clinic (<0.8m/s
pain in lumbar radiculopathy. PARTICIPANTS: Thirty subjects with and 0.8m/s). METHODS: Participants completed the 10m walk test
unilateral L5 discogenic sciatica and radicular symptoms of pain, at a self-selected speed in a clinic setting. Each participant then
numbness and/or weakness were randomly selected and examined. completed a 300m community based walking circuit. Gait velocity
Their age ranged from 25-45 years. METHODS: The subjects was measured at certain points in the circuit. The same circuit
were divided randomly into 3 groups of 10. Group (A) received and sampling points were used for all participants. The community
medications only in the form of NSAID, neurotonics and muscle based circuit was situated in a local shopping mall. ANALYSIS:
relaxant for 2 weeks. Group (B) received positional treatment in the Spearman’s rank correlation coefficients were used to deternine the
form of exercise based on Optimal Spinal Posture (OSP) 3 sessions correlation between the clinic based gait velocity and the community
per week for 2 weeks. The OSP was determined by conducting based gait velocity. A linear mixed model was used to examine the
the kinsiologic H-reflex of the soleus muscle. Group (C) received difference scores between each of the community conditions and the
both treatment protocols of group A and B for 2 weeks. Each baseline clinic gait velocity. RESULTS: Spearman’s rank correlation
subject had pre and post treatment evaluation of pain level using coefficients indicated that there was a strong correlation between
Visual Analogue Scale (VAS), and functional activity level using the total time taken to walk the 300m community based circuit and
Oswestry scale and Stanford score. ANALYSIS: Statistical analysis the clinic based velocity (r = −0.88, p < 0.0001. A linear mixed model
of the pre and post test using two ways ANOVA was performed with repeate dmeasures analysis revealed significant interaction
using Statgraphics software with multiple range tests to examine between the 2 groups on community based conditions [F(4,26) = 4.49,
the differences between the three studied groups. RESULTS: The p = 0.0068] and significant differences across community conditions
statistical analysis of this study indicated that the pain level reduced [F(4,26) = 7.12, p = 0.0005]. CONCLUSIONS: The clinic based 10m
significantly (p < 0.05) in group C compared to the other groups. walk test is able to predict walking velocity in a community setting
Group B showed significant improvement in the pain level compared in people with chronic stroke who score 0.8m/s or faster on the
to that of group A. Similarly, the Stanford scale improved significantly clinic based test. For those who score less than 0.8m/s in the
(p < 0.05) in group C compared to that of group A and group B. clinic test gait velocity in the community may be overestimated.
Regarding the Oswestry scale, the results revealed that there was no IMPLICATIONS: Clinic based 10m walk tests provides a useful
significant difference (p > 0.05) in the functional performance of group indicator of gait velocity in the community for people with chronic
A and group B. On the other hand, the functional performance of stroke who score 0.8m/s or higher. For those who score less
group C improved significantly (p < 0.05) compared to that of groups than 0.8m/s the clinic based test may underestimate community
A and B. CONCLUSIONS: Combining both chemical and mechanical performance. KEYWORDS: Gait velocity; 10m walk test; community
intervention in the form of medications and positional treatment based ambulation; stroke. FUNDING ACKNOWLEDGEMENTS: Faculty of
on OSP as an exercise program has a significant improvement Health and Environmental Sciences Contestable Grant.
in the level of pain and the functional performance in subjects ETHICS COMMITTEE: AUT Ethics Committee
with lumbar disc prolapse. IMPLICATIONS: It is recommended for
the physical therapist to combine the positional treatment based
on OSP with medications in treating patients with lumbar disc Research Report Platform Presentation
prolapse. KEYWORDS: Sciatica, H-Reflex, Medications. FUNDING 1488 Tuesday 5 June 14:20
ACKNOWLEDGEMENTS: Self. CONTACT: [email protected] VCEC Meeting Room 17
ETHICS COMMITTEE: EGYPTIAN PHYSICAL THERAPY SYNDI- GAIT PARAMETERS DURING WALKING WITH A FOUR-POINT
CATE CANE, SIMPLE CANE, AND NORDIC STICK IN PATIENTS WITH
POST-STROKE HEMIPARESIS
Allet L, Leemann B, Guyen E, Monnin D, Murphy L, Schnider A;
University Hospital Geneva
PURPOSE: The objective of this study was to examine the effects of
3 different walking aids on the gait parameters of patients with hemi-
paresis at an early stage of their gait rehabilitation and to evaluate
their satisfaction with each type. RELEVANCE: Walking aids have
been shown to improve stability but few studies have investigated
their effect on the temporo-spatial gait parameters of patients with
hemiparesis, under functional conditions. If walking aids improve the
efficiency of gait and reduce fear of falling they could have important dimensions were W20 x D12.5 x H7.5mm. Acceleration signals were
benefits for the patient’s independence and quality of life. Since it recorded from the right wrist, when the infant was in active alert
is the patient who will use the aid in question, their opinion of its state, lying in supine. The recording time was 200 seconds, based
benefit would seem an important point to consider. PARTICIPANTS: on recommendations for the characteristics of this accelerometer.
Eleven in-patients with a first cerebrovascular insult, able to walk 10 The acceleration signal was sampled at a rate of 200Hz (1/0.005 sec)
metres holding a handrail without therapeutic support, who had no and stored in the system memory. ANALYSIS: The acceleration time-
walking difficulties before their stroke and who were unfamiliar with series data were analyzed by linear and nonlinear analyses using the
any of the aids being tested. METHODS: The patient’s neurological package TISEAN. We utilized the following tools; 1) Power spectrum
deficit, functional independence and motor recovery were evaluated analysis, 2) Estimation of the optimal embedding dimension using
after recruitment. They were then tested over three consecutive days, the false nearest neighbor (FNN) method, 3) Test for the nonlinearity
each day with a different walking aid. The order in which the walking using the method of surrogate data, 4) Estimation of the Maximal
aids were tested was randomized. The test session included a walk Lyapunov exponent. RESULTS: The power spectrum analysis
on a seven-metre gait analysis walkway system (GaitRite® ) and a 6- appeared to be largely a linear random process in both healthy and
minute walking test. At the end of the test, patients were asked to rate brain injured infants. Results of nonlinear analysis provided evidence
(VAS) how the aid had helped their walking overall. ANALYSIS: We that the spontaneous movements have a nonlinear chaotic dynamics
carried out descriptive analysis and applied non-parametric statistics characteristic in both infants. This result indicates evidence that
to determine whether there was a significant difference between chaotic dynamic process generate an important role for acquisition of
the effects of the three walking aids. (Friedman test, Wilcoxon). movements during development. The characteristics of spontaneous
RESULTS: Patient walked a greater distance (p = 0.011), improved movements in brain injured infants showed significantly larger dimen-
the duration of single support on the paretic leg (p = 0.022) and sionality, and more unstable and unpredictable behavior than healthy
decreased the duration of stance (% of Gait cycle) on the non-paretic infants. CONCLUSIONS: Motor behavioral development proceeds in
side (p= 0.028) when using the simple cane with ergonomic handgrip a nonlinear manner, consistent with dynamical chaotic processes.
compared to the Nordic stick. No significant differences were found Brain injured infants might have problems of the processes of self-
between the 4-point cane and the other walking aids. Analysis organization as a function of the coordination of these subsystem
of the patient’s subjective ranking revealed significant differences based on nonlinear dynamic. IMPLICATIONS: Applications of
between the different types of aid (Friedman: p = 0.003). Patients nonlinear analysis to analyze the infants’ motor-behavior have led to
found both the simple cane and the 4-point cane to be significantly recent advances in resolution of developmental processes in infants
more beneficial than the Nordic stick (p = 0.01; 0.026 respectively) with motor learning difficulties as well as in understanding neuromotor
Furthermore the simple cane was ranked as the most beneficial aid development. KEYWORDS: spontaneous movements, nonlinear
by 7 of the 11 patients. CONCLUSIONS: The patient’s subjective analysis, brain injured infants. FUNDING ACKNOWLEDGEMENTS:
preference shows a relationship with some of the temporo-spatial This work was unfunded. CONTACT: [email protected]
gait parameters. Subjective appreciation could therefore be a relevant ETHICS COMMITTEE: Ethics Committee of the Seirei Christopher
criterion to be taken into consideration for the selection of the most University
appropriate type of walking aid IMPLICATIONS: In Switzerland the 4-
point stick, Nordic Stick and simple cane with ergonomic handgrip are
the aids most commonly used in the gait rehabilitation of hemiparetic
patients. Our study did not find any advantages for using a Nordic 1572 Tuesday 5 June 14:40
walking stick at an early stage of rehabilitation. Physical therapists PP Crystal Pavilion A
should question their criteria for choosing the most appropriate LEARNING PHYSIOTHERAPY IN CLINICAL PLACEMENT –
aid for each patient and consider both objective parameters and STUDENTS’ DESCRIPTIONS OF HOW AND WHY THEY LEARN
patients’ preference. KEYWORDS: walking aids, stroke, hemiparesis, Vaagstoel U1 , Skoien A2 ; 1 Bergen University College; 2 Bergen
gait parameters. FUNDING ACKNOWLEDGEMENTS: No funding. University College
ETHICS COMMITTEE: Univesrity Hospital of Geneva PURPOSE: With the following research question; “What do phys-
iotherapy students define as important for their learning process in
clinical placement?” the project tried to identify significant issues in
Research Report Platform Presentation the students’ learning process. RELEVANCE: Clinical placements
1475 Tuesday 5 June 14:20 are an essential component of the bachelor program in physiotherapy.
VCEC Meeting Room 18 It is regarded as crucial for the acquisition of theoretical knowledge,
NONLINEAR ANALYSIS OF SPONTANEOUS MOVEMENTS IN practical skills, and for the development of clinical judgement
INFANTS WITH BRAIN INJURIES and reasoning. Student activities in these periods consist of
assessment and management of different clinical tasks including
Ohgi S, Mizuike C, Shigemori K; School of Rehabilitation Sciences,
patient demonstrations for supervisors, teachers and fellow students.
Seirei Christopher University
Although most students evaluate their clinical placement as important
PURPOSE: The purpose of this study was to examine the for personal and professional development, relatively little is known
development of spontaneous movements with kinematic analysis in about the “how and why” learning takes place. Knowledge about
infants with brain injuries using nonlinear analysis. RELEVANCE: “how and why” may aid the physical therapy institution to customize
Assessment of the quality of infants’ spontaneous can thus provide the placement period for the individual student in collaboration with
insight on the functional integrity of the neonate’s central nervous clinical tutors to enhance the learning process. PARTICIPANTS: The
system. However, a major impediment has been the lack of an sample consisted of a) the first five 3rd grade students with completed
analytical system to evaluate the complex movements over time. clinical placements, who following a general invitation volunteered to
Recently, nonlinear analysis techniques have been applied in several take part in the study, and b) interns selected from a random list
studies to the analysis of motor development. PARTICIPANTS: contacted by telephone. The first five who gave a positive response
This study was approved by the Ethics Committee of the Seirei were included. None of the students had a close relationship to the
Christopher University. Participants were 7 healthy premature infants project leader. METHODS: Data were collected by semi structured
and 7 brain injured premature infants, at 1 month of corrected age. interviews. The interview guide was developed for this study and com-
METHODS: A tri-axial accelerometer (Motion Recorder MVP-A304Ac prised the following themes: Descriptions of a learning situation from
DigiTrac, Micro Stone Co. LTD. Japan) was used to measure limb the clinical placement period. Factors related to supervision. Factors
acceleration in three-dimensional space. Monitor weighted 4 g and related to the students own role. Factors related to fellow students’
role. Existing professional knowledge and experience. Organization in the control group. Both exercise groups improved more than
of the clinical placement situation. Working environment. ANALYSIS: the control groups (p<0.005), except for the VMO cross-sectional
The interviews were taped and transcribed, and further divided into area (CSA) and volume (p = 0.011–0.042), and for the VAS-activity
meaning units and analysed according to procedures accepted in between the hip adduction combined with knee extension exercise
the field of phenomenography. Data clustered into 4 main categories and control groups (p = 0.016). However, no differences were found
related to the student, the tutor, the task, and aspects related to the between two exercise groups. CONCLUSIONS: Immediate and
working environment. RESULTS: The main findings can be summa- similar effects of VMO hypertrophy, pain reduction, and functional
rized as follows: 1) Student related aspects: Being an active learner ability improvement was observed, followed by two exercise trainings.
throughout the placement period. 2) Tutor related aspects: A tutor IMPLICATIONS: Clinical practices may consider the application of
with capability to guide the student towards mastering and building of leg-press exercise alone with knee extension since additional equip-
confidence. 3) Task related aspects: Patient demonstrations involving ments are not required. KEYWORDS: Patellofemoral pain, vastus
tutor and fellow students were reported as important. 4) Working envi- medialis obliquus, exercise. FUNDING ACKNOWLEDGEMENTS:
ronment: the feeling of being included was central. CONCLUSIONS: National Science Council of Taiwan (NSC95-2314-B-002-217-MY2).
The students focused on how challenges and demands and CONTACT: [email protected]
subsequent mastering were important aspects in making them active ETHICS COMMITTEE: Ethics committee of National Taiwan
learners. Tutors capable of giving direct, specific feedback close in University Hospital
time to the relevant situation seemed to be essential. The practical
demonstration was seen as a situation were all the factors worked in
conjunction to enhance the learning process. The way students are
met by the professional community in the clinic is also essential in 1274 Tuesday 5 June 14:40
order to promote the learning process. IMPLICATIONS: For students VCEC Exhibit Hall A
the importance of being an active learner will be focused during DOES THE CLINICAL IMPRESSION OF EXTENDED SCOPE
classes and during clinical placement. Knowledge gained through PHYSIOTHERAPISTS MATCH THE FINDINGS ON MRI SCANS
this project is important for further cooperation with supervisors in the IN PEOPLE WITH LOW BACK PAIN.?
clinical field. KEYWORDS: Physiotherapy education, clinical place- Mercer C1 , Smith T2 ; 1 Worthing & Southlands Hospital NHS Trust,
ment, student perspective, qualitative research, phenomenography. Worthing, England; 2 Brighton & Sussex University Hospital NHS
FUNDING ACKNOWLEDGEMENTS: No economical funding was Trust, Haywards Heath England
received. The project was made possible by allocation of resources
from Bergen University College, Faculty of Health and Social PURPOSE: The main aim of this retrospective analysis was to
sciences, Department of Physiotherapy. CONTACT: [email protected] establish how accurate Extended Scope physiotherapists are with
their clinical impression in relation to the actual findings on lumbar
spine MRI scans. RELEVANCE: Physiotherapists have increasingly
Research Report Platform Presentation developed their role as first contact clinicians in the management of
1978 Tuesday 5 June 14:40 patients with musculoskeletal conditions in the UK. These extended
VCEC Ballroom A scope roles have expanded to include the requesting of MRI
EFFECTS OF LEG-PRESS EXERCISE ON MORPHOLOGY OF scans as well as other diagnostic imaging. Whilst there is growing
VASTUS MEDIALIS OBLIQUUS, PAIN, AND FUNCTION IN evidence that these models of care are cost effective, safe and
PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME effective at reducing waiting times, there is a paucity of evidence
evaluating the ability of these practitioners to request appropriate
Song C1 , Yen T1 , Wei T1 , Lin Y2 , Jan M1 ; 1 School and Graduate
MRI scans. PARTICIPANTS: Five Extended Scope Physiotherapist
Institute of Physical Therapy, College of Medicine, National Taiwan
working in musculoskeletal spinal clinics. All of the physiotherapists
University, Taipei, Taiwan; 2 Department of Orthopaedics, West
were senior clinicians and had been working in the spinal clinics
Garden Hospital, Taipei, Taiwan
for a minimum of two years. MRI scan requests made over a
PURPOSE: Patellofemoral pain syndrome (PFPS) is a common knee nine month period between January and September 2005 were
disorder characterized by anterior or retropatellar pain associated included in the study. METHODS: A retrospective analysis of 123
with activities which load the patellofemoral joint. VMO-specific train- MRI scan requests was undertaken. These requests were made by
ing is a well-accepted clinical treatment for PFPS. What remained to five Extended Scope Physiotherapists working in two NHS trusts. The
be determined is whether hip adductors enhance VMO contraction as study evaluated the clinical impression documented on the MRI scan
VMO is anatomically originated from hip adductors. The purpose of request form and compared this with the MRI scan report issued
this study was to investigate the effects of a new VMO strengthening by a consultant radiologist. Sensitivity, specificity and diagnostic
exercise which combines hip adduction with knee extension. We accuracy values were calculated for spinal stenosis and lumbar
applied ultrasonography to examine the changes in VMO morphology spine disc prolapse at the L3/4, L4/5, and L5/S1 levels. ANALYSIS:
as a measure to quantify the effects of the new exercise, a traditional Descriptive statistical analysis, using recognised formulae was used
knee extension exercise, and a control (no exercise) condition. to calculate the sensitivity, specificity and diagnostic accuracy. Sec-
RELEVANCE: This study provides evidence-based practice about ondary analysis of patients presenting with suspected serious spinal
the management of PFPS. PARTICIPANTS: 62 PFPS patients with pathology was also undertaken. RESULTS: L3/4 sensitivity 100%,
age under 55 were recruited for the study. METHODS: Patients were specificity 98%, accuracy 100%; L4/5 sensitivity 89%, specificity
randomly assigned to one of the three protocols (new, traditional, 96%, accuracy 94%; L5/S1 sensitivity 93%, specificity 85%, accuracy
and control). Muscle morphology of VMO (including cross-sectional 89%; Stenosis sensitivity 93%, specificity 98%, accuracy 97%.
area on patella-base level, and volume under patella-base level), 10 CONCLUSIONS: The findings of this study suggest that clinical
cm-VAS of usual pain (VAS-U), worst pain (VAS-W), activity pain impression of Extended scope physiotherapists accurately reflects
(VAS-activity), and Lysholm Scale scores were measured before and the findings on MRI scans. IMPLICATIONS: The findings of this study
after 8-wk leg press exercise training or control periods. ANALYSIS: support the continued development of extended scope physiotherapy
Two-way mixed ANOVAs were used for main comparative analyses roles in musculoskeletal spinal clinics. This audit suggests that
between baseline and final outcome measurements among three physiotherapists in these roles have the appropriate clinical skills to
groups. Post-hoc test with Bonferroni correction was performed. requests MRI imaging. Further research is required to evaluate other
RESULTS: Significant improvements of VMO CSA, volume, VAS- areas of extended scope practice. KEYWORDS: MRI, Lumbar Spine,
U, VAS-W, VAS-activity, and Lysholm Scale scores were observed Extended Scope. FUNDING ACKNOWLEDGEMENTS: Unfunded.
after 8-wk training in both exercise groups (p < 0.005), but not CONTACT: [email protected]
RELIABILITY OF THE SWEDISH VERSION OF THE SHOULDER PHYSIOTHERAPIST AND PATIENT PERSPECTIVES ON MAN-
RATING QUESTIONNAIRE, SRQ-S AGEMENT OF LOW BACK PAIN IN AN ARAB, ISLAMIC CONTEXT
Dahlgren G1 , Hjalmarsson U2 , Lundin-Olsson L1 ; 1 Physiotherapy, Naser M1 , Dawson L2 , Trew M3 , Louw G4 ; 1 Al Azhar University,
Department of Community Medicine and Rehabilitation, Umeå Gaza; 2 University of Brighton, UK; 3 University of Brighton, UK;
University, SE-901 87 Umeå, Sweden; 2 The Orthopaedic clinic, 4 University of Brighton
University Hospital of Umeå, SE-901 85 Sweden
PURPOSE: The purpose of the study was to explore the views
PURPOSE: The purpose of this study was to evaluate the test- and experiences of physiotherapists and patients with low back pain
retest reliability of the Swedish version of the Shoulder Rating about the physiotherapy management of non-specific low back pain
Questionnaire – SRQ-S, a self-administered questionnaire for
in the Gaza Strip. RELEVANCE: Physiotherapists face a significant
shoulder function. RELEVANCE: There is a need for a useful
challenge in the management of low back pain, because the cause
valid and reliable method for assessing shoulder function. A short
of pain often cannot be determined. There is an evidence that culture
questionnaire with the patient’s own subjective evaluation can be
plays an important role in the management of non-specific low back
cost-effective and easy to use in both the clinical setting and in
pain, and physiotherapists develop thier treatments according to their
research. PARTICIPANTS: 51 patients at the waiting list for shoulder
understandings of the origin of low back pain. Patient participation in
surgery at an Orthopaedic Clinic in Sweden were asked to participate
and 38 completed the study. They all had 1) a clinical stable shoulder the management of low back pain has been proved to be important
disorder and 2) pain duration of more than 6 months. The group for improving function and preventing resulting disability. There is
consisted of 24 males (mean 48.3 years, range 20-62) and 14 also evidence that physiotherapist-patient agreement on treatment
females (mean 42.3, range 21-59), 55% were working, 21% were of non-specific low back pain is important for better outcomes of
on sick-list, 13% had disability pension, 8% were students, 3% physiotherapy. PARTICIPANTS: The study used two focus groups of
were retired. They had the following registered diagnoses; rupture physiotherapists and two focus groups of patients with low back pain.
(n=12), impingement/rotatorcuffsyndrom/subacromial conflict (n=12), Each group included 6-8 individuals of the same gender. METHODS:
glenohumeral instability (n=10), other shoulder disorders (n=9). Five A qualitative approach was used to explore the experiences of
of the patients had two diagnoses in the shoulder. METHODS: The physiotherapists and low back pain sufferers about the current
SRQ comprises 21 questions, divided into six scored and weighted physiotherapy for low back pain and its implications in the Gaza
domains concerning health, pain, daily activities, recreational and Strip. Data were collected by means of focus group interviews,
athletic activities, work, satisfaction and a non-graded domain for the facilitated by the researcher and a colleage of the same gender
patient to score the two most important areas of improvement. The of each focus group, after undertaking a pilot study involving two
first five domains are included in the total score, ranging from 17 focus groups. Focus groups were audio-taped and transcribed. Field
(worst possible) to 100 (healthy) points. SRQ was translated and back notes were kept by the researcher in order to identify any potential
translated from English to Swedish according to an established inter- bias in data analysis. ANALYSIS: A thematic content approach to
national guidelines. The questionnaire was sent home to the subjects data analysis was used. The researcher invited two participants and
twice. After they had filled in and returned the first questionnaire, the one physiotherapist to verify the accuracy of the data transcribed
second questionnaire was sent. Mean interval of days between the and a translator to translate the transcripts from Arabic into English
questionnaires was 6 days (range 2-19). ANALYSIS: Agreement of language. A physiotherapist familiar with qualitative research and
the total score and the score for each domain was analysed with Intra data obtained was invited to vertify categories and themes generated
Class Correlation, ICC. Agreement on each question was analysed from the data. RESULTS: Eight themes emerged from analysis of
with Weighted Kappa. RESULTS: The agreement of the total score the physiotherapist focus groups and four themes emerged from
was excellent (ICC=0.97). All domains, except ‘recreational and patient focus groups analysis. Findings of the study showed a
athletic activities‘, also showed an excellent agreement (ICC 0.88- gap between the needs of patients and physiotherapy approaches
0.97). Individual questions resulted in a very high weighted Kappa provided in the management of patients with non-specific low back
value for seven of the questions (0.81-1.0), a substantial value pain. The findings identified socio-cultural, professional and economic
(0.61-0.80) for eleven questions and moderate values (0.41-0.60) factors as barriers to effective physiotherapy. CONCLUSIONS:
for three questions. CONCLUSIONS: The SRQ-S seems to be a Physiotherapists and patients showed dissatisfaction with phys-
tool for self rated shoulder function. However, more studies are iotherapy provided for non-specific low back pain in the Gaza
required to further investigate the psychometric properties in groups Strip. There is lack of autonomy of physiotherapists that has
of patients with different shoulder diagnosis. IMPLICATIONS: SRQ-
resulted in lack of physiotherapist-patient and physiotherapist-
S is a questionnaire for shoulder function which can be used in the
doctor communications. Patients were treated using the biomedical
clinical setting and in research. KEYWORDS: Assessment, question-
approach, ignoring the psychosocial factors that could affect the
naire, shoulder. FUNDING ACKNOWLEDGEMENTS: Minnesfonden,
outcomes of treatment. The findings of the study showed deficits
Swedish Association of Registered Physiotherapists, Stockholm.
in physiotherapy education and scope of physiotherapy practice in
the Gaza Strip. IMPLICATIONS: The findings of the study have clear
ETHICS COMMITTEE: The study was approved by the ethical
committee, Umeå University implications for practicing physiotherapists, physiotherapy educators
and physiotherapy students. Physiotherapists treating patients with
low back pain had gaps in their knowledge about the biopsychosocial
approach to management of low back pain and its implications for
physiotherapist-patient relationships. Skills not practised by Gazan
physiotherapists included communication, assessment and patient
education. KEYWORDS: Low back pain; physiotherapist, patient.
FUNDING ACKNOWLEDGEMENTS: The work was part of Ph.D
research project, funded by the Palestinian Ministry of Education.
ETHICS COMMITTEE: School of Health Professions Ethics Commit-
tee. University of Brighton, UK and the Palestinian Ministry of Health
Research Report Platform Presentation This research was supported by the Department of Veterans Affairs,
1632 Tuesday 5 June 14:40 Office of Rehabilitation Research and Development, Grants B2226R
VCEC Meeting Room 16 and B3102R. CONTACT: [email protected]
INNOVATIVE, EFFICACIOUS INTERVENTION AND ETHICS COMMITTEE: Louis Stokes Cleveland Department of
MEASUREMENT FOR DYSCOORDINATED GAIT COMPONENTS Veterans Affairs Medical Center, Internal Review Board
Daly J1,2 , Brenner I2 , Rogers J2 , McCabe J2 , Fredrickson E2 ,
Roenigk K2 ; 1 Department of Neurology, Case Western Reserve Research Report Platform Presentation
University School of Medicine; 2 Stroke Motor Control and Motor 2030 Tuesday 5 June 14:40
Learning Laboratory, LSC VA Medical Center, Cleveland Ohio VCEC Meeting Room 17
PURPOSE: Utilize theoretical models to develop an innovative DEVELOPMENTAL TRENDS IN TEMPORAL AND SPATIAL
intervention to restore persistent, dyscoordinated gait movement PARAMETERS RECORDED BY THE GAITRITE IN CHILDREN
components in stroke survivors. RELEVANCE: There is a dearth 4-14 YEARS
of studies regarding restoration of coordinated gait movement Alderson L1,2 , Watson T1 , Eleanor M2,3 ; 1 University of
components for stroke survivors. To develop the intervention, we Hertfordshire, Hatfield, UK; 2 Physiotherapy Department, Great
utilized two models: 1) World Health Organization, disability model, Ormond Street Hospital, London, UK; 3 Institute of Child Health,
(International Classification of Function and Disability(ICF)) to inform University College London, UK
the breadth of intervention, which was an array of impairments
thought to underlie dyscoordinated gait in stroke survivors; and 2) PURPOSE: Temporal and spatial measurements of gait in children
The Central Nervous System Activity-Dependent Plasticity Model and have the potential to quantify important clinical changes associated
its associated assumptions (CNS Plasticity) to develop the nature of with recovery or therapy. However, measurements in the clinical
the intervention, including close-to-normal motor practice, intensity environment rely on a clear understanding of normal developmental
of practice, and attention to practice. PARTICIPANTS: Forty-one gait changes during growth. Recent advances in electronic walkways
stroke survivors (>6 mo) were enrolled, with persistent swing and such as the GAITRite provide an accessible way for physiotherapists
stance phase deficits (attrition=3). METHODS: In a randomized, to measure gait in a clinical setting. The purpose of this study
controlled trial, participants were randomized to: 1) gait training was to investigate developmental trends in velocity, cadence, step
with functional neuromuscular stimulation (FNS) using intramuscular length, and single and double support in children between 4-14
(IM) electrodes (FNS-IM); or 2) gait training without FNS. Both years. RELEVANCE: There are currently no widely used, acceptable
groups had the following identical treatment: 1.5hrs/day, 5days/wk, and accurate measures of gait in a paediatric clinical setting. While
for 12wks, including 0.5hr coordination exercise, 0.5hr body weight there is some normative data in children from sophisticated gait
supported treadmill training, and 0.5hr over-ground gait training. laboratory equipment, normative paediatric data for the GAITRite
However, the FNS-IM group used FNS-IM for all aspects of treatment; walkway is sparse. PARTICIPANTS: 137 children aged 4-14 years
the No-FNS group did not. IM electrodes were provided for the with no neurological or musculoskeletal conditions were recruited
FNS-IM group for ankle, knee, and hip muscles. Primary outcome from local schools (59% boys). The first ten children in each school
measure was consistency of intralimb hip/knee coordination (H/K year group who returned signed parental consent were included.
ACC; 30 strides, volitional over-ground walking, no FNS-IM for METHODS: The children walked across the GAITRite walkway
testing, no brace, usual aid (cane/no cane)). Consistent hip/knee (5mx1m) three times at each of three speeds: preferred, fast and
coordination is necessary for safe execution of swing and stance. slow. One practice trial was permitted. Preferred speed was always
H/K ACC was proven valid, reliable, and capable of discriminating recorded first to ensure children had established a reference speed.
improvement in gait deficits of stroke survivors (in press, prior work). Footfalls were automatically recorded by GAITRite software and
H/K ACC was derived from kinematic gait data obtained using a edited following the prescribed protocol in the handbook. ANALYSIS:
VICON 370 motion-capture system (blinded team member). The Gender and left-right differences were assessed using t-tests and
qualitative secondary measure was participant report of functional paired t-tests respectively. Children were stratified into five age
and life role participation milestones achieved after treatment (e.g., groups (4-5yrs n=29; 6-7yrs n=22; 8-9yrs n=32; 10-11yrs n=28;
meal preparation, gardening). ANALYSIS: The following analyses 12-14yrs n=26). A one-way ANOVA was used to explore age
were performed: 1) Baseline group comparison; Mann Whitney group effects on velocity, step length, cadence, single and double
Test; 2) within groups, pre-/post-treatment comparisons; Wilcoxon support. Planned contrasts were completed to evaluate differences
Signed Ranks Test, for small sample not meeting all assumptions for between specific age groups. RESULTS: Velocity and step length
parametric analysis; 3) non-parametric regression model, with time- increased significantly with age (p < 0.001) at all three speeds.
since-stroke (independent variable) and H/K ACC gain (dependent Cadence reduced significantly with age at preferred and fast speeds
variable); 4) the functional and life role participation milestones only (p < 0.001); with the most significant changes occurring in the
were tallied for each group. RESULTS: At baseline, there was youngest three groups (4-9 years) at preferred speed, and the
no significant difference between groups, according to H/K ACC oldest three groups (8-14 years) at fast speed. Double and single
(p = 0.37). There was no significant pre-/post-treatment difference for support (percent of gait cycle) showed no significant age effects
No-FNS (p = 0.573). There was a statistically significant pre-/post- except for left single support at slow speed (p = 0.05), which was
treatment improvement for FNS-IM (p = 0.027). Time-since-stroke significantly shorter than the right (p = 0.05). There were no significant
was not a significant predictor of H/K ACC gains [F(1,37) = 1.105; gender differences. CONCLUSIONS: The increase in velocity and
p = 0.30]. The FNS-IM group reported a five times greater number step length can be explained by an increase in leg length with
of milestones for function and life role participation versus the No- growth. However both cadence and normalised velocity (divided by
FNS group. CONCLUSIONS: FNS-IM produced a significant gain in leg length) decrease with age, demonstrating that walking in older
a measure of movement coordination during walking, H/K ACC; and children is made more efficient by an increase in stride length
No-FNS did not. IMPLICATIONS: The study illustrates the potential and fewer steps per minute. This study shows that between 8-11
usefulness of theoretical models in developing efficacious gait years cadence approaches adult norms with inter-subject variation
training. The results showed that otherwise persistent dyscoordinated continuing to reduce up to 14 years. Walking speeds had different
gait components were improved in response to targeting an adequate effects on both cadence and single support, which reinforces the
number of impairments (ICF Model) that were addressed in a importance of using more than one speed in gait assessment.
manner fulfilling the principles of motor learning accompanying IMPLICATIONS: This study demonstrates that the GAITRite is an
the CNS Plasticity Model. KEYWORDS: gait, stroke, coordination, accurate yet relatively inexpensive way to measure temporal and
coordinated gait components. FUNDING ACKNOWLEDGEMENTS: spatial gait changes associated with development. Understanding
these changes will facilitate the assessment of therapeutic efficacy The combination of severe behavioural and emotional problems and
and natural recovery in children with walking and balance difficulties. motor coordinations difficulties could increase an already substantial
KEYWORDS: Walking, Measurement, Child development. FUNDING risk of social exclusion. IMPLICATIONS: Parents and professionals
ACKNOWLEDGEMENTS: This study was completed as part of a should be aware of the possibility of motor coordination difficulties
PhD, which was funded by the Health Foundation and Great Ormond in young children with severe behavioural and emotional problems.
Street Hospital. CONTACT: [email protected] Physical therapists can provide valuable assistance to this vulnerable
ETHICS COMMITTEE: Barnet and Enfield Research and Ethics group of children. KEYWORDS: Children with behavioural and emo-
Committee, London tional problems, developmental coordination disorder, comorbidity.
FUNDING ACKNOWLEDGEMENTS: Foundation for Education and
Research in Physiotherapy, Norway. CONTACT: [email protected]
ETHICS COMMITTEE: The Regional Comitee of Medical Research
2081 Tuesday 5 June 14:40 Etichs -region West
MOTOR COORDINATION DIFFICULTIES IN 6-YEAR-OLD
CHILDREN WITH SEVERE BEHAVIOURAL AND EMOTIONAL
PROBLEMS 2388 Tuesday 5 June 15:00
Iversen S1 , Knivsberg A2 , Ellertsen B2 ,
Nødland M3 ,
Både
Larsen T4 ; 1 Section of Physiotherapy Science, Department of Public ’ITS JUST NOT BLACK AND WHITE’. STUDENTS’ PERCEPTIONS
Health and Pirmary Health Care, University of Bergen, Norway; OF LEARNING CLINICAL SKILLS IN THEIR FIRST CLINICAL
2 National Centre for Reading Education and Research, University of PLACEMENT: LESSONS FOR EDUCATORS
Stavanger, Norway; 3 Madlavoll Scool, Stavanger, Norway; 4 Municipal Delany C1 , Bragge P, Remedios L; 1 The University of Melbourne,
Physio- and Occupational Therapy Services, Bamble, Norway Melbourne, Australia
PURPOSE: The main purpose was to evaluate incidence, severity PURPOSE: For undergraduate physiotherapy students, the first
and types of motor coordination difficulties in 6-year-old children major experience of interacting with and treating patients represents
with persistent behavioural and emotional problems. A secondary a key transition period where theoretical concepts are put into
aim was to compare motor profiles on the Movement Assessment practical clinical contexts. At the University of Melbourne School of
Battery for Children (M-ABC) with specific types of behavioural and Physiotherapy, third year undergraduate students attend three six-
emotional problems as assessed with Teacher’s Report Form (TRF). week blocks of supervised clinical placements as their first major
RELEVANCE: Children with developmental problems and disorders clinical placement. Students’ perception of their first clinical education
represent a complex, variable and vulnerable group, and recent experience has received little attention in physiotherapy clinical
research highlights comorbidity as a rule rather than the exception. education. The purpose of this study was to examine the experiences
Traditionally children with severe behaviour and emotional problems of a group of third year undergraduate physiotherapy students
are assessed within psychiatric settings, and comorbid motor over the period of their first three blocks of clinical placements.
coordination difficulties may easily be overlooked. It is important to RELEVANCE: Using clinical settings for the provision of clinical
investigate incidence and types of motor problems in this group as education for increasing numbers of graduating physiotherapists
additional motor coordination difficulties could increase an already is expensive in terms of both cost and resources. Like clinical
substantial risk for social inclusion. PARTICIPANTS: 29 6-year-old practice, clinical education must increasingly be both efficient and
children (4 girls, 25 boys, mean age 6.35 years) enrolled in a high- based on evidence of effectiveness. Measures to potentially increase
risk programme at a city school in Norway were compared to 29 age effectiveness in clinical education include having an understanding
and gender matched controls (mean age 6.17 years). The children of the factors that shape students’ learning and an ability to identify
in the high-risk group had been carefully selected by the municipal constraints to their full engagement with the obligations of clinical
school psychology services,and the main criteria for inclusion in the learning. PARTICIPANTS: Thirty students (40% of the total student
programme were persisting behavioural and emotional problems. The group) participated in focus groups held at the end of each of their
control group was randomly drawn from a total sample of 83 first three six week clinical placements in two major teaching hospitals.
grade children from two first grade groups in typical all-inclusive METHODS: Within the focus groups, students were encouraged
schools in a middle-sized Norwegian town. METHODS: The children to relate their experiences of learning clinical skills and how their
were assessed with Teacher’s Report Form (TRF), and the Movement experiences changed with different clinical placements. In addition,
Assessment Battery for Children (M-ABC). For children who obtained clinical educators from the same hospitals also participated in
M-ABC scores at or below the 15th centile, their teachers observed separate focus groups, which recorded their experiences of teaching
and graded chosen target skills over period of two weeks. ANALYSIS: third year undergraduate students. All focus groups were recorded
Non-parametric, two-tailed Mann-Whitney U-tests and Spearman and transcribed. ANALYSIS: Both student and educator focus group
rho correlations were applied. The teacher observations of target transcriptions were analysed using qualitative methods of content and
skills were graded into three categories: Age-expected perfomance, thematic analysis. This study reports primarily on student focus group
borderline performance or definite difficulties. RESULTS: 62.1% in data. The transcripts were coded for recurring themes, compared
the high-risk group and 20.7% in the control group showed borderline both within and between focus group transcriptions and a conceptual
or definite motor coordination difficulties at or below the 15th centile. analysis of students’ experience of their clinical placements was
In the high-risk group 55.2% fulfilled the criteria of the DSM-IV developed. RESULTS: Students identified the process of clinical
for developmental coordination disorder, compared to 3.4% of the reasoning, or making and justifying clinical decisions for patients
controls. The high-risk group showed a mixed profile, with significant in clinical contexts, as both exciting and enlightening, but also a
difficulties within all sub-areas of the M-ABC compared to controls. challenging and, at times uncertain task. For students, learning
Investigation of motor profiles for children in the high-risk group clinical skills involved being able to accommodate tensions between
with specific types of behavioural and emotional problems showed displaying commonsense with patients and applying appropriate
a significant relationship between attention problems and manual theoretical knowledge, and tensions between expectations of
dexterity difficulties, and continuous, precise movements stood out confidence/self motivation to learn, and the reality of learning
as particularly difficult. CONCLUSIONS: The majority of the children by mistakes being corrected. In addition to learning theoretical
with persistent behavioural and emotional problems showed fine- and practical clinical skills, over the three clinical blocks, students
as well as gross motor difficulties assessed with the M-ABC.They identified their learning needs to be empowerment to question, ways
also struggled at the functional levels of activity and participation. to build self-confidence, and skills to deal with uncertainty and
conflict management. CONCLUSIONS: Students’ initial experiences capable of being trained. For those PFPS patients who have a
of learning clinical skills within a hospital setting involve an ability proximally inserted VMO, strength training might not be effective
to link the certainty of theoretical knowledge with the uncertainty and surgery might be a better choice for treatment. KEYWORDS:
inherent in the educator/student and patient/student relationship, all Patellofemoral pain syndrome, vastus medialis obliquus, ultrasonog-
within the complex context of a busy public hospital. IMPLICATIONS: raphy, the percent of VMO attachment, VMO volume attached to
There is a need in physiotherapy clinical education to develop the patella. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
curriculum that incorporate methods of teaching in the ‘grey areas’ [email protected]
of uncertainty, relationships, communication and value conflict. ETHICS COMMITTEE: National Institute of Health, FDA
KEYWORDS: clinical education, student experience, uncertainty.
FUNDING ACKNOWLEDGEMENTS: Victorian Government, Depart-
ment of Human Services. CONTACT: [email protected]
ETHICS COMMITTEE: The University of Melbourne Human 1904 Tuesday 5 June 15:00
Research Ethics Committee. VCEC Exhibit Hall A
THE ROLES OF CLINICAL SPECIALISTS AND ADVANCED
PRACTITIONERS IN PHYSICAL THERAPY: RESULTS OF A
SURVEY IN ONTARIO, CANADA
VCEC Ballroom A Yardley D, Gordon R, Freeburn R, So C, Beauchamp D, Landry M,
Switzer-McIntyre S, Evans C, Brooks D; Department of Physical
MORPHOLOGY OF THE VASTUS MEDIALIS OBLIQUUS IN Therapy, University of Toronto, Toronto, Canada
PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME AND
HEALTHY YOUNG ADULTS –A SONOGRAPHIC STUDY PURPOSE: As in most jurisdictions, the roles and responsibilities
Mao H, Jan M; School and Graduate Institute of Physical Therapy, of health professionals are in a state of flux. Ongoing trends
College of Medicine, National Taiwan University, Taipei, ROC towards innovative approaches in the delivery of cost-effective, quality
services present opportunities for the expansion of roles of the
PURPOSE: To determine if there are significant differences in several physical therapist (PT), including the Clinical Specialist (CS) and
morphologic parameters of the vastus medialis obliquus(VMO) Advanced Practitioner (AP) models. The literature regarding CS and
between patients with patellofemoral pain sydrome(PFPS) and AP roles in physical therapy is relatively limited. This study examined
healthy controls under 50. RELEVANCE: Previous studies reveal the perceptions of PTs and employers of physical therapists (EPTs)
that the vastus medialis obliquus is an important dynamic medial in Ontario, Canada. A secondary purpose was to examine the role
stabilizer of the patellar. Insufficiency of the VMO leads to lateral professional associations and academic institutions may have in
shift of the patella, increases the patellofemoral contact force, and implementing specialized roles. RELEVANCE: As health systems
results in patellofemoral pain. However, an in vitro study conducted by reform continues, the roles and responsibilities of all health care
Hubbard JK. et al. claimed that there were no significant relationship professionals are being re-examined. In Canada, roles occupied by
between several morphologic characteristics of the VMO and the PTs continue to develop and evolve with system reform. Based on
extent of patellofemoral joint deterioration. We consider that the these ongoing changes a common understanding of scope of practice
condition might be different in vivo, so we chose ultrasonogrphy may enhance service utilization and provide better health outcomes.
as the measurement tool to examine the morphology of the VMO PARTICIPANTS: A random sample of 500 PTs and 500 EPTs was
in PFPS patients and healthy controls. PARTICIPANTS: Thirty- chosen from two databases. The PT database was derived from
one patients and 31 healthy controls were recruited for the study. a list provided by the Canadian Physiotherapy Association (CPA),
The patients were all less than 50 y/o and diagnosed with PFPS, comprised of the contact information of registered PTs practicing in
excluding any other coexisting knee disorders, among which 26 were the Province of Ontario. The PTs had to be members of the Ontario
women and 5 were men. Twenty of the patients were bilaterally Physiotherapy Association (OPA) and registered with the College
affected, thus data of both knees were taken. The control group of Physiotherapists of Ontario. The EPT list was obtained from a
was carefully matched to the patients by age, gender, BMI, and database established through the University of Toronto. To be eligible,
dominant leg. METHODS: The HDI 5000 ultrasonography machine EPTs had to employ at least one registered PT, or be a registered
was used to evaluate morphologic parameters of the VMO, including PT working as a sole practitioner. METHODS: A cross-sectional
the percent of patella attachment, fiber angle, the volume attached mail survey was conducted. Two questionnaires were developed,
to the patella, and the change of shape of the VMO. ANALYSIS: one for PTs and one for EPTs. Upon ethics approval from the
Descriptive statistics was used to display the basic data of the PFPS Research Ethics Board of the University of Toronto the questionnaires
and control groups. An independent T-test was calculated to evaluate were mailed out. A Modified Dillman Approach was used throughout
the morphologic parameters of the VMO.(a<0.05)Wilcoxon Signed the survey. ANALYSIS: A descriptive analysis was performed, and
Ranks Test was performed to analyze the data of the affected and frequency distributions were used to interpret the responses provided
unaffected side in unilateral affected patients.(a<0.05) RESULTS: in the completed questionnaires. RESULTS: Response rates were
Fifty-one data were collected in each of the two groups and were 60% for PTs and 53% for EPTs. Both groups had substantial interest
perfectly matched by age, gender, BMI, and dominant leg. The only in pursuing CS and AP roles. The primary motivation behind the
parameter that revealed significant difference was the percent of pursuit of specialized roles was to improve clinical reasoning skills in
patella attachment (p < 0.05). The mean percentage of the PFPS order to more effectively service clients (81% for CS and 71% for AP).
group was 40.61%, while that of the healthy group was 46.46% Responders supported the involvement of both academic institutions
(±7.6%). The actual length of the VMO attachment on the patella (60% for CS and 70% for AP) and professional associations (61%
was 2.07cm (±0.63cm) in the PFPS group and 2.43cm (±0.48cm) in for CS and 57% for AP) in the development of formalized programs.
the healthy group, revealing a 0.4 cm difference. On the other hand, Of interest, 33% of PT respondents already considered themselves
comparing the affected and non-affected side of the 14 unilateral CSs, and 8% considered themselves APs, despite not being formally
affected PFPS patients, all parameters failed to reveal significant recognized by the profession. CONCLUSIONS: PTs and EPTs are
difference. CONCLUSIONS: The only parameter which revealed supportive of specialization within the physical therapy profession.
significant difference between the two groups is the percent of Future research should explore the specific benefits CS and AP roles
VMO attachment (p < 0.05). IMPLICATIONS: Training programs for have on multiple stakeholders including clients, providers and the
PFPS patients usually include strength training of the VMO muscle, health care system in Canada. IMPLICATIONS: Promotion of CS
but the only morphological parameter which revealed significant and AP roles within and outside the physical therapy profession may
difference in our study, the percent of VMO attachment, was not develop an extended career trajectory to support PTs in this changing
health care system. KEYWORDS: practitioner, specialist, special- Taiwanese adolescents by using a larger randomized sampling.
ization. FUNDING ACKNOWLEDGEMENTS: Ontario Physiotherapy IMPLICATIONS: The investigation into QoL of adolescents is worthy,
Association Central Toronto District Student Research Grant; Dina considering the high potential and flexibility of adolescent lifestyle.
Brooks holds a New Investigator Award from the Canadian Institute Adolescence is a critical age for resisting many preventable health
of Health Research (CIHR). CONTACT: [email protected] problems and impairments, and continuing healthy development. In
ETHICS COMMITTEE: Research Ethics Board of the University of addition, a disease free sample population is useful for serving
Toronto as a reference group and offer norm-referenced QoL values for
studies on specific populations to compare with. KEYWORDS:
self-perceived, quality of life, Taiwanese adolescents. FUNDING
ACKNOWLEDGEMENTS: This study was supported by the grants
2272 Tuesday 5 June 15:00 from the National Science Council (NSC 94-2314-B-037-019, NSC
VCEC Meeting Rooms 8&15 94-2314-B-037-044). CONTACT: [email protected]
SELF-PERCEIVED QUALITY OF LIFE FOR ADOLESCENTS IN ETHICS COMMITTEE: The study was approved by the Institutional
TAIWAN Review Board of Kaohsiung Medical University
Wang H1,2 , Lo S3 , Lee S4 , Teng Y5 , Shih C6 , Lin J1,2 ; 1 Kaohsiung
Medical University, Kaohsiung city, Taiwan; 2 Department of Research Report Platform Presentation
Rehabilitation, Kaohsiung Medical University Hospital, Taiwan; 1773 Tuesday 5 June 15:00
3 Faculty of Health, Medicine, Nursing, and Behavioral Sciences,
Deakin University, Melbourne, Australia; 4 Faculty and Institute
of Physical Therapy, National Yang-Ming University, Taipei, Taiwan; CAN PRACTITIONERS’ BEHAVIOUR TOWARDS BACK PAIN
5 Department of Occupational Therapy, Chung Shan Medical BE CHANGED? A RANDOMISED CONTROLLED TRIAL WITH
University; 6 Department of Physical therapy, Tzu Chi College of PHYSIOTHERAPISTS, OSTEOPATHS AND CHIROPRACTORS
Technology Evans D1 , Foster N2 , Vogel S3 , Breen A4 , Pincus T5 , Underwood M6 ;
1 School of Health and Rehabilitation, Keele University, Staffordshire,
PURPOSE: The study purpose was to describe the current self-
UK; 2 Primary Care Musculoskeletal Research Centre, Keele
perceived quality of life (QoL) of healthy school adolescents in
University, Staffordshire, UK; 3 Research Centre, British School of
Taiwan. Specific objectives were to examine the association between
Osteopathy, London, UK; 4 The Institute for Musculoskeletal Research
QoL and gender, age, and area of habitation. RELEVANCE: A better
and Clinical Implementation, Bournemouth, UK; 5 Department of
understanding of the QoL of adolescents is of special relevance in
Psychology, Royal Holloway University of London, London, UK;
clinical health care, because QoL in this period forms the basis for 6 Centre for Health Sciences, Bart’s and The London, London, UK
health and QoL in adulthood. One way of measuring and interpreting
QoL data is to identify the QoL levels in different life domains PURPOSE: To test the effectiveness of a directly-posted, contextu-
and also from both the objective and subjective perspective on alised, printed educational package, containing recommendations for
QoL. Another interpretation of QoL outcome is to appreciate the the evidence-based management of acute low back pain (LBP), on
variations of QoL which depend on certain determinants. From the changing practitioners’ reported behaviour (practice), as measured
results of previoius studies, age, gender and living environment using three key quality indicators (advice to patients about activity,
are potential determinants that may influence the wellbeing of work and bed rest). RELEVANCE: The three professional groups
adolescents. PARTICIPANTS: A total of 1477 adolescents (53.2% of chiropractic, osteopathy and musculoskeletal physiotherapy are
boys), aged 10–18 years (mean 14.0±2.4) participated in the study. involved in the management of 15-20% of all people with LBP
They were recruited by convenience sampling from primary and high in the UK. Exploratory and descriptive research suggests that the
schools in the north, middle, south and east of Taiwan. METHODS: management of non specific LBP by a significant proportion of
The Comprehensive Quality of Life Scale Student Version, a each of these groups does not follow best available evidence.
multidimensional self-reported measure of objective and subjective PARTICIPANTS: Simple random samples were drawn from UK
QoL, was used. Both the objective and subjective subscales consist professional registers for each group, and practitioners (n = 3604)
of seven domains; these are Material Wellbeing, Health, Productivity, were invited by post to participate. The trial was powered to
Intimacy, Safety, Place in Community and Emotional Wellbeing.The detect a 10% shift between proportions of guideline consistent
QoL scores were calculated as a percentage of the maximum score and guideline inconsistent reported behaviour, based on the key
(%SM), which represents the highest positive QoL. Each participant quality indicators. The unit of randomisation and analysis throughout
completed the ComQoL-S questionnaire by themselves in their the trial was the individual practitioner. METHODS: A pragmatic
school classroom. ANALYSIS: In addition to descriptive statistics, randomised trial tested the effectiveness of a directly posted,
one-way analysis of variance (ANOVA) followed by Duncan’s post printed educational package versus a no intervention control. Health
hoc analysis was used to test any significant differences in objective care practitioners were invited to participate via postal invitation.
and subjective QoL scores between gender, the three age groups Consenting respondents were randomised into one of two groups,
and the residential regions. RESULTS: The findings showed that avoiding inclusion of practitioners who worked together at the
the overall objective and subjective QoL scores were 62.2%SM and same practice address. Intervention packages were sent to those
67.9%SM, respectively. In the objective subscale, the adolescents practitioners randomised to the intervention group. Postal follow up
reported the highest scores (85.2%) in the Health domain whereas questionnaires were sent 6 months later. ANALYSIS: Responses to
the Emotion domain was the lowest (49.5%). For subjective subscale, each of the three key quality indicators (activity, work and bed rest)
the highest score was in the Intimacy domain (71.7%) while the were dichotomised into either being consistent with recent guidelines
lowest score (59.9%) was in the Productivity domain. Boys scored or not consistent. An intention to treat approach was taken in the
significantly lower than girls in several objective domains. Lower QoL primary analysis, and multiple logistic regression models were used,
scores were found in older age groups. Besides, lower objective which were adjusted for baseline measures of the outcome variable
score was found in participants living in the east country. In contrast, as covariates. In addition, sensitivity analyses were performed to test
participants residing in the middle country reported significantly lower the stability of the models. RESULTS: 1758 consenting practitioners
subjective QoL scores. CONCLUSIONS: This study demonstrated were recruited into the trial, 876 randomised to the intervention group
the multidimensional aspects of QoL among school adolescents in and 882 to the control group. Overall response to the 6 month follow-
Taiwan; different extents of variations in self-perceived QoL were up was 1557/1758 (88.6%). Changes in reported practice behaviour
observed in different genders, age groups, and resident areas. at 6 months on the key quality indicators (odds ratios and 95%
Future research should analyze longitudinal change of QoL in confidence intervals) were: Activity: OR = 1.29 (1.04, 1.61); Work OR
= 1.27 (1.0, 1.59); Bed-rest: OR = 1.29 (0.96, 1.73). CONCLUSIONS: cane/no cane). ANALYSIS: 1) G.A.I.T. inter-rater reliability; IntraClass
These results demonstrate that directly-posted, printed educational Correlation Coefficient (ICC); two raters, 10 participants; 2) G.A.I.T.
material can make a small, but statistically significant change intra-rater reliability (ICC); 10 participants, one rater, two time periods;
in the reported practice behaviour of these practitioner groups. 3) capability to discriminate treatment response using within-groups
Given the likely limited effectiveness of educational interventions pre-/post-treatment comparison for both groups (Wilcoxon Signed
targeting individual health care practitioners, combing organisational Ranks Test; blinded examiner). RESULTS: The G.A.I.T. is a 27-item
interventions with educational approaches may be more effective. comprehensive measure of swing and stance phase components.
IMPLICATIONS: Used in isolation, printed educational material is The G.A.I.T. had good intra- and inter-rater reliability (p > 0.85).
likely to produce only very small changes in practice. Given the low The G.A.I.T. exhibited good capability to discriminate response to
unit cost, printed material should still play a part in implementation treatment. Both the No FNS and FNS-IM groups had significant pre-
strategies, but should not be used alone. KEYWORDS: Clinical /post-treatment change, respectively (p < 0.003). CONCLUSIONS:
guidelines, printed educational material, randomised controlled The G.A.I.T was reliable and capable of discriminating gains in
trial. FUNDING ACKNOWLEDGEMENTS: The School of Health coordinated gait components in response to the gait training targeted
and Rehabilitation, Keele University, The Osteopathic Educational to improve the coordinated movements of gait for those with
Foundation, the General Osteopathic Council, the Anglo-European persistent deficits. IMPLICATIONS: With the emergence of innovative
College of Chiropractic and the British Chiropractic Association. gait training methods, it is important to develop measures that are
Nadine Foster is funded by a Primary Care Career Scientist capable of comprehensively and accurately measuring response
award from the Department of Health and NHS R&D. CONTACT: to treatment. In order to develop an evidence-based practice,
[email protected] it is critical that measures are developed that can discriminate
ETHICS COMMITTEE: London Multi-Centre Research Ethics efficacious response to treatment. KEYWORDS: stroke, CVA,
Committee gait, measurement,outcomes,gait coordination, coordination, gait
components. FUNDING ACKNOWLEDGEMENTS: This research
was supported by the Department of Veterans Affairs, Office of
Rehabilitation Research and Development, Grant B2226R B3105R.
1695 Tuesday 5 June 15:00 CONTACT: [email protected]
VCEC Meeting Room 16 ETHICS COMMITTEE: Louis Stokes Cleveland VA Medical Center,
GAIT ASSESSMENT AND INTERVENTION TOOL (G.A.I.T.) FOR Internal Review Board
MEASURMENT OF COORDINATED GAIT COMPONENTS
Daly J1,2 , Nethery J2 , McCabe J2 , Rogers J2 , Brenner I2 , Gansen J2 ; Research Report Platform Presentation
1 Department of Neurology, Case Western Reserve University School
of Medicine, Cleveland, Ohio, USA; 2 Stroke Motor Control and Motor VCEC Meeting Room 17
Learning Laboratory, LS VA Medical Center, Cleveland, Ohio, USA
SINE WAVE ANALYSIS OF WALKING PATTERNS IN CHILDREN
PURPOSE: develop a measure of coordinated gait components that DEMONSTRATES CHANGES WITH MATURITY OF GAIT
is comprehensive, reliable, inexpensive, and capable of discriminating
Alderson L1,2 , Watson T1 , Main E2,3 ; 1 University of Hertfordshire,
gains in response to training targeted to correct dyscoordinated gait.
Hatfield, UK; 2 Physiotherapy Department, Great Ormond Street
RELEVANCE: The Gait Assessment and Intervention Tool (G.A.I.T.)
Hospital, London, UK; 3 Institute of Child Health, University College
was developed for use by clinicians, educators, and researchers to
London, UK
assess the presence/absence of coordinated movements composing
normal walking. The rationale is that available gait measures do PURPOSE: Walking on even surfaces generates a regular pattern
not meet all the following requirements: practicality; inexpensive; of weight shift. As the body moves forward the Centre of Pressure
comprehensive; a homogenous scale excluding confusion between (COP) follows a sinusoidal pattern, which has potential to describe
compensatory strategies and gait deficits; and capability to dis- both normal and abnormal gait. The GAITRite walkway provides raw
criminate gains in coordinated gait movements in response to COP data and preliminary results from a novel analysis of this data
interventions. PARTICIPANTS: Six therapists with 5–35yrs of neuro- (comparing the regularity of the COP walking pattern to a normal
rehabilitation experience developed and tested the G.A.I.T. Thirty-one sine-wave), show promise for clinical applications. In preparation
stroke survivor participants with persistent (>12 months) stance and for using this technique in children with balance difficulties and
swing phase deficits were enrolled (attrition=3) to test G.A.I.T. validity, irregular walking patterns, this study aimed to describe changes
reliability, and discriminability of treatment response. METHODS: during growth using a) the characteristics of the sine-wave during
Coordinated gait components were defined as movement excursions gait, and b) the variation between the predicted sine-wave for each
of the hip, knee, and ankle joints, torso and arms that occur in child and actual COP data. RELEVANCE: There are few appropriate
particular combinations, sequences, speeds, and timings during clinical outcome measures that provide quantitative information about
normal gait. The first draft of the G.A.I.T. measure was created dynamic walking balance in children. Temporal and spatial (TS)
by two therapists who compiled and organized gait component outcomes like velocity or step length do not provide sufficient
items from existing gait measures and generated new items for depth of information to describe control of movement when children
completeness. Four additional therapists evaluated the first draft and have walking and balance difficulties. PARTICIPANTS: 137 children
provided feedback for accuracy, clarity and completeness, followed aged 4-14yrs with no neurological or musculoskeletal conditions
by three rounds of evaluation, feedback, and revision, after which were recruited from local schools. The first ten children in each
all therapists approved the G.A.I.T. Participants with stroke were year group who returned signed parental consent were included.
randomized to either: 1) gait training with functional neuromuscular METHODS: The children walked across the walkway (5m x 1m)
stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM); three times at each of three speeds: preferred, fast and slow.
or 2) gait training without FNS. Both groups had the following Linear regression was used to find the best fit sine-wave for each
identical treatment: 1.5hrs/day, 5days/wk, for 12wks, including 0.5hr speed. The wavelength (represented by two step lengths) was used
coordination exercise, 0.5hr body weight supported treadmill training, to fit the model, and the amplitude (step width) and the gradient
and 0.5hr over-ground gait training. However, the FNS-IM group used (direction of line of progression) for each walk were computed.
FNS-IM for all aspects of treatment; the No-FNS group did not. The fit of the sine-wave (%) and the residual error (cm) were
IM electrodes were provided for the FNS-IM group for ankle, knee, calculated to provide absolute and relative measures of variation.
and hip muscles. Video gait records were made before and after ANALYSIS: Children were stratified into five age groups 4-5yrs;
treatment (no brace; volitional over-ground walking; usual device: 6-7yrs; 8-9yrs; 10-11yrs; 12-14yrs. A one-way ANOVA was used
to explore age group effects. Planned contrasts were completed p = 0.0001]. No significant difference was found between GAS
to evaluate differences between specific age groups. RESULTS: scores at conclusion of intervention and the end of the 3months
The fit of the model, and residual error both had significant age follow up period of no-intervention. CONCLUSIONS: This study
effects at all speeds (p 0.01). The fit increased with age from 80 suggests that GAS is a useful measure of quantitative child and
to 90%, and residual error decreased from 3 to 1.5cm. Both had family specific goals demonstrating improvement with physiotherapy
greatest differences between 4-9 years. The wavelength showed a intervention, in children with minor motor difficulties. Improvements
significant increase with age (p 0.02). The amplitude had significant made during intervention were maintained unchanged after a
increase with age at slow speed only (p < 0.001). The effect of further 3 months period of non-intervention. IMPLICATIONS: This
age on gradient was not significant. CONCLUSIONS: Regression tool can be used as a quantitative and individualized outcome
analysis was successfully used to fit a sine-wave to the GAITRite measure to evaluate change with intervention in this large client
COP data. This demonstrates that during development, wavelength group, providing evidence to support the efficacy of physiotherapy
(step length) increases, and the fit of a sine-wave model improves intervention. KEYWORDS: Paediatrics; Goal Attainment Scaling;
with a reduced error. This unique application of a sine-wave analysis Intervention. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT:
suggests children reduce variability of their walking as they grow, [email protected]
improving efficiency. This analysis has enormous potential to detect ETHICS COMMITTEE: Medical Research Ethics Committee of
subtle changes in the regularity of the walking pattern in children The University of Queensland, and Royal Children’s Hospital Ethics
of different ages and further work incorporating clinical populations Committee
is being undertaken to confirm its clinical value. IMPLICATIONS:
The GAITRite is a relatively inexpensive and simple tool that can
produce accurate TS and COP data. Sine-wave regression analysis Research Report Platform Presentation
enables clinicians to describe the uniformity of the walking pattern. 2594 Tuesday 5 June 15:20
KEYWORDS: Walking, Centre of Pressure, Sine-wave analysis. VCEC Ballroom A
FUNDING ACKNOWLEDGEMENTS: This study was completed as A SURVEY OF CURRENT PHYSICAL THERAPY MANAGEMENT
part of a PhD project that was funded by the Health Foundation and OF PATELLOFEMORAL PAIN SYNDROME (PFPS)IN THE
Great Ormond Street Hospital. CONTACT: [email protected] GREATER TORONTO AREA
ETHICS COMMITTEE: Barnet and Enfield Research and Ethics Couperthwaite S, Palinkas V, Sagur S, Tsai M, Zheng J, Laprade J;
Committee, London, UK. Department of Physical Therapy, Faculty of Medicine, University
of Toronto, Canada
Research Report Platform Presentation PURPOSE: This study aimed to determine the current management
2221 Tuesday 5 June 15:00 of Patellofemoral Pain Syndrome (PFPS) by Physical Therapists
VCEC Meeting Room 18 (PTs) in the Greater Toronto Area (GTA), compare current PT
GOAL ATTAINMENT SCALING AS AN OUTCOME MEASURE IN treatment to best available evidence in the literature and identify
AUSTRALIAN CHILDREN WITH MINOR MOTOR DIFFICULTIES gaps in the knowledge and information needs of PTs with respect
to this syndrome. RELEVANCE: PFPS is a common lower extremity
Klepper K, Burns Y, Watter P; The University of Quensland, Australia
disorder that affects 20-25% of the general population which is
PURPOSE: A study evaluating a family centred physiotherapy commonly managed by conservative means in Physical Therapy.
intervention for children with minor motor difficulties used several Despite vast amounts of clinical research relating to PFPS, the
outcome measures, including Goal Attainment Scaling (GAS). The management has been a challenge mainly due to the inconsistency in
study examined changes after intervention and after a following the literature regarding the definition, terminology and pathogenesis.
period of no-intervention. RELEVANCE: In a school aged population, Additionally, there is a paucity of randomized controlled trials (RCTs)
children with minor motor difficulties represent a large group requiring with strong methodological design making it difficult for clinicians
physiotherapy services. Use of a quantitative but individualized to manage their patients based on scientific research. Therefore,
outcome measure such as GAS allows change to be measured there is a need for further investigation on the nature of PTs clinical
after physiotherapy intervention in this client group. PARTICIPANTS: practice of PFPS and to what extent it matches the evidence.
Seventeen children aged 7 years 6 months-10 years 6 months PARTICIPANTS: A random sample of 800 PTs, 400 from Metro and
attending a community based child development unit for motor 100 from each of the remaining GTA regions was selected from the
coordination difficulties provided a sample of convenience, and were College of Physiotherapist of Ontario database. The inclusion criteria
included if they: were male or female; had no physiotherapy or included fluency in English, an active PT with a caseload of less than
occupational therapy in the prior 12m; scored <15th percentile on 50% paediatrics and practicing ten or more hours in an outpatient
Movement Assessment Battery for Children and provided signed orthopaedic setting. METHODS: A questionnaire comprised of 20
consent. Children were excluded if they had: Intellectual Impairment; items related to the definition, assessment, treatment and outcome
a specific sensory or neurological disorder. METHODS: Children measurement of PFPS was mailed out to selected therapists. The
were randomized to 1 of 2 groups and a cross-over study design therapists were also asked to comment on their information needs.
implemented. One group received intervention, while the other Articles were evaluated and deemed best available evidence when
received no intervention, providing a baseline for comparison. After scoring 3/5 via the Jadad Scoring tool. ANALYSIS: Responses
3months, the non-intervention group received intervention. Goal to open-ended questions or to categories labelled “other” were
Attainment Scaling was used at the commencement and conclusion systematically grouped and coded based on a content analysis. Two
of intervention for both groups. Goals were set by the family, designated investigators were responsible for coding and entering
child and therapist in consultation, and intervention was provided data. Data were summarized as the mean +/− SD or median and
over a 10 week period. Both groups were followed for a further range for continuous measures and as frequencies and respective
3months after cessation of intervention and reassessed to evaluate percentages for categorical variables. RESULTS: Eighty-four articles
maintenance of any gains made during the intervention period. pertaining to the treatment of PFPS were scored with fourteen
ANALYSIS: Distribution of scores was evaluated for normality. deemed the best available evidence. Best interventions included
Repeated Measures Analysis of Variance was used to evaluate acupuncture, SI manipulation, electrical muscle stimulation of the
changes between assessments for each group, and p was set VMO and a multimodal treatment approach. Four hundred fifty-
at 0.05. Power was calculated for all analyses. RESULTS: one questionnaires were returned, of which, 105 met the inclusion
Significant improvement in GAS scores after intervention was criteria. Females comprised 69% of the respondents. No consensus
found for both groups [F(1,8) = 378.7, p = 0.0001 and F(1,7) = 241.3, on a working definition of PFPS or essential assessment tests and
objective findings was reported. The highest reported interventions mean difference between test-retest equals 0.0 mV (1a, 1b) and (2a,
were patellar taping (91%), patellar mobilization (81%), VMO 2b), and 95% of the test-retest differences are located between
strengthening (80%), ultrasound (61%), foot orthotics (60%). Eighty −1.5 mV and 1.4 mV (1a, 1b) and between −0.9 mV and 0.9 mV (2a,
PTs stated using a combination of exercise, tape and stretching. Only 2b). ICC between test-retest without interval is 0.996 with SE of
42% of the therapists reported using outcome measures with the 0.001 (1a, 1b), and 0.998 with SE of 0.000 (2a, 2b); and with interval
LEFS(30%), VAS (19%) and PSS (1%) being most common. Clinical 0.926 with SE of 0.018 (1a, 2a), and 0.919 with SE of 0.019 (1b,
experience was identified by 70% of the therapist as being most 2b). Mean SNAP values are 20.2 mV (1a), 20.2 mV (1b), 21.1 mV
influential in managing PFPS. CONCLUSIONS: Many of the varied (2a), and 21.0 mV (2b). CONCLUSIONS: This study demonstrates
assessment and treatment techniques reported are currently not that a single tester can obtain reliable amplitude measurements
supported in the literature suggesting a mismatch between current of sensory nerve action potentials utilizing surface recording
practice and the literature. IMPLICATIONS: Further research and electrodes. IMPLICATIONS: To perform and report reliability studies
dissemination of current clinical knowledge and practice is required an appropriate research design and correct terminology is important.
in order to provide leading edge treatment to clients with PFPS. Minimal time interval should be used to study measurement
KEYWORDS: patellofemoral pain syndrome, survey, treatment, variability, larger time intervals between test and retest to study
assessment, management. FUNDING ACKNOWLEDGEMENTS: intra-subject variability, provided measurement variability is proved
None. CONTACT: [email protected] to be very low. KEYWORDS: reliability, intra-subject variability, nerve
ETHICS COMMITTEE: University of Toronto Research Ethics Board conduction. FUNDING ACKNOWLEDGEMENTS: The work was
unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: Committee of the Faculty of the University
VCEC Meeting Rooms 8&15 Research Report Platform Presentation
INTRA-EXAMINER RELIABILITY OF SENSORY NERVE 2339 Tuesday 5 June 15:20
CONDUCTION MEASUREMENTS VCEC Meeting Rooms 11-12
Ven A1,2 , Van Hees J3 , Stappaerts K1 ; 1 Department of ATTITUDES TO BACK PAIN AMONGST MUSCULOSKELETAL
Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation PRACTITIONERS: A COMPARISON OF UK PROFESSIONAL
Sciences, Catholic University of Leuven, Leuven, Belgium; GROUPS AND PRACTICE SETTINGS USING THE ABS-MP
2 Physiotherapy Ghent, Artevelde University College – Ghent Vogel S1 , Pincus T2 , Foster N3 , Santos R2 , Breen A4 ,
University, Gent, Belgium; 3 Department of Neurosciences and Underwood M5 ; 1 Research Centre, British School of Osteopathy,
Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium London, UK; 2 Department of Psychology, Royal Holloway
University of London, London, UK; 3 Primary Care Musculoskeletal
PURPOSE: To investigate the intra-examiner reliability of consecutive
Research Centre, Keele University, Staffordshire, UK; 4 Department
sensory nerve action potential (SNAP) amplitude measurements with
of Psychology, Royal Holloway University of London, London,
short time intervals. RELEVANCE: With this research, the influence
UK; 5 The Institute for Musculoskeletal Research and Clinical
of measurement variability versus intra-subject variability on sensory
Implementation, Bournemouth, UK; 6 Centre for Health Sciences,
nerve conduction has been clarified, which is highly important when
Bart’s and The London, London, UK
performing serial testing on patients or in research. PARTICIPANTS:
63 healthy volunteers (11 men, 52 women, age between 19–25 years, PURPOSE: To investigate differences between the attitudes to low
BMI between 16.11–24.83 kg/m2) participated. Exclusion criteria back pain (LBP) in three professional groups in the UK: chiropractors,
were diabetes, neuropathy, radicular syndrome, peripheral nerve osteopaths and musculoskeletal physiotherapists. Secondarily, the
damage, sensory disturbance in upper extremities and peripheral study explored differences in attitudes between National Health
edema. METHODS: Height and weight were measured. A constant Service (NHS) physiotherapists and those in private practice.
ambient temperature (mean, 18.2 ºC), combined with light clothing, RELEVANCE: Chiropractors, osteopaths and musculoskeletal phys-
minimized skin sympathetic reflex activity and resulting SNAP iotherapists play key roles in the management of low back pain
amplitude fluctuations. The skin was thoroughly scrubbed and in the UK. There is some evidence that practitioners’ beliefs
cleaned (impedance <20 kW). Stimulating electrodes were attached affect treatment recommendations, however no studies examine
to the wrist radial to the flexor carpi radialis tendon; the cathode chiropractors’, osteopaths’ and musculoskeletal physiotherapists’
was 140 mm distal to the active recording electrode, and the attitudes to LBP. PARTICIPANTS: A random sample of practitioners
anode more distal. The ground electrode was positioned midway. was drawn from the chiropractic (n = 300) and osteopathic (n
The recording electrodes were handheld on the location where the = 300) statutory UK registers. Physiotherapists listed as “muscu-
highest SNAP amplitude could be obtained; the active electrode loskeletal” were drawn randomly from the Chartered Society of
40 mm distal to the elbow fold, and the reference electrode more Physiotherapy register (n = 300). METHODS: A cross-sectional
proximal. Stimuli were supramaximal, and 5–10 responses were postal survey was sent to 900 practitioners, with one postal follow
averaged. A SNAP was measured (1a) (between the negative peak up to non responders. The questionnaire instrument was the
and the preceding positive peak). All electrodes were removed; recently developed and validated Attitudes to Back Pain Scale –
skin and electrodes cleaned. Conductive gel reapplied, and all musculoskeletal practitioners (ABS-mp). The ABS-mp contains two
electrodes were immediately repositioned. Again a SNAP was sections (Personal Interaction and Treatment Orientation). The
measured (1b). Following an interval of 90 minutes, during which overall response rate was 61%. ANALYSIS: Multivariate analyses of
all subjects were submitted to the same passive protocol, all variance (ANOVA) were performed to investigate group differences
electrodes were repositioned and a SNAP was measured (2a). All across subscales and between settings using effect size (Cohen’s d).
electrodes were removed; skin and electrodes cleaned. Conductive To assess the relationship between demographic variables and ABS-
gel reapplied, and all electrodes were immediately repositioned. mp subscales correlation coefficients were computed. RESULTS:
Again a SNAP was measured (2b). ANALYSIS: Bland-Altman plots 465 responses were used in the final analyses: 132 chiropractors,
were constructed to visualize differences between two amplitude 159 osteopaths and 174 musculoskeletal physiotherapists. All three
measurements against the mean of the measurements, situating professional groups endorse a psychosocial approach to treatment.
the obtained data and the accepted limits of association for the Re-activation is seen across the professions as an important
population. Intraclass correlation coefficients (ICC) were calculated, treatment goal. There were some significant differences between
with a standard error (SE). All analyses were performed with the SAS- the groups: Physiotherapists endorsed limiting the number of
statistical package. RESULTS: Visualised in Bland-Altman plots, treatment sessions more than osteopaths and osteopaths more than
chiropractors (large effect size). Physiotherapists felt more connected support (SLS)of the paretic leg (swing time of the non paretic leg)
to a net-work of care (moderate effect), and endorsed items became more consistent. The coefficient of variation (CV) of the SLS
supporting a biomedical approach less than chiropractors (large decreased from 5.3±1.6% while walking with AFO to 4.3±1.4% while
effect). Comparisons between NHS-based physiotherapists and walking with the neuroprosthesis (p = 0.01). The gait symmetry index
those who worked in private practice showed significant differences in improved by 15%, from 0.20±0.09 with the AFO to 0.17±0.08 with
willingness to limit treatment sessions and in advice about restricting the neuroprosthesis (p < 0.05). All of the participants preferred the
activities. These findings were not affected by gender, clinical neuroprosthesis to the AFO for daily ambulation. CONCLUSIONS:
environment or geographical location. CONCLUSIONS: The ABS- After initial adaptation, the neuroprosthetic effect on gait was similar
mp is a sensitive tool, which allows comparison of subtle differences to an AFO, but was significantly better after eight weeks. The results
between professional groups who share many attitudes. The findings thus indicate that the use of an FES neuroprosthesis (NESS L300TM )
that all three groups endorse psychological exploration with patients is likely to enhance gait performance in comparison to walking
and support re-activation as a major treatment goal are in line with with an AFO. The neuroprosthesis improved walking pace, with gait
current guidelines. The difference observed on the endorsement of becoming less variable and more consistent. These findings suggest
limiting treatment sessions might reflect practical or professional enhanced “automaticity of gait”, and a reduction in the risk of falls.
considerations and warrants further investigation. The tendency The ongoing improvement at 8 weeks further suggests that continued
towards limiting sessions was found in private, as well as NHS-based use may lead to further normalization of gait. IMPLICATIONS: These
physiotherapists, and cannot be explained by this factor alone. Future findings suggest that compared to an AFO, an appropriate dynamic
research should explore the relationship between reported attitudes, FES neuroprosthesis may yield better balance control and symmetry
clinical decisions, and outcome in patients. IMPLICATIONS: The during walking, and thus more effectively manage foot drop due to
relationship between attitudes and beliefs in clinicians, their clinical stroke or traumatic brain injury. KEYWORDS: Neuroprosthesis, AFO,
choices and the process of care (including multiple outcomes) is Gait. FUNDING ACKNOWLEDGEMENTS: Equipment provided by
poorly understood. The findings suggest that both similarities and NESS, Ltd., Raanana, Israel.
differences exist between the three professional groups, and help pin- ETHICS COMMITTEE: Human Studies Committee, Lowenstein
point areas for future research. KEYWORDS: Professional attitudes, Rehabilitation Hospital
low back pain. FUNDING ACKNOWLEDGEMENTS: Economic and
Social Science Research Council (ESRC). Nadine Foster is funded
by a Primary Care Career Scientist award from the Department of Research Report Platform Presentation
Health and NHS R&D. CONTACT: [email protected] 2623 Tuesday 5 June 15:20
ETHICS COMMITTEE: Worksop Multi Region Ethics Committee VCEC Meeting Room 17
MUSCLE CO-CONTRACTION DURING WALKING:
COMPARISONS BETWEEN YOUNG AND ELDERLY WOMEN
2194 Tuesday 5 June 15:20 Dias J, Alencar M, Arantes P, Kirkwood R, Dias R; Physical
VCEC Meeting Room 16 Therapy Department, Federal University of Minas Gerais, Belo
Horizonte, Brazil
FES NEUROPROSTHESIS VERSUS AN ANKLE FOOT
ORTHOSIS: THE EFFECT ON GAIT STABILITY AND SYMMETRY PURPOSE: The objective of this study was to compare co-
contraction levels between young and elderly women with regard
Weingarden H1,2 , J2−4 ; 1 Sheba
Hausdorff Medical Center
to the vastus lateralis and biceps femoris (VL-BF) and the tibialis
Department of Neurological Rehabilitation; 2 Sackler School of
anterior and gastrocnemius (TA-GAS) muscles, 200 ms before and
Medicine,Tel-Aviv University, Tel-Aviv, Israel; 3 Movement Disorders
after initial contact (IC) during gait. Comparisons of gait velocity,
Unit, Neurology Department, Tel-Aviv Sourasky Medical Center, Tel-
knee and ankle angles at IC and work for body mass (W/BM) were
Aviv, Israel; 4 Division on Aging, Harvard Medical School, Boston, MA
also analyzed. RELEVANCE: An investigation into the presence
PURPOSE: To compare the effects of an FES neuroprosthesis of co-contractions as a possible strategy adopted by the elderly
(NESS L300TM ), versus an Ankle Foot Orthosis (AFO), on gait during this initial contact phase and its correlations with kinematics
stability and symmetry in patients with foot drop. RELEVANCE: alterations in gait and muscle performance, may contribute to a better
Gait rehabilitation is a cornerstone of physical therapy practice. understanding of the mechanisms of dynamic joint stabilization.
PARTICIPANTS: 15 patients (age: 52.2±3.6 yrs) with chronic This evidence may also contribute with important information to the
hemiparesis (5.9±1.5 yrs) whose walking was impaired by foot drop existing body of knowledge and assist in the elaboration of more
and regularly used an AFO. 12 patients were post stroke and 3 patient efficient strategies for gait training. PARTICIPANTS: Forty women
were post traumatic brain injury. METHODS: After providing written participated in this study: 20 young (20-27 yrs; 22.5±2.21 yrs)
informed consent, approved by the Human Studies Committee, and 20 elderly (65-79 yrs; 71±4.23 yrs). The volunteers had to
Lowenstein Rehabilitation Hospital, the FES neuroprosthesis was meet the following criteria: live independently in the community, be
applied individually for each patient. There was a four week capable of walking without an assistance device and be sedentary
adaptation period during which participants increased their daily use in accordance with the classification of the American College of
of the neuroprosthesis; while using the AFO for the rest of the day. Sports Medicine (ACSM). This study was approved by the Federal
Gait was then assessed in a 6 minute walk while wearing force- University Ethics Committee-number 2004/579. METHODS: Muscle
sensitive insoles, alternately using the neuroprosthesis and the AFO co-contraction was assessed through surface electromyography and
in a randomized order. An additional gait assessment was conducted kinematics parameters during gait. Gait velocity and knee and ankle
after using the neuroprosthesis for a further four weeks. Stride time joint angles at initial contact were obtained by motion analysis
(inverse of cadence) was determined, as were gait symmetry index system. Work normalized by body mass was obtained through
and swing time variability, both markers of gait stability and fall concentric contractions using isokinetic dynamometry. ANALYSIS:
risk. ANALYSIS: Paired t-tests were used for each parameter to Distribution of data was tested by the Shapiro-Wilk and Lilliefors
compare the AFO and neuroprosthetic effects after four and eight tests and the homogeneity of variance was tested by the Cochran
weeks. RESULTS: After the four week adaptation period, the FES and Bartlett tests. ANOVA with posterior average comparisons
neuroprosthesis and the AFO affected gait similarly (p > 0.05). After (Student-t test) was performed to compare groups regarding to
eight weeks of walking with the neuroprosthesis, gait was significantly variables of co-contraction levels, gait velocity, knee and ankle joint
improved relative to the AFO. Stride time, a measure of the walking angles at initial contact and W/BM. The observed co-contraction
pace, improved from 1.48±0.21 sec while walking with the AFO to levels, kinematics parameters and muscle performance in each
1.41±0.16 sec with the neuroprosthesis (p < 0.02).The single limb group were analyzed by Pearson correlation test. The level of
significance was set at 5%. RESULTS: The elderly women co- on the child. In both the UE and AX, such changes only occurred
contracted VL-BF and TA-GAS more than the young women both between the baseline and the first follow-up, but none after that. In
before and after IC (p0.0005). Gait velocity and W/BM were the UE, the most common MP change was from a push-and-reach
lower for older women (p0.0003). No differences were observed to a bilateral push (both hands, placed on the ground beside the
with regard to joint angles (p0.493). For the younger group, pelvis), to an asymmetrical push-and-reach pattern. In the AX, the
moderate correlations were only observed between TA-GAS co- children tended to rise with less body rotation. CONCLUSIONS: This
contractions before IC and dorsiflexor W/BM (r = 0.504; p = 0.024) study demonstrated that the greatest MP change occurred between
and plantar flexors W/BM (r = 0.602; p = 0.005. CONCLUSIONS: 3 and 4 years old, and one common feature of such change was
Elderly women showed higher levels of co-contraction of the VL- found in the UE and AX, though the MP change in the LE varied
BF and TA-GAS during the initial contact phase of the gait when among the children. IMPLICATIONS: These results suggested that it
compared with young women. This increase in co-contraction may is important for the physiotherapist to observe the MPs in the UE
be a strategy the elderly adopt to ensure dynamic joint stability and and AX in order to evaluate the development of the child, rising
be better prepared for potentially unstable situations during gait. from a supine position. KEYWORDS: longitudinal study, healthy
However, the possible factors associated to this phenomenon are children, rising from a supine position to an erect stance. FUNDING
not yet completely known and require future studies to elucidate ACKNOWLEDGEMENTS: NA. CONTACT: [email protected]
this issue. IMPLICATIONS: It is likely that these adaptations are u.ac.jp
strategies to compensate for present limitations due to the aging
process and a means of maintaining functionality. The results of
this study suggest that physical therapy programs for elderly women Research Report Platform Presentation
might be beneficial to enhance these adaptations. KEYWORDS: 3157 Tuesday 5 June 15:40
elderly, young, co-contraction. FUNDING ACKNOWLEDGEMENTS: PP Crystal Pavilion A
Financial support: CNPq – Brazilian Funding Research Agency. AN EXPLORATION OF CLINICAL INSTRUCTORS’ EXPERIENCES
CONTACT: [email protected] AND PERCEPTIONS OF THE PHYSICAL THERAPIST CLINICAL
ETHICS COMMITTEE: Federal University Ethics Committee-number PERFORMANCE INSTRUMENT
2004/579. Creaser G; Mount Saint Vincent University, Halifax, Nova Scotia,
Canada
Research Report Platform Presentation PURPOSE: The purpose of this study was to explore the shared
2235 Tuesday 5 June 15:20 experiences of physiotherapist clinical instructors using the Physical
VCEC Meeting Room 18 Therapist Clinical Performance Instrument and their perceptions
THE MOVEMENT PATTERNS OF RISING FROM A SUPINE of its relevance to their clinical practice and student evaluation.
POSITION TO AN ERECT STANCE IN HEALTHY CHILDREN: A RELEVANCE: Education and evaluation of physiotherapy students’
THREE-YEAR LONGITUDINAL STUDY clinical performance is carried out under the guidance of physio-
therapist clinical instructors (CIs) who have had varying amounts
Nakano C1 , Shiba Y2 , Sakamoto M2 , Sato H2 , Mihara N3 ;
1 Graduate school of medical science, Kitasato University; 2 Kitasato of preparation for their roles. CIs observe students’ behaviour
within the complex context of patient care and interpret their
University, School of Allied Health Sciences; 3 Tsukuba Memorial
performance as it relates to defined evaluation criteria. The CPI
Hospital, Rehabilitation Center, Ibaraki, Japan
was developed as an evaluation tool that would be widely accepted
PURPOSE: The ability to rise from a supine position to an erect and applicable to a broad range of clinical environments. There
stance is a significant part of physical independence, and is an is a need to study how CIs use the CPI and if they consider it
important step toward the development of functional capabilities in to be useful for clinical evaluation. PARTICIPANTS: A purposeful
early childhood. Previous studies on children’s rising from such a sample of 16 CIs from three tertiary healthcare centres affiliated
position concentrated on cross-sectional analysis, in which various with Dalhousie University, Halifax, Nova Scotia, participated. The
types of movement patterns (MPs) were shown to develop according CIs provided care for adults or children on either inpatient or
to age, though the development of physical functions depended outpatient services in acute-care or rehabilitation settings. The CIs
on each child. Therefore, as the purpose of this study was to had a mean of 15.5 years of clinical experience and they had
demonstrate the MP changes in a child’s ability to rise from such instructed a mean of 4.6 students. METHODS: The study was
a position, a longitudinal study was used so as to explain sequential undertaken using a qualitative methodology. Each clinical instructor
development. RELEVANCE: Such a longitudinal study as this can participated in one of three focus groups. All discussions were
reveal normal MP development in this action in early childhood. audiotaped and verbatim transcipts constituted the data for the
PARTICIPANTS: This involved 17 healthy children belonging to the study. ANALYSIS: Each transcript was thoroughly reviewed and
youngest year at kindergarten (mean age ±SD = 3y 9mo ±4mo), word/phrase lists were compiled, compared and colour coded.
who were then followed, on a yearly basis, over a three-year period Topics were clustered and broad headings initially identified were
between 2003 and 2005. METHODS: In 2003, children in the regrouped resulting in four emergent themes. Five themes were
youngest year at kindergarten were regarded as the baseline (mean identified in the final analysis: CPI for summative evaluation, CPI
age ±SD = 3y 9mo ±4mo). In 2004, they had their first follow-up for formative evaluation, Training to use the CPI, Shared learning,
(mean age ±SD = 4y 9mo ±4mo), with their second one in 2005, and Practicality of the CPI. RESULTS: The CIs described factors
at which time they were then (mean age ±SD = 5y 9mo ±4mo). that influenced their perceptions of the value of the CPI and
They were videotaped with 2 cameras simultaneously from both the their application of it. The strength of the CPI was considered
frontal and sagittal planes, while rising from a supine position, and its use as a tool to promote dialogue and learning. Its use for
MPs were classified according to VanSant’s descriptions of the action summative evaluation was perceived to be problematic due to
of three bodily movements: the upper extremity region (UE); the axial inconsistent application across clinical instructors. Training to use
region (AX); and the lower extremity region (LE). These three were the CPI was useful and was considered a positive influence on
then categorized in four to five steps. ANALYSIS: The MP change of CIs’ understanding of the instrument. The language, relevance of
these three regions in every child was investigated over a three-year the performance criteria, and excessive overall length of the CPI
period, and the incidence was calculated, based on each different were considered to have a negative impact on its practicality.
change. RESULTS: 9 of the 17 (52.9%) children in the UE and 6 CONCLUSIONS: This exploratory study cannot be generalized to
of the 17 (35.3%) in the AX, showed the same MPs over the three- all clinical instructors but it indicated challenges and the potential
year period. However, in the LE, the MP changes varied depending impact that inconsistent understanding of the CPI can have on
the clinical evaluation. The evaluation of physiotherapist students’ mid-thigh nerve bed. This research confirms that varying degrees
performance in the context of patient care delivery is complex and of transverse and longitudinal movement do occur and supports
CIs’ understanding and application of the CPI should not be left to the suggestion that neural mobilisation can be effective in the
chance. IMPLICATIONS: Further study is required to determine the treatment of altered neurodynamics. IMPLICATIONS: This research
impact that training has on CIs’ application and satisfaction with the may validate the claim that its effectiveness is due to movement
CPI. Inconsistent application of the CPI could erode students’ and of peripheral nerves in relation to surrounding tissues. Therefore,
CIs’ confidence in clinical evaluation as a fair and consistent process. if the hypothesis of this project is accepted, then there may be a
KEYWORDS: CPI, clinical education, physiotherapy. FUNDING wider implication for ultrasound imaging of neural mobilisation in
ACKNOWLEDGEMENTS: This research was not funded by an pathological populations. KEYWORDS: diagnostic ultrasound, neu-
external agency. CONTACT: [email protected] ral, mobilisation. FUNDING ACKNOWLEDGEMENTS: New Zealand
ETHICS COMMITTEE: University Research Ethics Board of Mount Society of Physiotherapy and the Auckland University of Technology.
Saint Vincent University. CONTACT: [email protected]
ETHICS COMMITTEE: AUTEC – Auckland University of Technology
Ethics Committee
VCEC Exhibit Hall A Research Report Platform Presentation
DIAGNOSTIC ULTRASOUND ASSESSMENT OF SCIATIC NERVE 1478 Tuesday 5 June 15:40
MOVEMENT DURING NEURAL MOBILISATION VCEC Meeting Rooms 11-12
EXTENDED SCOPE PRACTITIONERS’ MANAGEMENT OF
Hing W1 , Ellis R1 , Allen S2 ; 1 Physical Rehabilitation Research
LUMBAR SPINAL STENOSIS
Centre, Auckland University of Technology, New Zealand; 2 Horizon
Scanning, Auckland University of Technology, New Zealand Browne J1,2 , Roberts L1 ; 1 School of Health Professions and
Rehabilitation Sciences, University of Southampton, Southampton,
PURPOSE: The aim of this project is to assess movement UK; 2 Therapy Department, Royal Cornwall Hospital, Truro,
of the sciatic nerve, using real-time ultrasound imaging during Cornwall, UK
neural mobilisation techniques. The study assesses whether sciatic
nerve movement occurs during neural mobilisation. RELEVANCE: PURPOSE: Lumbar spinal stenosis (LSS) refers to narrowing of the
Peripheral nerves must be able to dynamically move in relation spinal canal, nerve root or intervertebral canal resulting in variable
to their surrounding tissues for efficient function. Pathological signs and symptoms. Extended Scope Practitioners (ESPs) often
adherence or compression of peripheral nerves may impact on their assess and manage patients with LSS in clinics, however clinical
ability to effectively move in respect to surrounding tissues, which may guidelines and clear evidence of how best to manage these patients
result in neural damage and dysfunction. A ‘slider’ is a neurodynamic is yet to evolve. The aim of this research is to identify factors that
technique designed to promote movement of peripheral nerves. affect clinical decision-making in ESP clinics. RELEVANCE: LSS is
Essentially tension is taken up from one end of the nerve trunk the most common diagnosis associated with lumbar spinal surgery
whilst it is simultaneously released from the opposite end. This in adults over 65 years old and its management remains a focus
sequence is then reversed allowing longitudinal sliding to occur. In for debate. Initially the prognosis of LSS was believed to be poor in
pathological situations where nerve movement may be reduced, it the absence of laminectomy, recommended for patients with “severe
would potentially be helpful to quantify movement loss or restriction symptoms” and conservative treatment was limited to patients with
and also to allow comparison of relative neural movement pre- minimal symptoms, elderly patients with co-existing illnesses, or
and post-intervention. Objective measurement of nerve movement who contraindicated surgery. Over time, it has been shown that
using real-time ultrasound, may be extremely useful clinically. There long-term outcomes following surgery can produce disappointing
are numerous studies which have measured longitudinal nerve results, and that many patients do well without surgery. Patients with
movement, of upper limb nerves using real-time ultrasound. As for moderate symptoms fall into a “grey zone” in which the appropriate
the sciatic nerve, there appears to be no ultrasound studies that treatment is not obvious and clinical decisions are based on multiple
make any quantifiable analysis or measurement. PARTICIPANTS: factors. However, there are no reported randomised-controlled trials
Subjects (n=15) who met the inclusion criteria were seated in a in the literature comparing surgical and non-surgical management.
custom built standardised rig, specifically designed to maintain the Therefore the predictors of outcome, relative risks, efficacy and cost
subject in a slump position. METHODS: Ultrasound images from of surgical versus non-surgical management are difficult to discern.
a Philips HD11 ultrasound machine using a linear array probe PARTICIPANTS: The target population included all ESPs in the
(5-12 MHz, 55mm) were collected. Two standardised positions United Kingdom (UK), defined as “clinical physiotherapy specialists
of a) the mid-point of the posterior thigh (mid-thigh nerve bed) in any recognised speciality with an extended scope of practice”
and b) at the level of the popliteal crease were visualised. At registered in the ESP Occupational Interest Group (OIG) and
each of these positions recordings within the transverse plane and working in clinics with patients who have spinal conditions (n=288).
the longitudinal plane were collected. The video loops were then METHODS: This quantitative study used a postal questionnaire
converted to digital format using conversion software. For the purpose design and two clinical vignettes. Reminders were sent at one and
of this study, a neurodynamic ‘slider’ was utilised in order to allow four weeks. Data were analysed using the Statistical Package for the
movement of the sciatic nerve. ANALYSIS: A method of frame- Social Sciences (SPSS 11.0). ANALYSIS: Multivariate descriptions
by-frame cross-correlation analysis (Dilley et al. 2001) was utilised of service characteristics were attained through cross tabulations.
to determine and measure the relative in-vivo nerve movement Possible associations between the characteristics were established
between successive frames in the sequence of ultrasound images. using Pearson’s chi-squared and Somers’d test. Open questions were
RESULTS: Transverse movement of (mean±SD) 4.42±0.89mm analysed by thematic and content analyses. RESULTS: Of the 288
vertical and 7.29±2.33mm horizontal was measured at the popliteal questionnaires were sent out, 226 were returned (response rate
crease compared with 0.69±0.31mm vertical and 0.83±0.43mm 78.5%). Of the returned questionnaires, 134 were ESPs working
horizontal measured at the mid-thigh nerve bed location. Longitudinal in clinics with patients who have spinal conditions. The main
nerve movement measured 0.87±0.09mm at the popliteal crease factors found to affect clinical decision-making were: accessibility
compared to 2.18±0.59mm at mid-thigh nerve bed. CONCLUSIONS: to resources (including MRI and surgeons); patient choice; and
In line with the ‘convergence theory,’ a greater degree of transverse severity of symptoms. CONCLUSIONS: The results indicated that
movement (versus longitudinal movement) was measured at the there was a lack of consensus amongst ESPs in the UK as to the
popliteal crease location while the opposite was observed at the most appropriate management of patients who have suspected LSS.
Referral patterns vary considerably throughout the UK and there pain and swelling. The patient adapted well to the tuned AFO and
are currently no national guidelines or protocols, which are followed stated that tuning has been “a life changing experience” for her.
in clinic to help standardise the management of these patients. IMPLICATIONS: The effects of tuning of AFO-FC are evident from
IMPLICATIONS: This lack of consensus for management has a cost this case study. Future randomized controlled studies are required
and waiting time impact for the National Health Service. The natural to generalise these results. References: 1. Owen E (2002) Gait &
history of LSS does not appear to be one of inevitable deterioration, Posture 16: Supp 1, S132-S133. 2. Owen E (2005) Gait & Posture
challenging the need for routine further investigations. Further 22S: S36-S37. KEYWORDS: Hemiplegia, Ankle Foot Orthoses,
research is needed to develop and implement clinical guidelines Tuning. FUNDING ACKNOWLEDGEMENTS: The first author of this
for patients with LSS. KEYWORDS: stenosis, conservative, sur- study is funded by Queen Margaret University College, Edinburgh in
gical. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT: the form of scholarship. CONTACT: [email protected]
[email protected]
ETHICS COMMITTEE: South West Multi Research Ethics Comittee
2662 Tuesday 5 June 15:40 DO ANATOMICAL MEASURES EXPLAIN GENDER
VCEC Meeting Room 16 DIFFERENCES IN HIP AND PELVIS MOTION DURING GAIT?
EFFECT OF THE TUNING OF ANKLE FOOT ORTHOSES-
Chumanov E1 , Wall-Scheffler C2 , Heiderscheit B3 ; 1 University
FOOTWEAR COMBINATION (AFO-FC) ON GAIT OF A
of Wisconsin – Madison Department of Mechanical Engineering;
HEMIPLEGIC PATIENT- A CASE STUDY 2 Department of Zoology; 3 Department of Orthopedics and
Jagadamma K1 , Coutts F1 , Owen E2 , Herman J3 , Yirrell J4 , van Rehabilitation
der Linden M1 ; 1 Queen Margaret University College, Edinburgh,
UK; 2 Child Development Centre, Bangor, UK; 3 Anderson Gait PURPOSE: The purpose of this study was to determine if
Analysis Laboratory, Edinburgh, UK; 4 Royal Hospital for Sick gender differences in pelvis and hip kinematics during walking and
Children, Edinburgh, UK running on a range of inclines correlate to anatomical measures.
RELEVANCE: Patellofemoral pain and iliotibial band syndrome are
PURPOSE: Ankle Foot Orthoses (AFO’s) are commonly prescribed common running related injuries, particularly in females. Abnormal
for patients with hemiplegia to control ankle joint motion. It has non-sagittal hip and pelvis motion has been observed among females
been suggested that the optimal alignment can be gained by and suggested as the cause of the injury-rate disparity between
tuning the AFO -footwear combination (AFO-FC) using wedges genders. It is reasonable that these differences in pelvis and thigh
and rockers to realign the Ground Reaction Force vector (GRF) motion may be related to the gender-specific morphology of the
relative to the joint centres minimizing abnormal joint moments1,2 . pelvis and thigh. It is therefore important to consider how anatomical
RELEVANCE: Although some studies have provided evidence differences between gender could influence the pelvis and hip
regarding the importance of the alignment of AFOs, tuning of kinematics. PARTICIPANTS: Twenty-six healthy athletes (10 females
the AFO-FC by optimising the alignment of the shank and GRF and 16 males), 18–31 yr old, participated in this study. METHODS:
is not common in clinical practice. Objective data is needed to An optical motion analysis system was used to collect the kinematic
establish the effects of tuning AFO-FCs on the gait of patients trajectories of 40 reflective markers while subjects walked (1.2, 1.5,
with hemiplegia. PARTICIPANTS: This single case study involved a and 1.8 m/s) and ran (1.8, 2.7, and 3.6 m/s) at inclines of 0, 10,
61 year old female with left hemiplegia; generalised hypertonicity, and 15%. A circumduction motion of the thigh on both the right and
short gastronemius, and reduced muscle power on the left side. left side was performed to estimate the location of the functional hip
She presented with constant pain and swelling in the left knee joint center. A three-dimensional 14 segment, 29 degree of freedom
caused by excessive hyperextension but was ambulant with one musculoskeletal model (SIMM) was used to compute hip and pelvis
stick. METHODS: Data collection was part of routine clinical gait angles throughout the motion. ANALYSIS: The effects of gender
analysis and the subject agreed the use of the data for research on peak joint angles and angular excursions (internal hip rotation,
purposes. Gait analysis (Vicon 612 with two AMTI force plates) lateral pelvic tilt) were determined using repeated measures ANOVA.
was performed on three occasions; baseline (with untuned AFO Anthropometric measures (height, mass, BMI, leg length, thigh
prescription), immediately after tuning and 3 months after tuning. length, trochanteric breadth, iliac breadth, and distance between
In tuning, wedges were attached to the heel of the shoe until the functional hip joint centers) were compared between genders using
Shank to Vertical Angle (SVA) of the AFO-FC, in standing, was an independent t-test. Pearson’s r coefficients and forward stepwise
approximately 12º inclined. The SVA was further adjusted to optimise regression analysis were used to determine the relationship between
joint kinematics at midstance and orientation of the GRF relative the anthropometric measures and kinematic variables. RESULTS:
to the knee and hip joints. The optimum SVA for midstance tuning Females displayed significantly greater lateral pelvic tilt excursion
was 14º inclined. A rocker was added to tune terminal stance. Gait (1.5-5.8º; p < 0.001) compared to males across all walking speeds
analysis was repeated for the finalised AFO-FC and reassessment and inclines. They also displayed significantly greater peak internal
was carried out after three months. ANALYSIS: Comparisons were hip rotation (1.6-4.3º; p < 0.05) across walking and running and
made between the walking speed and the graphs showing knee at all surface inclinations. Significant differences between genders
flexion-extension movement and flexion extension moments of the were present for all anthropometric measures (p < 0.05). However,
knee joint in all the three sessions. RESULTS: While the walking no significant correlations (r = 0.00-0.50) were observed between
speed decreased from 0.95 m/s with the original AFO-FC to 0.81 the anthropometric measures and the pelvis and hip motions.
m/s with the tuned AFO-FC on the same day, it increased to 1.03 CONCLUSIONS: Healthy female athletes exhibited greater lateral
m/s after using the tuned AFO-FC for three months. Knee flexion pelvic tilt during walking and greater internal hip rotation during both
during early stance increased and hyperextension during mid stance walking and running compared to males. However, these kinematic
decreased by the use of tuned AFO-FC in comparison with the distinctions do not appear to be related to the anthropometric
original prescription. The knee extension moment during stance differences between genders. IMPLICATIONS: Healthy subjects
phase decreased towards normal. CONCLUSIONS: Reduction of exhibited gender related differences in the pelvis and hip kinematics
the knee hyperextension and the excessive knee extension moment during walking and running, suggesting the need for gender specific
throughout stance can be attributed to the realignment of GRF criteria to be applied during the clinical evaluation of individuals
through modification of SVA and the addition of a rocker sole. with running related injuries. Furthermore, anatomical differences
Reduction in hyperextension has led to significant decrease in knee alone do not explain the discrepancies in pelvis and hip kinematics
between genders. KEYWORDS: running injury, patellofemoral pain, dyslexia, motor function. FUNDING ACKNOWLEDGEMENTS: The
anthropometry. FUNDING ACKNOWLEDGEMENTS: NSF Fellow- study was supported by Foundation for Education and Research in
ship (E.Chumanov); University of Wisconsin graduate and medical Physiotherapy, Norway. CONTACT: [email protected]
schools. CONTACT: [email protected] ETHICS COMMITTEE: Approved by regional devision of National
ETHICS COMMITTEE: University of Wisconsin – Madison Health Committee for Research Ethics in Norway.
Sciences Institutional Review Board
2476 Tuesday 5 June 15:40 PP Crystal Pavilion B & C
VCEC Meeting Room 18 FACTORS ASSOCIATED WITH MANUAL FORCES APPLIED
MOTOR COORDINATION DIFFICULTIES IN A MUNICIPALITY DURING CERVICAL MOBILIZATION
GROUP AND IN A CLINICAL SAMPLE OF POOR READERS
Snodgrass S1 , Rivett D1 , Robertson V2 , Stojanovski E3 ; 1 Discipline
Iversen S1 , Berg K2 , Ellertsen B3 , Tønnesen F3 ; 1 Section of of Physiotherapy, School of Health Sciences, The University of
Physiotherapy Science, Department of Public Health and Primary Newcastle, Australia; 2 School of Health Sciences, The University of
Health Care, University of Bergen, Norway; 2 Department of Newcastle and North Sydney Central Coast Health, NSW, Australia;
Physiotherapy, Faculty of Health and Sosial Sciences, Bergen 3 School of Mathematics and Physical Sciences, The University
University College, Norway; 3 The Reading Centre, University of of Newcastle, Australia
Stavanger, Norway
PURPOSE: To investigate associations between manually applied
PURPOSE: We wanted to investigate incidence, severity and types cervical mobilization forces and characteristics of therapists and
of motor problems in two different groups of children with reading mobilized subjects. RELEVANCE: Optimizing manual treatment
difficulties compared to a control group of children with good reading to the cervical spine necessitates evaluation of the application
abilities. RELEVANCE: Research regarding motor coordination of commonly used techniques. PARTICIPANTS: 116 physical
difficulties and dyslexia is somewhat conflicting. Further research therapists practicing in outpatient musculoskeletal clinics primarily
from different angels is warranted. As a member of a multidisciplinary in NSW Australia and 35 asymptomatic volunteers. METHODS:
team, physiotherapist can offer children with such problems help Each therapist applied a central and a unilateral postero-anterior
to improve their motor performance. PARTICIPANTS: A group of (PA) mobilization technique to the spinous and articular processes
children with severe dyslexia (CD), a teacher selected municipality (one right and one left) of both C2 and C7 of a single volunteer.
sample (MUN) comprising the 5% poorest readers, and a control Maitland mobilization grades I through IV were applied at each pre-
group (CON) consisting of the 5% best readers, participated. The CD marked location in randomized order. Therapists repeated all four
group, 20 children, mean age 11.1 years, were all the children who mobilization grades at a single location on the same volunteer after 20
over a period of 14 month, were referred to a regional Competence minutes. Manual forces were measured in three directions using an
Centre due to severe reading problems and received a diagnosis instrumented treatment table fitted with seven bi-axial load cells. Prior
of dyslexia at the centre. The MUN group, 17 children, mean age to mobilization, spinal stiffness at both C2 and C7 was measured with
10.6 years, and CON group, 22 children, mean age 10.5 years, were a device that applied five cycles of standardized mechanical force at
randomly selected from each of the teachers identified 5% poorest 1 Hz to the spinous process while recording force and displacement.
readers and 5% best readers in school grade 6 in a Norwegian Age, gender, height and weight of both therapists and mobilized
municipality. The MUN group satisfied psychometric criteria for a subjects were documented. Other therapist characteristics recorded
diagnosis of specific reading problems. METHODS: A quantitative included years of experience, training, frequency of performing
approach was used. The participants were assessed applying a cervical mobilizations, work setting, history and frequency of thumb
norm-based, standardized measure by Henderson and Sugden 1992 pain, change in technique due to thumb pain, current symptoms
(The Movement Assessment Battery for Children). ANALYSIS: The in the upper limbs due to previous injuries, and understanding
three groups were compared with regard to total motor impairment of the mobilization grades. Three parameters of applied force
scores as well as within the sub-areas of manual dexterity, ball- were examined: peak force (average peak of oscillations, N), force
skills and balance. Overall group comparisons were analysed using amplitude (average difference between minimum and subsequent
one-way ANOVA. Chi-square was used to analyse frequency tables. maximum forces for each oscillation, N), and oscillation frequency
Significance level was set at p = 0.005. RESULTS: Shown by one- (rate of force application, Hz). ANALYSIS: One-way anovas with
way ANOVA, there was an overall significant difference between the Bonferroni post-hoc tests were used to examine differences between
three groups on the total M-ABC impairment score [F(2,58) = 6.23, mobilization grades and techniques. Regressions were used to deter-
p = 0.004], in manual dexterity [F(2,58) = 9.18, p < 0.001] and in mine associations between force parameters and characteristics of
balance [F(2,58) = 3.54, p = 0.036], but not in ball skills. More than therapists and mobilized subjects. Directions of force were analyzed
50% of the children in both groups of poor readers showed definite separately. RESULTS: Therapists applied different forces for different
motor difficulties at or below the 5th percentile. Children in both techniques and grades, greater force at C7 than C2, and greater
groups showed difficulties within manual dexterity in particular and mediolateral force for unilateral techniques (all significant at the 0.001
the ability to perform continuous, precise fine-motor movements was level). Oscillation frequency did not differ between techniques, but
severely affected (sub-test manual dexterity 3). For this sub-test Chi- between grades I and IV and grades II and III (p < 0.005 for each
square analysis of the frequency table of CD versus CON yielded pair of grade comparisons). Characteristics associated with force
c2 (1,42) = 22.51, p < 0.001, and for MUN versus CON c2 (1,39) = 7.97, parameters varied with technique and grade. Gender of therapist
p < 0.001. CONCLUSIONS: The high incidence of motor coordination and mobilized subject were associated with vertical peak force
problems in the two groups of poor readers indicates that all (p < 0.001 for most techniques and grades); mobilized subject height
children with reading difficulties should be screened for possible and weight were associated with caudad-cephalad peak forces and
motor difficulties. Further research is needed with regard to various force amplitudes for C7 techniques (p 0.001 for grades II-IV); and
types of fine motor function in children with reading difficulties, frequency of thumb pain, change in technique due to thumb pain, and
and in order to clarify functional consequences of motor difficulties therapist understanding of the mobilization grades were associated
at activity and participations levels. IMPLICATIONS: The diversity with oscillation frequency for all techniques and grades (p < 0.001).
and complexity of developmental disorders point to the importance CONCLUSIONS: Factors associated with cervical mobilization forces
of providing a multidisciplinary assessment and intervention within vary depending on the technique and grade applied. IMPLICATIONS:
a broad dynamic developmental framework. KEYWORDS: DCD, These results describe characteristics of therapists and mobilized
subjects associated with manual cervical mobilization forces. Rec- recommendations include offering improved privacy, individualized
ognizing these associations may optimize therapists’ application treatment, educational sessions, and providing opportunities for peer
of manual cervical treatments, and impact on future research support and rehab outings. KEYWORDS: spinal cord injury, women,
and training programs for cervical mobilization. KEYWORDS: body image. FUNDING ACKNOWLEDGEMENTS: The original study
musculoskeletal manipulations, cervical vertebrae, physical therapy was supported by the Ontario Neurotrauma Foundation.
modalities. FUNDING ACKNOWLEDGEMENTS: This work was ETHICS COMMITTEE: The Health Sciences II Research Ethics
supported by a University of Newcastle Early Career Researcher Board at the University of Toronto
Grant. CONTACT: [email protected]
ETHICS COMMITTEE: The University of Newcastle Human Re-
search Ethics Committee, and ethics committees of Hunter New
England Health and Central Coast Health 748 Tuesday 5 June 16:15
DELISTING PUBLICLY-FUNDED COMMUNITY-BASED
Research Report Platform Presentation PHYSICAL THERAPY SERVICES IN ONTARIO, CANADA: A
2247 Tuesday 5 June 16:15 12-MONTH FOLLOW-UP STUDY
VCEC Ballroom A
Paul J1 , Park L1 , Ryter E1 , Miller W1 , Ahmed S1 , Landry M2 ,
WOMEN LIVING WITH A SPINAL CORD INJURY: PERCEPTIONS Cott C2 ; 1 Department of Physical Therapy at the University of
ABOUT THEIR CHANGED BODIES Toronto, Toronto, Canada; 2 Department of Physical Therapy at
Chau L, Hegedus L, Praamsma M, Smith K, Tsukada M, Yoshida K; the University of Toronto, and The Arthritis Community Research
University of Toronto and Evaluation Unit, Toronto, Canada
PURPOSE: The purpose of this study is to illuminate narratives PURPOSE: Publicly-funded community-based physical therapy (PT)
of women living with a spinal cord injury (SCI) with regards to (1) services in Ontario were partially delisted in April 2005. This study
learning how to live with a changed body and (2) exploring the factors is a 12-month follow up to previous studies that assessed short-term
that influence how they feel towards their new bodies. RELEVANCE: consequences of the delisting. This follow up aimed to assess the
A SCI produces immediate physical impairments resulting in a long-term consequences of the policy decision from the perspectives
changed body, which refers not only to physical modifications, but of both PT providers and clients in Ontario. RELEVANCE: Reduc-
also to changes in emotional and social experiences. Through ing expenditures on publicly-funded health services has become
its focus on enhancing the body, physical therapy can help to necessary as health care costs are increasing. Examining the
promote a positive view of the self within the changed body. To consequences of the delisting provides substantiation of its impact on
date, research surrounding the social-psychological aspects of SCI both clients and the PT profession, which may help direct future policy
rehab has been very limited and there is a lack of focus on the decisions. PARTICIPANTS: Sixteen provider participants (89%) were
specific concerns of women. More research about lived experiences recruited from the 18 providers who participated in a previous
is needed to better understand the role that physical therapy plays provider study regarding the delisting and who agreed to be
in the development of body image and self-concept of women post- contacted for follow up. These providers worked in one of four practice
SCI. PARTICIPANTS: This secondary study extracted data for all categories: (1) publicly-funded, community-based clinics (termed
15 female participants from a primary study sample of 80 adults Designated Physiotherapy Centres), (2) privately-funded clinics, (3)
living with a SCI. The primary study was conducted by Dr. Karen hospitals, or (4) home care under contract with Community Care
Yoshida and Dr. Rebecca Renwick (2004). Participants, aged 27 Access Centres. Sixty-four client participants (65%) were recruited
to 59 years, included 7 with paraplegia and 8 with quadriplegia. from the 98 clients who participated in a previous client study
METHODS: A qualitative secondary analysis of semi-structured regarding the delisting and who agreed to be contacted for follow up.
face-to-face interviews was conducted. Coded segments of the These clients had been accessing publicly-funded, community-based
interviews from the primary study were analyzed and compared to PT services prior to the delisting. METHODS: At 12 months following
identify broader conceptual concepts concerning body image and the partial delisting, provider and client participants completed
self concept in women with spinal cord injury. These concepts were a 10 minute telephone interview that included both quantitative
then integrated into an initial framework that attempts to describe the and qualitative components. ANALYSIS: Quantitative data from
relationships between these concepts, and the factors that contribute participant interviews were systematically analyzed using descriptive
to them. ANALYSIS: A modified grounded theory method was used, statistics. Qualitative data from provider interviews were entered into
focusing on memoing and integrating codes. RESULTS: Findings a data analysis software package, and major themes derived from
derived a middle-range framework illustrating a fluid three-phase the data were subsequently analyzed. RESULTS: At 12 months
progression of attitudes towards living with a changed body that follow up, 28 of 37 (76%) client participants considered ineligible for
generally moves from (1) discomfort, (2) moving towards comfort, publicly-funded, community-based PT, reported increased difficulty
(3) comfort. Discomfort, in this analysis, refers to a sense of accessing PT services. Several of these clients also expressed health
uneasiness related to one’s changed body and the associated loss concerns. A decrease in demand for PT was reported by providers at
of control over bodily functions, privacy, and treatment approach. Designated Physiotherapy Centres, whereas most providers in other
The second stage, moving towards comfort, is characterized by settings reported no change resulting from the delisting. Providers
strategies progressing from social isolation to representing oneself in reported that clients were increasingly using other publicly-funded
a positive light through appearance and behaviour. Finally, comfort health care services after the partial delisting. Lastly, there were
is fulfilled by educating others about visible disabilities and by mixed perceptions regarding the impact of the delisting on the PT
surrounding oneself with an accepting environment. The framework’s profession in Ontario. CONCLUSIONS: Long-term consequences of
dual-directionality reflects the continual shift in comfort experienced the delisting were not significantly different from short-term effects
by the participants. CONCLUSIONS: Physical therapy can potentially identified two weeks after the policy implementation. Follow-up
influence the process of women gaining comfort with their changed results indicate that clients requiring PT services in publicly-funded,
bodies following SCI. The proposed framework provides a basis community-based settings are unable to access services elsewhere.
for future research into the recovery process following SCI. Future Further research is required to assess the cost-effectiveness of
prospective studies should investigate the significance of gender, shifting fiduciary health care responsibility away from the provincial
ethnicity, and spinal level of injury. IMPLICATIONS: This framework government and moving it towards private and third-party payers.
and participants’ narratives yielded recommendations for enhancing Research into innovative resource allocation methods is needed to
the role of physical therapy in the SCI rehab process. These sustain public health care systems. IMPLICATIONS: Documentation
and dissemination of these results will help inform the PT profession COPD. However, the regression equation may be more applicable to
in Ontario, as well as stakeholders in other jurisdictions who may participants with mild to moderate lung disease as some participants
face similar policy changes. Failure to remodel health policy to with severe disease had difficulty completing the constant-load cycle
meet emerging demands may ultimately shift the Canadian health exercise. Future research with a larger sample size, particularly
care paradigm away from equal access. KEYWORDS: Delisting, those with severe disease, is required. IMPLICATIONS: The ability
Health Policy, Public Funding. FUNDING ACKNOWLEDGEMENTS: of clinicians to more precisely prescribe cycle training intensity from
Medicare to Home and Community (M-THAC) Research Unit at the a simple, reliable and inexpensive 6MWT will enhance effective,
University of Toronto, Ontario Physiotherapy Association, Ontario individualised exercise prescription for patients with COPD referred to
Physiotherapy Association – Hamilton District, Ontario Physiotherapy pulmonary rehabilitation. KEYWORDS: COPD, six-minute walk test,
Association – Central Toronto District, Physiotherapy Association cycle training prescription. FUNDING ACKNOWLEDGEMENTS: The
of British Columbia, Alberta Physiotherapy Association, Toronto University of Sydney. CONTACT: [email protected]
Rehabilitation Institute and the Arthritis Community Research and ETHICS COMMITTEE: 1) Sydney South West Area Health Service;
Evaluation Unit. 2) The University of Sydney
ETHICS COMMITTEE: The University of Toronto Health Sciences II
Research Ethics BoardThe University Health Network
1812 Tuesday 5 June 16:15 EXERCISE MOTIVES OF OLDER ADULTS
Thow M1 , Rafferty D1 , Carson M1 , Chandler C; 1 Glasgow
PRESCRIBING CYCLE TRAINING INTENSITY FROM THE Caledonian University
SIX-MINUTE WALK TEST (6MWT) FOR PATIENTS WITH
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PURPOSE: There is a predicted increase in the number of older
people that will make up the world wide population. It will be
Zainuldin M1 , Knoke D1 , Mackey M1 ,Luxton N1 ,Alison J1,2 ; important that this population maintain good health to minimise
1 Discipline of Physiotherapy, The University of Sydney, Sydney,
the impact on health services. There is compelling evidence of
Australia; 2 Department of Physiotherapy, Royal Prince Alfred the physiological and psychosocial benefits of habitual exercise for
Hospital, Sydney, Australia older people. These benefits will only be achieved with adherence
PURPOSE: Cycle training intensity for patients with COPD is to exercise participation. The motives that affect adherence to
normally based on an incremental cycle test (ICT). Such tests are exercise are less well known in this population. The aim of this
expensive and not readily available to clinicians. Previous research study was to investigate the exercise motives of older women.
has shown that the peak oxygen consumption (VO2peak ) for ICT RELEVANCE: The understanding of exercise motives of older people
and 6MWT is equivalent. A regression equation relating distance will inform practictioners and health professionals on strategies to
walked on the 6MWT and peak work rate (Wpeak ) on the ICT has encourage exercise participation and adherence. PARTICIPANTS: A
been reported. The aim of this pilot study was to prescribe cycle convienience sample of 51 women, mean age 71 (SD±7.9) years of
training intensity from the 6MWT (using the regression equation) and age, was recruited from an over-50’s exercise class. The women had
determine whether this resulted in a level of exercise (measured by been attending a weekly exercise class for more than three months.
VO2 ) known to produce physiological training effects in people with METHODS: The 51 subjects completed a validated questionnaire.
COPD. RELEVANCE: This study provides a quantitative method for The instrument used was the Exercise Motivations Inventory (EMI-
more precise, individualised prescription of cycle training intensity 2) (Markland & Ingledew 1997). The questionnaire comprises 51
from a simple 6MWT in patients with COPD. PARTICIPANTS: 12 questions that address five characteristics of participation: personal,
participants with stable COPD and mild to severe lung disease were interpersonal, health, appearance and fitness. The responses are
recruited from referrals to pulmonary rehabilitation. Subjects with co- on a Likert scale of 0-5. ANALYSIS: The mean and SD for each
morbidities limiting exercise performance were excluded. The mean category was established. RESULTS: The highest scores were for
±SD age was 66 ±9 years; percent predicted forced expiratory nimbleness 4.2 SD±0.9, ill health avoidance 4.3 SD±0.9, positive
volume in one second (FEV1 %pred) 49±19%; ratio of FEV1 to health 4.2 SD ±1.0,affiliation 3.0 SD±1.4, revitalisation 3.4 SD±1.4,
forced vital capacity (FEV1 /FVC) 0.47±0.13. Based on FEV1 %pred, enjoyment 2.9 SD ±1.2. The lowest scores were for competition
five participants had severe lung disease, three moderate and four 0.5 SD±0.7 and social recognition 0.5 SD ±0.5. CONCLUSIONS:
mild. METHODS: This study was a prospective, repeated measures The maintenance of good health and avoidance of illness are
design. Two 6MWTs were performed. The better 6MWT was then strong motivators. In addition, agility and feeling good are important
used to calculate Wpeak for cycle exercise from the regression for the older women. Lastly, enjoyment and social contact are
equation. After 30 minutes rest, subjects performed ten minutes highly. IMPLICATIONS: Physiotherapists should be aware of the
of constant-load cycle exercise at 60% of the calculated Wpeak . motivators for older exercisers. The identification of reliable predictors
During all exercise, cardiorespiratory and metabolic data (Cosmed of exercise and motivation will help physiotherapists effectively
K4b2), dyspnea and rate of perceived exertion (RPE) were recorded. intervene and improve the pattern of physical activity in older adults.
ANALYSIS: The VO2 measured at the end of cycle exercise was In addition, awareness of motivational factors can provide a basis
compared to VO2peak of the 6MWT (VO2bike /VO2walk ). Pearson’s for motivational interviewing and behaviour change to enhance
correlation coefficient was calculated for the relationship between adherence in this ever growing population. KEYWORDS: Older
VO2bike and VO2walk . An ANOVA, with Bonferroni correction, was adults, exercise, motivation. FUNDING ACKNOWLEDGEMENTS:
performed to determine whether VO2bike /VO2walk was affected by None. CONTACT: [email protected]
disease severity. RESULTS: VO2bike was significantly correlated with ETHICS COMMITTEE: The School of Health and Social Care
VO2walk (r = 0.701, p = 0.01).The mean ±SD VO2bike /VO2walk was 82 Glasgow Caledonian University
±14%. Three participants with severe lung disease were not able to
complete the ten minutes of the cycle exercise due to breathlessness.
However, there were no significant differences between subgroups
of disease severity and VO2bike /VO2walk . CONCLUSIONS: The
6MWT can be used to prescribe cycle training intensity from the
regression equation, since the VO2 achieved (82% VO2peak ) is
known to produce physiological training effects in patients with
FUNCTION-CENTERED TREATMENT INCREASES WORK A WEB-BASED SURVEY OF 14-16 YEAR OLDS: THE
DAYS IN PATIENTS WITH NON-ACUTE NON-SPECIFIC LOW RELATIONSHIPS BETWEEN BACK PAIN AND LIFESTYLE
BACK PAIN: ONE-YEAR RESULTS FROM A RANDOMIZED Candy E1,2 , Stephenson R1 , Jerosch-Herold C1 ; 1 University of
CONTROLLED TRIAL East Anglia, Norwich, Norfolk. UK; 2 Gwent Healthcare NHS Trust,
Kool J1 , Bachmann S1 , Oesch P1 , Knuesel O1 , Ambergen T2 , Gwent, Wales,UK
van den Brandt P3 , de Bie R3 ; 1 Department of Rheumatology,
PURPOSE: The purpose of this Web based survey was to define
Rehabilitation Centre Valens, Valens, Switzerland; 2 Department
the prevalence of back pain in 14-16 year olds and identify
of Methodology and Statistics, University of Maastricht, Maastricht,
potential lifestyle factors associated with back pain. RELEVANCE:
the Netherlands; 3 Department of Epidemiology, University of
By the age of 15 the prevalence of back pain is equal to that in
Maastricht, Maastricht, the Netherlands
adulthood. Previous surveys have established links between back
PURPOSE: To compare the effect of function-centered (FCT) pain and gender, sport, psychological stress and sitting. The links
and pain-centered treatment (PCT) on the number of work days, between lifestyle and back pain in young people require further
permanent disability, and the unemployment rate. RELEVANCE: exploration if effective preventative measures are to be introduced.
Days lost from work are responsible for the major costs related to PARTICIPANTS: An Internet survey of school students aged from
low back pain (LBP). FCT was developed for patients with multiple 14-16 in a predominantly rural county in Eastern England UK was
nationalities working in Switzerland. Most of these patients have undertaken (potential population of 17,640 children). METHODS:
limited knowledge of the Swiss national language; many are at risk of The Local Education Authority gave permission to approach all 38
developing permanent LBP disability. Multidisciplinary rehabilitation state schools. The 9 independent schools were contacted directly.
is effective compared with usual care. It is unknown whether FCT is A contact teacher was established in each participating school to
superior to PCT in this population. PARTICIPANTS: Eligible were provide links between the researcher and the children. Presentations
patients between 20 and 55 years with non-acute (duration 6 were given to all eligible students to explain the nature of the study.
weeks) non-specific LBP, 6 weeks of sick leave in the previous 6 The contact teacher distributed the URL to the students. The survey
months. Written informed consent was available in German, Italian, was completed between November 2004 and May 2005. ANALYSIS:
Serbo-Croatian, Albanian, Turkish, French, Spanish and Portuguese. Data was downloaded directly into the survey design program and
We excluded patients with co-morbidity and patients who did not transferred into Excel for organisation and coding. SPSS was used
understand German or Italian sufficiently to cooperate with the initial for analysis. Logistic regression was used to observe relationships
assessment. METHODS: Randomized controlled trial with one-year and trends in the data. RESULTS: Seventeen schools agreed to take
follow-up. FCT was 4 hrs/day during 3 weeks and emphasised part (population of 6,507 children). An overall student response rate
activity in spite of pain using work simulation, strength, endurance of 8% (492 children) was achieved; but 5 schools failed to return any
and cardiovascular training. PCT was 2.5 hrs/day during 3 weeks responses. 69% (341 children) reported back pain, of these 26% (90
and emphasised pain reduction and included passive and active children) reported some functional limitation. Significantly more girls
mobilisation, stretching, strength training and a mini back-school. We reported back pain (60%; 206 girls) than did boys (40%; 135 boys)
collected work days with questionnaires sent to the employers and with an odds ratio (OR) of 1. 68 (95% CI 1.13 to 2.53, p = 0.01).
physicians responsible for work certificates. The study was approved Those who carried their school bags all day (73%, 358 children)
by the ethical committee of St.Gallen. ANALYSIS: Intention-to-treat were significantly more likely to reported back pain (OR=2.83, 95% CI
analysis. We analyzed between group comparisons of work days with 1.36 to 5.98, p = 0.01). A family history of back pain was reported
negative-binomial logistic hurdle regression. RESULTS: We included by 64% (316 children), and was also significantly associated with
174 patients, 79% male, age 42, previous sick leave 6 months. back pain (OR= 2.01, 95% CI 1.36 to 3.01, p 0.001). There were
The one-year follow-up completeness of work days was 96%. After no significant associations in this group between the intensity of back
one year, the FCT group had more work days (118, 95% CI=89- pain, mood, sport and sitting duration. CONCLUSIONS: Accepting
147) than the PCT group (74, 95% CI=50-98, p = 0.011). The OR of that the low response rate may incorporate survey bias towards
returning to work in the FCT/PCT group was 2.1 (95% CI=1.1-3.6). back pain, the survey offers further evidence of a high prevalence
There was a negative effect for litigation, longer sick leave before of back pain in school children which may be linked to gender, bag
treatment, and South-East European nationality without interaction carrying and family history. IMPLICATIONS: Further exploration of
with treatment. The differences in unemployment rates and in the these factors should be undertaken to establish the nature of the
numbers of patients receiving compensation for permanent disability relationships. KEYWORDS: Web survey, Back pain, Young People.
were not significant but the study was underpowered for these FUNDING ACKNOWLEDGEMENTS: This study was supported
outcomes. CONCLUSIONS: FCT is more effective than PCT for by funding from the Chartered Society of Physiotherapy Eastern
increasing work days. IMPLICATIONS: Function-centred treatment Board and Backcare (registered charity no: 256751). CONTACT:
is effective in patients from multiple countries with limited knowledge [email protected]
of the Swiss national language. FCT should be generally used ETHICS COMMITTEE: East Suffolk Local Research Ethics Commit-
instead of the still predominantly applied PCT. We currently perform tee
a three-year cost-effectiveness analysis of FCT. KEYWORDS:
Randomized controlled trial, low back pain, occupational diseases, Research Report Platform Presentation
sick leave, vocational rehabilitation, exercise therapy, outcome 1381 Tuesday 5 June 16:15
assessment, predictive factors. FUNDING ACKNOWLEDGEMENTS: VCEC Meeting Rooms 19-20
This randomized controlled trial was supported by grant 00.00437 FACTORS THAT IMPACT INCONTINENT WOMEN’S
from the Swiss Federal Office of Health. CONTACT: j.kool@klinik- PARTICIPATION TO A PELVIC FLOOR MUSCLE EXERCISE
valens.ch CLASS AND A HOME PROGRAM
ETHICS COMMITTEE: St Gallen, Switzerland
Martin C1 , Dumoulin C1 , Tannenbaum C1 , Corriveau H2 , Tu L2 ,
Corcos J3 , Marchand M1 ; 1 University of Montreal; 2 University of
Sherbrooke; 3 McGill University
PURPOSE: This study seeks to identify factors that facilitate or
impede: participation of older women with urinary incontinence (IU)
in weekly pelvic floor muscle (PFM) exercise classes; completion of Research Report Platform Presentation
a 12-week exercise class program; and daily home PFM exercises 1010 Tuesday 5 June 16:35
throughout the program. Data were collected as part of a feasibility PP Crystal Pavilion A
study looking at the use of a PFM exercise class program to treat THE INTEGRATION OF REHABILITATION INTO PRIMARY
older women with UI. RELEVANCE: Supervised PFM exercises HEALTH CARE: RESULTS OF A RANDOMIZED TRIAL
alone or in combination with bladder retraining is the first-line
Richardson J1 , Letts L1, , Chan D2,3 , Stratford P1 , Baptiste S1 ,
treatment for stress UI and mixed UI. Both interventions can
Edwards M1 , Coman L1 , Price D2,3 , Hilts L3,4 , Law M1 ; 1 School
be delivered either in one-on-one therapy or class therapy by
of Rehabilitation Science, McMaster University, Hamilton, Ontario,
physiotherapists. Since they have proven effective, it is assumed
Canada; 2 Dept of Family Medicine, McMaster University, Hamilton,
that they can be applied to both younger and older UI women, but
Ontario, Canada; 3 Stonechurch Family Health Centre,McMaster
this assumption has not been formally tested for women of over
University, Hamilton, Ontario, Canada; 4 School of Nursing,
60 suffering from UI and following a PFM exercise class program.
McMaster University, Hamilton, Ontario
PARTICIPANTS: A total of 27 community-dwelling older women
aged 70.77±7.75 years with signs and symptoms of stress UI or PURPOSE: The objectives were to determine whether adults with
mixed UI, participated in the study. They were recruited from three a chronic illness receiving care in a Primary Care(PC)setting as
UI clinics in Montreal and participated in 12 PFM weekly exercise a result of a rehabilitation intervention, compared with adults in
classes in groups of six to eight. METHODS: A cross-sectional the PC setting who do not receive the intervention:1.show greater
qualitative study using focus group methodology was conducted. improvement in health status 2.have fewer hospital admissions and
There were four different focus groups with six to eight subjects at emergency room visits 3.show greater improvement in physical
the end of the 12-week PFM exercise class program. Subjects were functional status,and decreased falls 4.show greater satisfaction.
asked what made them participate or not in weekly PFM exercise RELEVANCE: The future of Primary Care lies in its ability to meet
classes; complete or not the 12-week exercise class program and the needs of persons who are chronically ill (Anderson & Wagner,
do or not do daily home PFM exercises throughout the duration 2003).Persons with chronic illness, especially older persons who
of the program. Open discussion of the participant’s perceptions are most at risk for functional decline, are currently not receiving
was facilitated by the moderator. Subjects who withdrew from the effective management(Grumbach & Bodenheimer, 2002).This project
study were contacted to solicitude the same information. Data introduced Physical Therapy and Occupational Therapy into a PC set-
was collected, revised and compiled using a tape-based abridged ting to address this need. PARTICIPANTS: Adults 44 years or older
transcript method. ANALYSIS: Data was analyzed with a long- with one or more chronic conditions who had 4 or more physician
table approach described by Kruger and Casey. RESULTS: For visits in the previous year were selected from the Stonechurch family
participation in weekly PFM exercise classes, the facilitators were, in practice database and invited to participate. Mean age was 64 years,
order of importance; the desire to reduce UI; a sense of responsibility 56% 46-64 years, 63% were women. METHODS: Blind assessors
towards the study; close supervision by the physiotherapist and (PTs and OTs) assessed patients in their homes on four occasions.
group support. Impedimenta were: illness, medical appointments and The outcomes used were the SF-36, the Late-Life Function and
planned social activities. For the completion of a 12-week exercise Disability Index,ER visits and hospitalizations and caregiver strain
class program, the facilitators were the perceived severity of UI and index. Semi-structured qualitative interviews were undertaken with
the desire to avoid surgery; follow the doctor’s recommendations, patients and staff. Rehabilitation services offered through the project
help in UI research and avoid the waiting list for other treatment. involved:screening and prioritizing individuals in both the intervention
Impedimenta were illness and conflict with social activities. For the and the control groups at risk for functional decline,a recent fall
home PFM exercises, facilitators were the desire to reduce UI and to and the probability of hospitalization; assessment by a PT or an
make exercises part of a daily routine. Impedimenta were: a busy OT for persons in the intervention group to establish treatment
schedule, the length of the home exercise program and illness. goals;home, clinic or community visits; group or individual interven-
CONCLUSIONS: Two major themes emerged: individual factors tion directed at chronic disease self-management(CDSMP) based
(motivation, responsibility) and situational factors (home exercise on the CDSMP from Stanford and adapted to focus on rehabilitation-
program length, class schedule, and illness) CONCLUSIONS: Two related strategies;collaborative goal setting; an Activity and Wellness
major themes emerged: individual factors (motivation, responsablilty) Group that provides opportunities to explore healthy lifestyles PT
and situational factors (home exercise program lenght, class Individual services included individualized exercise programs using
schedule, illness). IMPLICATIONS: To be successful, a PFM motor learning principles, modalities, acupuncture, manual therapy;
exercise class program must target modifiable factors to insure consultation regarding mobility devices and funding, home safety and
older women’s optimal participation. KEYWORDS: physiotherapy; falls prevention and posture and positioning.A website I Am Able
urinary incontinence; pelvic floor muscle; exercise class; focus group; Website (www.iamable.ca)was developed with information regarding
older women. FUNDING ACKNOWLEDGEMENTS: This project was rehabilitation and community resources. ANALYSIS: An analysis of
funded by the Incontinence Axis of the Quebec Network for Research covariance was used to analyze the continuous variables, logistic
on Aging, Quebec Fund for Health Research. regression for dichotomous variables and Mann-Whitney U-test for
ETHICS COMMITTEE: Ethics commitees: CSSS-IUGS of Sher- ordinal variables. RESULTS: The intervention group had fewer
brooke, Laval health and social services center and Sir Mortimor planned hospital days,adjusted difference=0.60 p < 0.01, a cost
B. Davis Jewish General Hospital saving $490/day with an overall saving of $65,700. There was greater
satisfaction with rehabilitation services for the intervention group
p < 0.001. Other trends in favour of the intervention group were fewer
falls,less caregiver strain, better communication with physician and
fewer home hazards. There were no significant group differences
on the SF-36. CONCLUSIONS: Physical therapy services can be
effectively delivered by condition based clinics, education, triaging
and interdisciplinary formats in a primary care setting and with
associated cost savings. IMPLICATIONS: The project integrated
physical therapy and occupational therapy into the primary care
team and enabled opportunities for the appropriate team member to
provide care. This allowed physicians and nurses to focus on expert-
specific roles. Chronic disease self-management programs that incor-
porate rehabilitation principles are effectively delivered by physical
therapists. KEYWORDS: primary care, randomized controlled trial, the transition to chronic pain, but it is still difficult to underpin this
physical therapy. FUNDING ACKNOWLEDGEMENTS: This study seemingly evident statement with scientific evidence. KEYWORDS:
was funded through the primary health care transition fund through neck pain, prognostic indicators, psychological factors. FUNDING
the Ministry of Health. CONTACT: [email protected] ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
ETHICS COMMITTEE: Hamilton Health Sciences/McMaster Univer- ETHICS COMMITTEE: VU University ethical committee
sity Ethics Board
2289 Tuesday 5 June 16:35 VCEC Ballroom A
PP Crystal Pavilion B & C TRAINING SKILLED WALKING: A NEW APPROACH FOR
ARE PSYCHOLOGICAL FACTORS PROGNOSTIC INDICATORS INCOMPLETE SPINAL CORD INJURY
OF OUTCOME IN PATIENTS WITH SUB-ACUTE NECK PAIN? Musselman K1 , Roy F2 , Norton J2,3 , Gorassini M2,3 , Fouad K1 ,
Pool J1 , Ostelo R1,2 , Knol D1,3 , Bouter L1 , De Vet R1 ; 1 EMGO Misiaszek J4 , Yang J3,5 ; 1 Faculty of Rehabilitation Medicine;
institute VU University medical centre Amsterdam; 2 Department 2 Department of Biomedical Engineering; 3 Centre for Neuroscience;
of Allied Health Care Research, Amsterdam School for Allied 4 Department of Occupational Therapy; 5 Department of Physical
Health Care Education; 3 Department of Clinical Epidemiology and Therapy, University of Alberta, Edmonton, Canada
Biostatistics, VU Medical Center, Amsterdam
PURPOSE: To design and test the effectiveness of a program to
PURPOSE: Our aim was to identify psychological factors that are enhance walking skills for individuals with incomplete spinal cord
prognostic indicators of the short and long term outcome of patients injury (iSCI). Walking in the home and community is an important
with sub-acute neck pain in terms of perceived recovery, pain goal for clients with iSCI. Body weight-supported treadmill training
and functional disability. RELEVANCE: An increasing amount of (BWSTT) helps some of these individuals regain the ability to
attention is being paid to psychological factors in the development walk. Walking in the community, however, requires a variety of
and maintenance of pain and disability. Furthermore, psychological walking skills. For example, community walking entails negotiating
and social factors are possibly involved in the transition from curbs, doors and uneven terrain. Would intensive training of a
acute to chronic neck pain. PARTICIPANTS: This prospective study variety of relevant walking skills enable individuals with iSCI to
was conducted within the framework of a randomised clinical walk in the community to a greater extent than BWSTT? To
trial comparing two types of conservative therapy in 146 patients address this question, we first designed a new method (skill
with non-specific sub-acute neck pain. METHODS: At baseline, training) that is intensive, variable and relevant to daily walking.
146 patients completed a questionnaire containing questions about The aim of skill training is to challenge the nervous system
potential prognostic indicators such as: gender, age, history of to solve motor problems in walking, and consequently, maximize
neck complaints, severity of the pain. Furthermore, the 4 dimension the use of spared descending pathways and spinal circuits to
psychological symptomatology questionnaire (4DSQ) was used to promote plasticity for optimal performance (Raineteau et al. 2002,
measure: somatisation, distress, depression and fear, and the Ballerman & Fouad 2006). Secondly, we compared clinical and
Pain Coping and Cognition List PCCL was used to measure: neurophysiological outcomes of BWSTT and skill training in a pilot
catastrophysing, coping, and internal and external pain control. Fear group of persons with iSCI. RELEVANCE: Gait training is an
of movement was measured with the Tampa Scale for Kinesiophobia integral part of the rehabilitation of many clients with neurological
(TSK), the level of chronicity was assessed with the Graded Chronic deficits. Developing increasingly efficacious methods will benefit
pain Scale (GCPS). The patients preference or non-preference for physical therapy practice. PARTICIPANTS: Seven individuals with
therapy, manual therapy, physical therapy, and general practitioner iSCI have participated to date (2 in the development phase and 5
attitude towards neck pain were assessed with the Pain Beliefs and in the randomized-controlled trial (RCT)). METHODS: Skill training
Attitude Scale. Three primary outcome measurements were defined incorporates 3 principles: 1) practice walking skills important for daily
and measured at 12 and 52 weeks. 1)perceived recovery on a 7- life (Musselman & Yang 2005) to ensure training is task-specific, 2)
point ordinal rating scale. 2)The severity of neck pain was scored practice these skills in a variety of environments to train the nervous
on an 11-point Numerical Rating Scale (NRS). 3)The Neck Disability system to adapt, and 3) train intensively (5x/week). To assess the
Index (NDI) was used to measure functional status. ANALYSIS: The feasibility of the new method, 2 individuals with iSCI, who had
relationship between each potential prognostic indicator and outcome completed BWSTT, participated in skill training for 3 months. Their
was evaluated, adjusting for the randomly allocated intervention. As feedback was used to further refine the program. Subsequently, a
the interventions were performed by a number of therapists, we RCT was initiated to compare walking gains made through BWSTT
took patients clusters under therapists into account in the analysis. and skill training. All subjects complete 3 months of BWSTT, followed
Therefore a multilevel analysis was performed, with two levels: by either 3 months of skill training or another 3 months of BWSTT.
patients and therapists. RESULTS: The short and long term results Walking ability and participation are assessed using standardized
for the three outcomes were very diverse. Furthermore, the explained measures (i.e., 6 minute walk, speed, modified Emory Functional
variance in the short term ranged from 16% to 30%, and from 6% to Ambulation Profile (mEFAP, which is a measure of skilled walking)).
34% in the long term. This can be considered to be low, and applies Two neurophysiological measures, transcranial magnetic stimulation
that it is difficult to predict the course of neck pain. The sub-scales of (Thomas & Gorassini 2005) and inter-muscular coherence (Norton &
the used questionnaires, i.e. the Pain Coping and Cognition List, and Gorassini 2006), are used to estimate the strength of descending
the 4 Dimensions of Psychological Symptomatology Questionnaire, connections from the motor cortex. Outcomes are assessed monthly
did not contributed significantly to all of the multilevel models. Only during training, and 3, 6 and 12 months post-training. ANALYSIS:
the factor ‘fear of movement’ (Tampa scale) was consistently and The Wilcoxon Signed Rank Test is used to compare outcomes of
significantly present in the univariable analysis for all outcomes at BWSTT and skill training (p < 0.05). RESULTS: Preliminary findings
both follow-up measurements, and also for the short term outcome show that walking speed and endurance improved with both types of
pain and disability in the multivariable analysis. CONCLUSIONS: We training. Greater gains on the mEFAP were seen with skill training,
conclude that we were unable to identify a core set of prognostic especially in the obstacles and stairs subscales. Neurophysiological
psychological factors that predict the short and long term outcome measures showed strengthening of descending connections from
of sub-acute neck pain. Further prognostic research is needed the motor cortex with training. CONCLUSIONS: Preliminary findings
to achieve more consistent results. IMPLICATIONS: In clinical suggest that the new method of skill training effectively trains many
practice it is thought that psychological factors are important in of the skills needed for community ambulation. IMPLICATIONS: Skill
training can be easily incorporated into a treatment plan for clients COPD, exercise training, supplemental oxygen, 6MWD. FUNDING
with ISCI. KEYWORDS: training community walking. FUNDING ACKNOWLEDGEMENTS: Funding for the study was gratefully
ACKNOWLEDGEMENTS: Christopher Reeve Foundation, Canadian received from The Swedish Heart and Lung Foundation. CONTACT:
Institutes of Health Research, Alberta Heritage Foundation for [email protected]
Medical Research, Neuroscience Canada, Killam Trust. CONTACT: ETHICS COMMITTEE: The Research Ethics Committee of Umeå
[email protected] University, Sweden.
ETHICS COMMITTEE: Health Research Ethics Board of the
University of Alberta and Capital Health, Edmonton
2407 Tuesday 5 June 16:35 WHAT INFLUENCES ACTIVITY LEVEL AND EFFECTS ACTIVITY
VCEC Meeting Rooms 11-12 LEVEL CHANGE IN WOMEN AGED 40 TO 80 YEARS?
MECHANISMS OF IMPROVED PHYSICAL PERFORMANCE
Nitz J, LowChoy N; The University of Queensland
AFTER TRAINING WITH AND WITHOUT OXYGEN IN PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE PURPOSE: Higher levels of physical activity are encouraged for
optimal health and to reduce fall’s risk with ageing. The purpose of
Janaudis-Ferreira T1 , Henriksson-Larsén K2 ,
Lundgren R3 ,
this study was to report habitual physical activity level in community
Wadell K1,3 ; 1 Dep of Community Medicine and Rehabilitation,
living women aged 40-80years and document the change in level of
Physiotherapy, Umeå University, Umeå, Sweden; 2 Dept of Surgical
activity and the factors effecting this change over a 5-year period.
and Perioperative Sciences, Sports Medicine, Umeå University,
RELEVANCE: It is predicted that by 2031, 25% of the population
Umeå, Sweden; 3 Dept of Respiratory Medicine and Allergy,
in Australia will be aged over 65years. Currently the incidence of
University Hospital, Umeå, Sweden
falls is 1 in 3 per year among people in this age group. The
PURPOSE: The aim of this study was to investigate whether cost of fall related injury is growing in accordance with population
the increased exercise performance in patients with COPD after increase. A higher level of habitual activity has been identified as
training with or without oxygen supplementation is due to central or reducing the risk of a fall. Therefore the factors influencing level
peripheral adaptations. RELEVANCE: Previous studies have come of activity in women and the effect of a change in this level of
to different conclusions regarding additional benefits of supplemental activity needs elucidation. This information is relevant in order to
oxygen during training. It is of great importance to put focus on inform strategic planners regarding approaches that might be most
the physiologic effects of different methods to enhance physical effective in raising activity level in younger women to preempt decline
performance in patients with COPD. PARTICIPANTS: Twenty-two in physiological processes that contribute to increased fall’s risk. This
patients with moderate to severe COPD. METHODS: The patients is an important approach to reducing the cost of fall related injuries
were randomised to interval training on a treadmill with or without in older women since current interventions for those over 65 are only
oxygen (single blind design), three times per week for eight serving to stabilize costs and not reduce them. PARTICIPANTS: 463
weeks. They performed two six minute walking tests with different women completed our longitudinal observational study of balance
instructions, one standardised (6MWD) and one modified (they were and postural stability as one part of a large multimodal assessment of
stopped if they desaturated below 90%) (mod-6MWD)), before and ageing. METHODS: Assessment recorded self-reported age, activity
after the training period. ANALYSIS: Non- parametric tests were level, fall history, number of co-morbidities and measured BMI and
applied and the results are presented as median, minimum, and balance. ANALYSIS: ANOVAs were used to estimate the effect of
maximum values. Wilcoxon matched-pairs signed ranks test was activity level at baseline on activity change over the 5-year period.
used to compare differences within groups and Mann-Whitney U- The effect on change in activity level from falls, BMI, change in
test was used to compare differences between groups. To account number of co-morbidities during the study period and age and
for the risk of mass significance the level of significance was set stability at base line also was determined. RESULTS: Activity level
to p < 0.01. RESULTS: The group training with air (AG) increased at baseline significantly affected change in activity level over 5 years
distance walked in both tests and walking speed in 6MWD. The (P < 0.000). This change was negatively affected by age (P = 0.045)
group training with oxygen (OG) increased the distance walked and and BMI (P < 0.000). Initial activity level had a positive effect if
walking speed after training in 6MWD. No changes in lactate levels subjects participated only in household chores or self paced activity
during test were found in the AG after compared to before training once or twice weekly (P < 0.001). This picture of change was most
in either of the tests. The OG had larger increase in lactate levels evident in the cohort of women in their 40s. Women undertaking
after compared to before training in the 6MWD but not in the mod- more strenuous activity one or more times per week tended to reduce
6MWD. The total time during which the patients desaturated below their level of activity over the study period. There was no influence
90% did not change in AG in any of the tests after compared to from stability, history of falling or number of co-morbidities on change
before the training period, though there was a trend towards longer in activity level. CONCLUSIONS: Younger less active women were
time of desaturation for the OG in the 6MWD. The AG rated lower more likely to increase their activity level during the study period.
perceived exertion in 6MWD after training. There were no significant This finding shows that sedentary younger women are more likely
differences between groups regarding changes after training in either to be receptive to a lifestyle change that includes an increase in
of the tests. CONCLUSIONS: Our data suggests that training without activity level compared to older women or those with a higher BMI.
supplemental oxygen might provide both central and peripheral Being unsteady or having already fallen did not stimulate change.
adaptations while training with supplemental oxygen mainly seems IMPLICATIONS: Physiotherapists should be working with strategic
to contribute to central adaptations. Patients in the OG tended to planners to suggest a variety of activities that have proven efficacy
have higher levels of lactate and longer periods of desaturation in regarding maintenance of balance to encourage increased levels of
tests after training. This indicates an increased anaerobic metabolism activity in women from before the menopause if cost of fall related
which is not considered to be a beneficial training effect for these injuries is to be controlled. KEYWORDS: women, activity level.
patients, since it might limit their exercise performance. The AG on FUNDING ACKNOWLEDGEMENTS: Royal Brisbane and Women’s
the other hand improved distance walked with no concurrent increase Hospital Foundation, Australasian Menopause Society. CONTACT:
of lactate or increased time of desaturation. IMPLICATIONS: These [email protected]
results implies that the effects of supplemental oxygen during ETHICS COMMITTEE: The Medical Research Ethics Committee of
training needs further investigation and should not be applied the University of Queensland and the Royal Brisbane and Women’s
routinely until more studies have been conducted. KEYWORDS: Hospital Research ethics Committee.
EFFECT OF FREQUENCY OF STABILIZATION EXERCISES ON A BEHAVIORAL APPROACH USING MESSAGE BANNERS AND
PLASMA SEROTONIN LEVELS IN PARTICIPANTS WITH SUB POSTERS: PROMOTING STAIR USE IN JAPAN
CLINICAL CHRONIC LOW BACK PAIN
Nomura T1 , Yoshimoto Y2 , Akezaki Y2 , Tomita Y2 , Hamakubo T2 ,
Sokunbi O1 , Moore A1 , Watt P2 ; 1 Clinical Research Centre Fujiwara R2 , Higashi T2 , Sato A3 ; 1 Department of Physical
for Health Professions, University of Brighton, Eastbourne, UK; Therapy, School of Comprehensive Rehabilitation, Osaka Prefecture
2 Department of Sport and Exercise Science, Chelsea School, University; 2 Graduate School of Human Life Science, Kochi
University of Brighton, Eastbourne, UK Women’s University; 3 Faculty of Human Life and Environmental
Science, Department of Health Science, Kochi Women’s University
PURPOSE: To investigate the effects of frequency of application PURPOSE: It has been proven that appropriate exercise lowers
of stabilization exercises on plasma serotonin levels and low back the risk of chronic disease, but continuing regular exercise remains
pain outcome measures in participants with chronic low back difficult for most people. Stair climbing is frequently available
pain. RELEVANCE: It is not clear, if with the use of stabilisation to most population groups, and it provides a useful model for
exercises; endogenous pain neurotransmitters can play a role in lifestyle exercise intervention. The main goal of this study was to
the analgesic and treatment outcomes for low back pain patient. evaluate the effectiveness of using message banners and posters
Furthermore, it is not clear what dosage of the exercise might be in order to encourage the use of stairs instead of escalators at a
sufficient to ensure that the patient is achieving optimal benefit in department store and a train station in Japan. RELEVANCE: These
terms of reduction of chronicity and disability caused by low back data can be utilized to develop new approaches to enable such
disorder. PARTICIPANTS: Eighty four participants, 50 females and individuals as diabetic or obese patients to increase their chances
34 males were recruited to participate in this study. They were to perform meaningful exercise on a daily basis. PARTICIPANTS:
participants with non specific mechanical chronic low back pain. The general public. METHODS: In study 1, the use of an escalator
Only those who agreed not to undergo any other specific therapeutic and adjacent stairs was monitored at a department store from
intervention (sub-clinical) during the time this study were recruited. 11:00 to 13:00, 3 days a week, from November through January.
METHODS: Participants were randomly allocated to the control (no In study 2, the use of an escalator and adjacent stairs was
exercise) or the exercise treatment groups in which they carried monitored at a commuter train station from 7:30 to 9:30, on
out stabilization exercises at different frequencies i.e. once weekly, consecutive weekdays days, excluding weekends, from July through
twice weekly and three times weekly. Outcome measures used September. ANALYSIS: All participants were coded for gender
and age in both studies, and the presence of hand bags in
in the RCT were plasma serotonin level measured with Enzyme-
one study 1. In addition, the temperature, humidity and weather
linked radioimmunoassay technique,pain intensity measured with
environmental factors in study 2 regarding observations before
Numeric rating scale, Functional disability measured with Roland-
and after each observation period. In both studies, a 2-week
Moris Disability Questionnaires and Quality of life measured with
baseline period was followed by a 4-week intervention period
Nottingham Health Profile. Data were collected at baseline, after using motivating messages written on banners and posters which
six weeks of intervention and at 18 week follow up assessments. encouraged the use of stairs. The follow-up data were also
ANALYSIS: Data obtained from the measurement of dependent collected for 1 and 2 weeks after the removal of the banners
variables did not show symmetrical distribution. Thus, they were 2 and 3 weeks later. To investigate the effects when using or
presented as median with accompanying semi-interquartile range, not using such banners, the intervention and follow-up periods
Kruskall-Wallis test and Wilcoxon test were used to analyse between were compared to the baseline period using both the chi-square
group and within group differences respectively. RESULTS: The and logistic regression analysis: a logistic regression analysis was
results of the RCT showed that spinal stabilization exercises used for escalator/stair use as a dichotomous outcome variable.
produced a significant increase in plasma serotonin level by 17.8% RESULTS: In study 1, a total of 9,834 escalator/stair-choice
at all stages of data collection in all the exercise groups. All observations were made. The percentage of people who used the
the participants in the treatment groups experienced significant stairs increased significantly from 46.0% to 51.1% during the 3-
reduction by more than 50% in pain and functional disability and 4 week intervention period (p < 0.001). When the banners were
improvement by more than 50% in quality of life scores after six removed, the percentage still remained higher than at baseline.
weeks of treatment (P < 0.05). The extent of reduction in pain The odds ratio for baseline vs intervention (3-4 weeks) of the
and functional disability scores and improvement in quality of banner, gender, age and presence of hand bag were 1.249,
life showed a clear trend in favour of the three times weekly 0.951, 2.071, 0.874. In study 2, a total of 43,241 escalator/
exercise group at 18 week follow up assessments(P < 0.05). A stair-choice observations were made. The percentage of people
linear regression analysis showed significant correlation between the who used the stairs increased significantly from 3.58% to 5.80%
changes in plasma serotonin and each of pain, functional disability during the 3-4 week intervention (p < 0.001). The odds ratio for
baseline vs intervention (3-4 weeks) with the banner, gender, age,
and quality of life scores(r2 values ranged from 0.42 to 0.67,
temperature, humidity and weather were 1.483, 0.581, 2.930, 0.996,
P < 0.05). CONCLUSIONS: The results of this study indicated that an
0.989, 1.100. CONCLUSIONS: This above described intervention
increase plasma serotonin level gained with the use of stabilisation
method was therefore found to effectively encourage physical
exercise could have a role to play in the outcome of treatment activity among the general public. As one method with wide
with this type of exercises. IMPLICATIONS: The cost effectiveness applications for encouraging meaningful exercise for an unspecified
of undergoing 18 sessions of treatment (x3 weekly for 6 weeks) number of individuals in the general public, this intervention
with stabilization exercises for an optimal therapeutic benefit may method was therefore considered to be successful. IMPLICATIONS:
warrant further investigation. KEYWORDS: Back Pain, Stabilization education. KEYWORDS: exercise, daily physical activity, behavioral
exercise, Serotonin. FUNDING ACKNOWLEDGEMENTS: This study approch. FUNDING ACKNOWLEDGEMENTS: The authors thank
was funded by The Association of Commonwealth Universities. Prof. Hiroyuki Nakamura (Department of Environmental Medicine,
CONTACT: [email protected] Kochi Medical College) and the management personnel at the
ETHICS COMMITTEE: University of Brighton Research Ethics experimental sites (a department store in Kochi City and a train
Committee station in Himeji City) for their valuable assistance in conducting this
intervention study. The authors also thank the observers. CONTACT: Research Report Platform Presentation
[email protected] 1450 Tuesday 5 June 16:55
ETHICS COMMITTEE: Graduate school committee, Kochi Women’s PP Crystal Pavilion A
University A QUALITATIVE EVALUATION OF THE PHYSIOTHERAPY
SERVICE FOR HOMELESS PEOPLE IN GLASGOW, SCOTLAND
Research Report Platform Presentation Hislop J1,2 , Smith J3 ; 1 Queen Margaret University College,
1484 Tuesday 5 June 16:35 Edinburgh; 2 Glasgow Caledonian University, Glasgow; 3 Greater
VCEC Meeting Rooms 19-20 Glasgow Primary Care NHS Trust, Glasgow
CAN 3D ULTRASOUND BE USED IN MEASUREMENT OF THE PURPOSE: The purpose of this study was to explore homeless
SIZE OF LEVATOR HIATUS AND PELVIC FLOOR MUSCLE peoples’ views and experiences of a specialist physiotherapy service
THICKNESS? for homeless people in Glasgow, Scotland. RELEVANCE: Evidence
Braekken I1,2 , Majida M3 , Marie E3 , Umek W4 , Dietz H5 , Bø K1 ; suggests that homelessness increases the risk of poor health
1 Norwegian School of Sport Sciences, Oslo, Norway; 2 Hans & and makes access to appropriate healthcare difficult. Benefits of
Olaf Physiotherapy, Oslo, Norway; 3 Akershus University hospital, specialist health services for homeless people have been identified
Akershus, Norway; 4 University of Vienna, Vienna, Austria; and can improve access to appropriate healthcare. In Glasgow,
5 University of Sydney, Sydney, Australia a specialist physiotherapy service has existed since 1996. The
aim of this study was to evaluate the physiotherapy service from
PURPOSE: The aim of the present study was to evaluate test the perspective of homeless people. This would allow for the
retest and intra-tester reliability of the determination of thickness development of a service which is responsive to the needs of the
of the pelvic floor muscles and dimensions of levator hiatus using population it serves. PARTICIPANTS: A sample of convenience of
3D translabial ultrasound. RELEVANCE: Pelvic floor muscle training twelve homeless people (11 males, 1 female, mean age: 47±13.6
(PFMT) may increase physiological cross sectional area of the years) was recruited from a homeless drop-in centre in Glasgow.
pelvic floor muscles and decrease the size of levator hiatus. Three METHODS: Ethical approval to carry out this study was granted from
dimensional (3D) ultrasound may be capable of measuring these Greater Glasgow Primary Care NHS Trust ethics committee. Using a
parameters. Ultrasound has the advantage of allowing multiplanar qualitative approach, 1-hour semi-structured interviews and a focus
real-time imaging, which is almost impossible using current MRI group were conducted with 12 homeless people. Five participants
technology. Few studies have evaluated intra-tester reliability of had experience of the specialist physiotherapy service, 7 had not.
measurement of the morphology of these muscles. This has to be Interviews were conducted within a private room, were audio-
established in order to evaluate the mechanical effects of PFMT. taped and transcribed verbatim. ANALYSIS: Using an interpretive
This is a test retest study to evaluate the reliability of sonographic phenomenological approach to data analysis, recurrent themes were
biometric measures of pelvic floor muscle anatomy. DESCRIPTION: identified from interview transcripts. Member checking of identified
17 healthy female volunteers (mean age 47.9 years; range 29-71, themes was undertaken. RESULTS: The findings revealed that
mean parity 1.8; range 0-4) were examined twice, using a “GE participants who had used the physiotherapy service were positive
Voluson 730 Expert system”. The intervals between the two tests about this and valued the one-to-one contact they had with their
varied between 7 to 35 days (mean 15.9 days). 3D static volumes physiotherapist. The fact that the physiotherapist came to them in
were recorded at rest in dorsal lithotomy position, with an empty their hostel or at a drop-in clinic meant that it was easily accessible.
bladder. Analyses were done offline on a PC using the software Despite the availability of direct access to the service none of the
“4DView” (GE Healthcare). Hiatal dimensions were measured in the participants had initiated a self-referral and instead relied on a
axial plane. The plane of minimal hiatal dimensions was identified as support or hostel worker for this. Participants felt that physiotherapy
the minimal distance between the posterior aspect of the symphysis was for people who had sustained serious injuries, such as car
pubis and the anterior border of the back sling of the pubovisceral accidents or for people with sports injuries. As a result physiotherapy
muscle. The thickness of the m. puborectalis was measured in two was not felt to be relevant to them and their problems. While good
different locations in the axial plane of maximal muscle thickness. health was valued, poor health was often tolerated as an expected
Test retest was analysed using the intra-class correlation coefficient consequence of homelessness. CONCLUSIONS: Homeless people
(ICC, repeated measures) with 95% confidence intervals (CI), and by in this study were positive about their experiences of the specialist
coefficient of variation (CV). ICC values under 0.20 were considered physiotherapy service. However there was limited awareness of what
poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81- physiotherapy might offer and this could reduce participants’ self-
1.00 very good. EVALUATION: ICC values for transverse and referring to the physiotherapy service. A strength of this study was
anterio- posterior hiatal dimensions were 0.72 and 0.61, and CV that it allowed individuals to voice their opinions of the physiotherapy
was 5.5 and 5.7%. Area of levator hiatus showed ICC value 0.56 service. A weakness is that the sample comprised of self-selecting
and CV was 8.8%. Cross sectional area for the pubovisceral muscle participants. Further research on how to support homeless people
was measured with ICC values 0.59 and 0.70 on the left side to access physiotherapy services is needed. IMPLICATIONS: The
and 0.13 to 0.36 on the right side. All the CV values were below study revealed a need to raise awareness about physiotherapy and
16.5% for measurements of thickness. CONCLUSIONS: Transverse the services available amongst homeless people and those who work
and anterio- posterior hiatal diameters demonstrated good reliability, closely with them. Homeless people experience difficulties accessing
and hiatal area demonstrated moderate reliability. Measurement of appropriate and timely healthcare and may require support to do
m. puborectalis thickness was less reliable, especially on the right so. KEYWORDS: Homelessness, access, service users. FUNDING
side. However the coefficient of variation was under 16.5% for all ACKNOWLEDGEMENTS: Greater Glasgow Primary Care Trust,
parameters. IMPLICATIONS: 3D translabial ultrasound can be used ‘Involving People’ grant scheme. CONTACT: [email protected]
in clinical trials evaluating changes in anatomical parameters after ETHICS COMMITTEE: Greater Glasgow Primary Care NHS
PFMT. KEYWORDS: Reliability, ultrasound, pelvic floor muscles. Trust ethics committee, Glasgow, Scotland; Glasgow Caledonian
FUNDING ACKNOWLEDGEMENTS: This project has been financed University Research Ethics committee, Glasgow, Scotland
with the aid of EXTRA funds from the Norwegian Foundation for
Health and Rehabilitation and the Norwegian Women’s Public Health
Association.
ETHICS COMMITTEE: The Regional Medical Ethics Committee in
Norway approved the study, and all subjects gave written informed
consent to participate.
A NOVEL METHOD OF NECK-COORDINATION EXERCISE – DIRECT ACCESS TO PHYSICAL THERAPY IN THE
EFFECTS ON SENSORIMOTOR FUNCTIONS AND SELF NETHERLANDS: RESULTS ONE YEAR AFTER INTRODUCTION
REPORTED HEALTH AND FUNCTIONING Leemrijse C, Swinkels I, Veenhof C, De Bakker D; Netherlands
Röijezon U1−3 , Björklund M1,2 , Djupsjöbacka M1 ; 1 Centre for Institute for Health Services Research
Musculoskeletal Research, University of Gavle, Box 7629, S- 907 PURPOSE: In the Netherlands, patients have direct access to
12 Umeå, Sweden; 2 Alfta Research Fundation, Alfta Rehab Centre, physical therapy since January 2006. One of the reasons for
Box 94, 82222 Alfta, Sweden; 3 Dept of Community Medicine and introducing direct access was the increasing pressure on the
Rehabilitation, Physiotherapy, Umea University, SE-901 87 Umeå, access of primary health care and the growing workload of general
Sweden practitioners. The aim of the present study was to investigate how
PURPOSE: To evaluate the efficacy of a novel method for neck- many patients and for which health problems, make use of direct
coordination exercise in chronic neck pain persons. RELEVANCE: access to physical therapy. Furthermore, it was examined how
Neck pain is often associated with changes in sensorimotor functions, many physical therapy contacts self referred patients have, and
such as reduced proprioceptive acuity, disturbed coordination of the whether this policy measure leads to an increasing demand for
cervical muscles, and increased postural sway. In line with this, physical therapy. RELEVANCE: Direct access implies a recognition
there is a growing body of evidence supporting the efficacy of of the professional expertise of the physical therapists. National
exercises targeting different aspects of sensorimotor function, e.g., representative figures are indispensable in order to evaluate the
training aimed at improving proprioception and muscle coordination. effects of this policy measure for both physical therapy practice and
It is important to further develop this type of exercises. Hence patients. PARTICIPANTS: Data will be used of all patients who
we have designed a devise and method for a specific exercise to visited the physical therapy practices participating in the National
improve sensorimotor control, which may improve motor functions Information Service for Allied Health Care (in Dutch: LiPZ) in 2006
like stabilising and moving the neck as well as postural control. (approximately 12,000). METHODS: Data were collected within the
PARTICIPANTS: Fourteen persons, mean age 35 years (10 females) National Information Service for Allied Health Care (LiPZ). LiPZ
with non-traumatic neck pain (mean duration 19 months) participated is a nationally representative electronic registration network, based
in the study. METHODS: The study was designed as an uncontrolled on physical therapists’ electronic medical records, in which about
clinical trial. A newly developed device was used for the neck- 100 physical therapists working in 40 private practices all over
coordination exercise. The device consisted of a plate (28 cm in the country participate. These therapists monthly provide data on
diameter) with a rim, and was fixed on top of the persons’ head. patients, referrals, health problems and treatments. In June 2007,
The person was seated and provided with visual feedback of the data from 2006 will be complete. ANALYSIS: Data were analysed
device via mirrors during the exercise. The task was to move a metal with descriptive statistics. In order to test for differences in categorical
ball from a starting position to the centre of the plate by controlled data, such as education level, Chi-square tests were used, while
movements of the head. The person performed the exercise at differences in continuous data, such as age, were analysed with t-
eight occasions (2-3 times a week), each session lasting 10-15 tests. RESULTS: Preliminary results from January through June 2006
minutes. Tests of sensorimotor functions -postural sway in quiet revealed that nearly 25% of the patients visited the physiotherapist
stance and cervical rotation, including repositioning, movement time without a referral. These direct access patients were more likely to
and and smoothness of movements (i.e., movement jerkiness)- were be male, younger, higher educated, suffering from symptoms of the
performed prior to and after the exercise intervention. A follow up spine and were more often treated before by a physical therapist
with questionnaires: (Short Form 36 (SF-36), Neck Disability Index (34.8% versus 18.3%). Furthermore, patients with health problems
(NDI), Disability of Arm, Shoulder and Hand (DASH), Self Efficacy existing for shorter than one month, made more use of direct access
Scale (SES) and Tampa Score of Kinesiophobia (TSK)) was done as compared to patients with longer existing problems (34.5 versus
after six months. ANALYSIS: Data were analysed with paired t-test. 18.4%). The total number of patients visiting the physical therapist
RESULTS: The analysis revealed a significant reduction in postural had not changed. In June 2007, updated results will be presented,
sway, and movement time and jerkiness of cervical rotation after the together with results about the number of physical therapy contacts.
training. No effect on cervical repositioning was detected. At the six CONCLUSIONS: The proportion of patients visiting the physical
months follow up, significant improvements were seen in three of therapists without referral exceeds expectations. Furthermore, a
the eight scales in SF-36 (physical functioning, vitality and social specific group of patients uses direct access. As the volume of
functioning), as well as on NDI, DASH and TSK. CONCLUSIONS: the physical therapists’ patient population has not grown and the
The improvements in sensorimotor function outcomes suggest a demographics of the patient population did not change, it seems
transfer effect from the exercise to more general, non-task specific that the demand for physical therapy as yet remains the same.
motor functions. The improvements in the questionnaire scores at six IMPLICATIONS: Direct access makes the profession of physical
months follow up may indicate a long term beneficial effect. Future therapists more challenging and increases their independence within
work should include a randomized controlled trial as well studies of the health care system. If physical therapists would like to further
the mechanisms behind the exercise effects. IMPLICATIONS: The enlarge the effect of direct access on their daily practice, they should
present method may be effective in improving the motor control of focus on specific groups of patients, for example patients who are
the cervical spine as well as postural control in neck pain patients. less known with physical therapy. Further research is needed to
KEYWORDS: Neck pain; coordination; postural control. FUNDING monitor the costs-effectiveness of direct access and to evaluate
ACKNOWLEDGEMENTS: Alfta Research Foundation and University the satisfaction of the physical therapists’ patients. KEYWORDS:
of Gävle. CONTACT: [email protected] Patients characteristics, policy. FUNDING ACKNOWLEDGEMENTS:
ETHICS COMMITTEE: By the ethic committee of the Faculty of LiPZ is financed by the Dutch Ministry of Health, Welfare and Sports.
Medicine at Uppsala University [email protected].
Research Report Platform Presentation USA. 2. Postgraduate Support Grants – School of Physiotherapy
2758 Tuesday 5 June 16:55 and Faculty of Health Sciences, La Trobe University. CONTACT:
OUTCOMES OF PROGRESSIVE RESISTANCE EXERCISE ETHICS COMMITTEE: La Trobe University; The Alfred Hospital;
FOR PEOPLE WITH CHRONIC OBSTRUCTIVE PULMONARY Wodonga Regional Health Service; Northeast Health Wangaratta;
DISEASE (COPD) Wagga Wagga Base Hospital
O’Shea S1,2 , Taylor N1 , Paratz J3 ; 1 School of Physiotherapy, La Trobe
University, Melbourne, Australia; 2 Community Rehabilitation Centre, Research Report Platform Presentation
Wodonga Regional Health Service, Wodonga, Australia; 3 School 2027 Tuesday 5 June 16:55
of Physiotherapy, University of Queensland, Brisbane, Australia VCEC Meeting Room 16
PURPOSE: To examine the effectiveness and efficacy of a THE EFFECTS OF THE SQUAT TRAINING MACHINE FOR
predominantly home-based 12 week progressive resistance exercise PHYSICAL FUNCTIONING IN FRAIL ELDERLY PEOPLE: A
(PRE) program on measures of impairment, activity, and participation RANDOMIZED CONTROLLED TRIAL
for people with COPD. Longer term outcomes were also examined Kato H1,4 , Shimada H2 , Iriyama W3 , Niino N4 , Obuchi S2 ,
12 weeks after the intervention concluded. RELEVANCE: Skeletal Suzuki T2 ; 1 Faculty of Health Science, School of Physical Therapy,
muscle weakness is common in people with COPD and associated Gunma-PAZ College; 2 Tokyo Metropolitan Institute of Gerontology;
with reduced exercise tolerance, higher health care utilisation, and 3 School of Technology for Social Medicine; 4 Department of
poorer prognosis. Whilst improvements in muscle strength have been Gerontology, Graduate School of Obirin University
demonstrated after PRE, it is unclear how increases in muscle
strength influence functional performance or long-term outcomes. PURPOSE: The purpose of this study was to determine effects
In addition, the feasibility of PRE programs conducted at home or of machine squat training on frail elderly people utilizing day care
with equipment other than weight machines is not known in this program. RELEVANCE: A relationship putatively exists between
population. PARTICIPANTS: Fifty-four people (33 women, mean lower extremity strength and falls, balance, and activities of daily living
age = 67.7 ±8.6 years) with moderately severe COPD (mean (ADL). Development of convenient and effective training machines
FEV1%predicted = 51 ±23%) were recruited from four hospitals. and knowledge of their effects are necessary for frail elderly people
Inclusion criteria required no pulmonary rehabilitation in the previous using community care services. PARTICIPANTS: Subjects were
12 months. Participants were excluded if they had unstable medical 72 community-dwelling elderly people (mean age: 81.3±7.9 years)
conditions. METHODS: A single-blind randomised controlled trial in who were using a day-care facility. METHODS: The subjects were
conjunction with qualitative interviews was undertaken. Participants separated randomly into a training group (n=36) and a control group
were randomly allocated into a PRE (n = 27) or no-intervention (n=36). The training group performed squat training using a machine
group (n = 27). The PRE group completed three sessions per week at a frequency of 1–2 days per week for 12 weeks. Training was
(one supervised, two home-based) for 12 weeks. Six exercises were performed by staff who had been educated by a physical therapist.
performed at an intensity of three sets of 8–12 repetition maximum, The control group did not change their exercise or other activities for
progressed against graduated elasticised resistance bands. Major the intervention period. Physical function tests such as maximal knee
outcomes included muscle strength, six-minute walk distance, extension strength, grip power, Timed Up and Go Test, Functional
grocery-shelving task, Chronic Respiratory Disease Questionnaire, Reach Test, and Chair Stand Test were measured at pre-training and
and Patient-Specific Functional Scale. Measures were assessed post-training. ANALYSIS: Baseline measurements were compared
at baseline, post-intervention (12 weeks) and 12 weeks after the between the training group and control group using independent
intervention (24 weeks). The PRE group were invited to participate Student’s t-test. Repeated measures ANOVA was used to investigate
in interviews regarding the outcomes of training at 12 and 24 weeks. the effect of the training. RESULTS: At post intervention, 22
ANALYSIS: Two-way ANOVA for repeated measures, with and subjects received no measurements (Squat training group n = 11,
without intention-to-treat analysis, were used to examine changes Control group n = 11). No significant differences were found in any
occurring between 0–12 and 0–24 weeks. Interview data were audio- measurements at baseline between the squat training group and
taped, transcribed, and then coded by two independent researchers. control group. Compared to the control group, the training group
RESULTS: The PRE program was completed by 15 out of 27 showed significant improvement in maximal knee extension strength,
participants. Participants completing PRE demonstrated improved grip power, and the Chair Stand Test. However, the Timed Up and
muscle strength (27–46%), dyspnoea, and fatigue levels at 12 Go Test, Functional Reach Test showed no significant differences.
weeks when compared with no-intervention, but the benefits had CONCLUSIONS: Results showed that squat training with a machine
dissipated by 24 weeks. No differences were detected between by day-care staff can improve muscle strength in elderly people.
groups for measures of activity or participation, or when all outcomes However, improvements were apparent only in muscle strength. We
were examined using intention-to-treat analysis. People with COPD should perform squat training along with other interventions such as
perceived physical, psychological, and social benefits after PRE, walking and balance exercise. IMPLICATIONS: Squat training using
which had a positive effect on activity performance. The perceived a machine was effective to improve lower-extremity muscle strength.
physical benefits of PRE were not prominent at 24 weeks, but feelings It can be used supplementarily with physical therapy or community
of increased confidence and control persisted. CONCLUSIONS: care. KEYWORDS: randomized controlled trial, elderly people, squat
When performed consistently, predominantly home-based PRE can training. FUNDING ACKNOWLEDGEMENTS: This study was funded
improve muscle strength, dyspnoea, fatigue, and perceptions of by a grant from OGA Co., Tokyo, Japan. CONTACT: [email protected]
control during activity for people with COPD. The physical outcomes ETHICS COMMITTEE: My work was apporoved by the ethics
of short-term PRE decline after training stops, but psychological committee in Tokyo Metropolotan Institute of Gerontology.
benefits influencing activity may persist. IMPLICATIONS: Longer
duration exercise interventions may be necessary to maximise
rehabilitation outcomes for people with COPD. Further research is
required to determine optimal maintenance dose exercise prescrip-
tions, effective and cost-efficient methods for delivering maintenance
programs, and factors influencing long-term exercise adherence in
this population. KEYWORDS: COPD, pulmonary rehabilitation, pro-
gressive resistance exercise. FUNDING ACKNOWLEDGEMENTS:
1. Equipment Grant – Theraband Academy, Hygenic Corporation,
Research Report Platform Presentation Scotland (NES), the Scottish Executive Health Department and the
2074 Tuesday 5 June 16:55 Health Foundation. CONTACT: [email protected]
VCEC Meeting Room 17 ETHICS COMMITTEE: NHS Grampian Research ethics Committee
AN EXPLORATORY STUDY TO INFORM THE DEVELOPMENT
OF PATIENT-CENTERED INTERVENTIONS FOR PEOPLE WITH
CHRONIC LOW BACK PAIN
Cooper K1 , Hancock E1 , Smith B2 ; 1 The Robert Gordon University, VCEC Meeting Room 18
Aberdeen, UK; 2 University of Aberdeen, Aberdeen, UK
PHYSICAL ACTIVITY AMONG HIGH SCHOOL STUDENTS –
PURPOSE: The purpose of this study was to explore the perceptions OUTCOME OF FIRST SOUTH AFRICAN YOUTH RISK
of people who had received physiotherapy for chronic low back BEHAVIOUR SURVEY
pain (CLBP). RELEVANCE: Guidelines suggest that physiotherapy Amosun D1 , Reddy P2 , Kambaran N3 , Omardien R3 ; 1 School
for CLBP should be patient-centered, should optimise function of Health & Rehabilitation Sciences, Faculty of Health Sciences,
and encourage self-management. Exploring the perceptions of University of Cape Town, Cape Town, South Africa; 2 National
people who have received physiotherapy for CLBP will help to Health Promotion Research & Development Group, Medical
understand the extent to which this is being achieved in practice Research Council, Cape Town, South Africa; 3 ARCH Actuarial
and allow their views to be considered in future service redesign. Consulting, Cape Town, South Africa
PARTICIPANTS: Twenty-five people aged between 18 and 65 who
had attended outpatient physiotherapy for the treatment of non- PURPOSE: The first Youth Risk Behaviour Survey in South Africa
specific CLBP were recruited by mail. They were purposively sampled sought to obtain representative data on self-reported prevalence of
for geographical location of physiotherapy treatment, number of health risk behaviours that contribute to intentional and unintentional
sessions attended, management style, age and gender. METHODS: injury; tobacco use; alcohol and drug abuse; sexual behaviours;
physical inactivity; and dietary behaviors. Though physical inactivity
Semi-structured interviews were conducted with all participants. The
is a major contributory factor to chronic diseases of lifestyle in South
interviews were designed to explore expectations of and satisfaction
Africa, there is no reliable database on the status of involvement
with physiotherapy, participants’ perceptions of patient-centered
of youths in physical activity. RELEVANCE: Physical inactivity is
physiotherapy, the importance of function to people with CLBP,
a known major risk factor for cardiovascular disease, type 2-
and participants’ perceptions of long-term management. ANALYSIS:
diabetes, and some musculoskeletal disorders. Physiotherapists
Data was analysed using the framework method, resulting in
play major roles in prevention as experts in exercise prescription.
both descriptive and explanatory accounts of the data. RESULTS:
PARTICIPANTS: This cross-sectional prevalence study targeted
Participants had expected exercises or hands-on treatment, long
students in grades 8-11 in public schools in the nine provinces.
sessions with the physiotherapist, and a diagnosis to be made.
The sampling frame was the database from the School Information
They had expected pain-relief to be achieved, although some
Services Directorate, National Department of Education. Using a two-
participants had expected increased knowledge on self-management
stage cluster sample design to ensure nationally and provincially
strategies or for improvements in function to be the outcome.
representative data, 206 schools were eligible to participate in
There were varied levels of satisfaction within the sample, and a
the survey, and 364 classes with 14,766 students, were randomly
complex relationship emerged between satisfaction and treatment selected. However, 10,699 students (54.0% females, 46.0% males)
outcome. The participants considered patient-centered physiotherapy in 345 classes from 188 schools submitted completed questionnaires.
to be a complex combination of five key factors (information METHODS: Adapting the Youth Risk Behaviour Survey of the
giving, organisation, individualised treatment, the physiotherapist, Centers for Disease Control, a questionnaire was developed in
and decision-making) underpinned by effective communication. English, and pre-tested for face and construct validity. Thereafter,
Function was of great importance to the participants. All freely the questionnaire was translated and back-translated into the
discussed functional limitations, many had functional treatment goals remaining 10 official languages in preparation for the pilot study.
and some measured treatment effect in terms of functional ability. Ethical approval was obtained from the South African Medical
However, participants commonly felt that their functional limitations Association. Informed consent was also obtained from the National
were not addressed in physiotherapy. The participants commonly Department of Education, School Principals, parents and learners.
did not feel that physiotherapy had empowered them to manage Participating students completed the self-administered questionnaire
their CLBP. The perceived need for follow-up and future access to in the classroom under the supervision of trained research assistants.
physiotherapy was a strong theme, with several methods suggested The section of the questionnaire relating to physical activity
for supporting people with CLBP in the longer-term. CONCLUSIONS: sought information on participation in vigorous physical activity,
This study has provided some insight into several aspects of the moderate physical activity, and insufficient physical activity in the
physiotherapy experience from the point of view of those with CLBP. seven days preceding the survey; reasons for abstaining from
A larger study will be required in order to generalise the findings. participation; and types of activities carried out during physical
Nonetheless, the findings will help physiotherapists in understanding education classes. ANALYSIS: Epi-Info 2002 was used to analyse
the needs of this client group and they have highlighted several areas the data. Weighted prevalence rates and 95% confidence intervals
to focus future research on. IMPLICATIONS: Physiotherapists should were computed. Differences between prevalence estimates were
encourage realistic expectations of physiotherapy to be adopted by considered statistically significant at the level of p < 0.05 if the 95%
people with CLBP. Physiotherapists need to be aware of the factors confidence intervals did not overlap. RESULTS: Data of 10,699
that people with CLBP consider important in relation to patient- students (54.0% females, 46.0% males) revealed that majority
centred physiotherapy. Physiotherapists should address and evaluate of respondents were aged 14-18 years. About 38.0% of the
functional limitations of those presenting with CLBP and should respondents did not participate in sufficient physical activity or
explore methods of supporting this client group in the long-term abstained completely, while the remaining students participated in
management of their chronic condition. Enhancement is required either vigorous physical activity, moderate physical activity or a
in both under and postgraduate education in the fields of commu- combination of both. Among those who abstained from participation,
nication skills, patient-centredness and self-management education 25.9% reported an unwillingness to participate. Out of 10,313
strategies. KEYWORDS: Expectations, patient-centred, long-term students, 29.0% did not have physical education classes at school.
management. FUNDING ACKNOWLEDGEMENTS: This project was CONCLUSIONS: Though the promotion of physical activity and
supported by the Nursing, Midwifery and Allied Health Professions healthy lifestyle is a national priority of the government of South
Research Training Scheme (Scotland), funded by NHS Education for Africa, the survey suggests the need to pay attention to an
appreciable proportion of high school students who do not participate any observable benefit from adhering to treatment, with patients
sufficiently in physical activity. IMPLICATIONS: Physiotherapists in unprepared for long-term commitment. CONCLUSIONS: Exploring
South Africa should become actively involved in the development experiences of undertaking and prescribing conservative treatment
of appropriate intervention programs to enhance physically active for UI reveals the importance of specialised health professional
lifestyles. KEYWORDS: Physical activity, Youth Risk Behaviour Sur- roles for understanding and facilitating adherence. IMPLICATIONS:
vey. FUNDING ACKNOWLEDGEMENTS: The National Department Overcoming barriers to help-seeking and doing exercises long-term
of Health, South Africa. The Centres for Diseases Control, USA is difficult, suggesting potential for cognitive-behavioural approaches
(technical and financial assistance). The Medical Research Council, to be used in future clinical research trials for rehabilitation of
South Africa. CONTACT: [email protected] UI. KEYWORDS: Incontinence, exercise, adherence. FUNDING
ETHICS COMMITTEE: The South African Medical Association ACKNOWLEDGEMENTS: This study was funded by a University of
Otago Research Grant. CONTACT: [email protected]
ETHICS COMMITTEE: This study received ethical approval from the
National Ethics Committee of New Zealand.
THE SPECIAL SPECIALIST: EXPLORING HOW HEALTH Research Report Platform Presentation
PROFESSIONALS FACILITATE UNDERSTANDING AND 2975 Tuesday 5 June 17:15
ADHERENCE TO CONSERVATIVE TREATMENT FOR WOMEN PP Crystal Pavilion B & C
WITH URINARY INCONTINENCE CERVICAL SPINE MOBILISATION: ADJUSTMENT OF DOSE IN
Dean S1 , Hay-Smith J; 1 Rehabilitation Teaching and Research RELATION TO EXPERIENCE AND PATIENT
Unit, University of Otago, Wellington, New Zealand Shirley D, Langshaw M, Refshauge K; School of Physiotherapy,
The University of Sydney
PURPOSE: To explore women’s and health professionals’ percep-
tions regarding conservative treatment of urinary incontinence (UI); PURPOSE: The purpose of this study was to quantify the forces
identify shared (coherent) or mismatched views about this treatment, used in the different grades of cervical spine mobilisation, identify
and discuss the implications of establishing coherent perceptions differences in techniques applied by novice and experienced phys-
for facilitating understanding and long-term treatment adherence. iotherapists, and to determine the effect of patient characteristics on
RELEVANCE: Systematic review of randomised trials shows that the dosage applied. RELEVANCE: Cervical spine mobilisations are
individual components of conservative treatment (e.g. pelvic floor commonly used by physiotherapists to assess and treat cervical spine
muscle training) and conservative treatment as a whole, are effective pain. Although cervical spine mobilisation is used widely in clinical
for women with symptoms of stress, urge and mixed UI. However, ad- practice the forces used in mobilisation have not been quantified, the
herence to such programmes can be problematic because treatment effect of therapist experience has not been described and the effect
has to be continued to be effective. Through exploring experiences of different patient characteristics on treatment dose has not been
of health professionals and patients this study identifies ways to explored. The accurate acquisition of this fundamental information
promote treatment adherence. PARTICIPANTS: Six women over 40 is an essential step towards a more comprehensive understanding
years of age referred for conservative treatment of stress or urge UI of cervical spine mobilisation. PARTICIPANTS: Three groups of
symptoms, and four physiotherapists / two continence advisors who participants were recruited for this study. A group of 4 subjects was
provided treatment. Women with any physical or psychological co- selected as patient models to represent varied spinal stimuli. There
morbidity that rendered usual conservative treatment inappropriate were also 2 therapist groups; the first consisted of 9 novice therapists
were excluded. METHODS: This qualitative study comprised in- who were physiotherapy students and the second was a group 9
depth audio-taped interviews. Participants were interviewed twice: experienced physiotherapists who were practicing clinicians and/or
at the start and end of treatment. Transcribed interview data were physiotherapy academics. METHODS: All of the therapists applied
explored using Interpretative Phenomenological Analysis (IPA). This mobilisations to each patient model that was lying on an instrumented
qualitative approach has explored individual experiences of health treatment plinth. The custom built, instrumented plinth was equipped
related issues, and of rehabilitation adherence. ANALYSIS: Three with load cells to measure the magnitude and amplitude of force,
levels of analysis occurred: 1) content analysis whereby repeated as well as the frequency of oscillation applied during mobilisation.
reading and line by line notation of key words or sentences that gave Therapists were asked to apply 4 grades of mobilisation and find end
insight into participants’ experiences produced emergent themes; of range, in random order. This study was approved by the University
2) a re-iterative process developed the themes, ensuring in-depth of Sydney Human Research Ethics Committee. ANALYSIS: Data
and detailed case by case analysis afforded by small participant was analysed with SPSS 12 for Windows. Descriptive statistics
numbers (and characteristic of this methodology) could occur; 3) were used to characterise mobilisation doses in terms of force,
robust verification procedures refined the themes. In IPA verification amplitude and frequency. Comparisons of mobilisation variables
occurs in stages: 1) a researcher, who was independent from data between therapists and novices were made using 2 way repeated
gathering, commented on the themes; 2) discussion occurred with measures ANOVA. The average force, frequency and amplitude
regard to final themes and interpretation and 3) agreement was applied by experienced therapists and novices to the 4 different
made on the extent to which raw data represented themes and patient models were also compared using 2 way repeated measures
interpretations. Participants had opportunity to comment upon their ANOVA. RESULTS: The characteristics of forces (magnitude, ampli-
transcripts, pseudonyms ensured anonymity. RESULTS: Will focus tude and frequency) applied by experienced physiotherapists were
on three themes emerging from the analysis: ‘the special specialist’ significantly different from those applied by novices for all 4 grades
refers to how health professionals perceive their role in this highly of mobilisation. Specifically, novices applied significantly greater
personal service including how they attempt to be like a personal forces, amplitudes and frequencies than the experienced therapists
trainer for motivating and supporting patients in doing their treatment; during lower mobilisation grades. In addition, patient characteristics
‘seeking and regaining control’ relates to patients concerns about influenced the force magnitude and amplitude, but not the frequency
seeking help for an essentially private ‘inside’ problem yet the lack of mobilisation techniques. CONCLUSIONS: This study provides
of control and bothersomeness of leakage showing on the ‘outside’ valuable information on quantifying mobilisation doses of the cervical
and in public acts to facilitate seeking help and adherence to spine. There are differences in mobilisation dose between novices
treatment in order to regain control on the inside and outside; and experienced physiotherapists. Although patient model influenced
‘expectations of outcome’ reveal differences in perceptions between mobilisation dose the interaction of patient model characteristics and
patients and health professionals regarding the timeline to obtaining therapist characteristics in determining mobilisation doses requires
further investigation. IMPLICATIONS: The differences in dosage of vs. 39%PC, respectively, (p > 0.05)). CONCLUSIONS: Compared
forces applied during mobilisation between experienced and novice to standard manual WC propulsion, PAPAW substantially reduces
therapists suggest that when teaching manual therapy techniques shoulder muscular demand during free level and graded propulsion,
novices require guidance in the selection of the magnitude of force, as demonstrated by reduction in median intensity and duration of
amplitude and frequency they apply during the lower grades of EMG activity of the primary push phase muscles. The decrease
mobilisation. Also guidance is required to determine the appropriate during the graded condition occurred despite significantly greater
mobilisation doses according to the characteristics of individual velocity during PAPAW propulsion (38% increase). IMPLICATIONS:
patients. KEYWORDS: cervical spine mobilisation, experience, Individuals with spinal cord injury and impaired upper extremity
doasge. FUNDING ACKNOWLEDGEMENTS: This project was not function and/or shoulder pain are often hesitant to transition to
funded. CONTACT: [email protected] a power WC owing to reduced portability and maneuverability,
ETHICS COMMITTEE: The University of Sydney Human Ethics reduction in physical activity, and increased appearance of disability
Committee with power WC use. This study demonstrates, however, that PAPAW
reduces shoulder demands while preserving the benefits of manual
propulsion. KEYWORDS: spinal cord injury, wheelchair propulsion,
shoulder pain. FUNDING ACKNOWLEDGEMENTS: NIDRR RERC
3183 Tuesday 5 June 17:15 #37098. CONTACT: [email protected]
VCEC Ballroom A ETHICS COMMITTEE: IRB at Rancho Los Amigos National
EFFECT OF A PUSH-RIM ACTIVATED POWER ASSIST Rehabilitation Center and Los Amigos Research and Education
WHEELCHAIR ON SHOULDER MUSCULAR DEMAND DURING Institute
MANUAL WHEELCHAIR PROPULSION IN PERSONS WITH
TETRAPLEGIA Research Report Platform Presentation
Lighthall Haubert L, Requejo P, Mulroy S, Newsam C, Gronely J, 2772 Tuesday 5 June 17:15
Perry J; Pathokinesiology Service at Rancho Los Amigos National VCEC Meeting Rooms 11-12
Rehabilitation Center, Downey, United States
FACTORS INFLUENCING ADHERENCE TO PROGRESSIVE
PURPOSE: Determine whether use of a Push-Rim Activated Power RESISTANCE EXERCISE FOR PEOPLE WITH CHRONIC
Assist Wheelchair (PAPAW) reduces shoulder muscular demands of OBSTRUCTIVE PULMONARY DISEASE (COPD)
manual wheelchair (WC) propulsion in individuals with tetraplegia.
O’Shea S1,2 , Taylor N1, , Paratz J3 ; 1 School of Physiotherapy, La
RELEVANCE: Shoulder pain is prevalent in spinal cord injury and
Trobe University, Melbourne, Australia; 2 Community Rehabilitation
impaired upper extremity function in those with tetraplegia addi-
Centre, Wodonga Regional Health Service, Wodonga, Australia;
tionally impedes manual WC propulsion. PARTICIPANTS: Thirteen 3 School of Physiotherapy, University of Queensland, Brisbane,
males with complete tetraplegia (C6=5, C7=9) were recruited from
Australia
outpatient clinics at Rancho Los Amigos National Rehabilitation
Center. METHODS: Subjects pushed a standard WC and PAPAW PURPOSE: To explore factors influencing short and longer term
on an ergometer at a self-selected matched free velocity during adherence of people with COPD to a program of predominantly
level and simulated graded (4% or 8%) propulsion. Indwelling wire home-based progressive resistance exercise (PRE). RELEVANCE:
electrodes recorded muscle activity from 4 push-phase muscles Exercise is an important treatment modality for people with COPD.
(anterior deltoid (ADELT), pectoralis major (PEC), infraspinatus However, the benefits of exercise interventions have been shown
(INFRA), supraspinatus (SUPRA)). EMG intensity was normalized to diminish over time. High levels of non-adherence to health care
to maximal voluntary isometric contraction (MVC). Propulsion interventions such as exercise have been reported for people with
velocity was calculated from Vicon motion marker trajectories of chronic health conditions. Yet, the factors influencing adherence to
the wheel. Anterior/posterior trajectory of the lateral epicondyle exercise for people with COPD have been examined infrequently.
marker determined push cycle. Median EMG intensity and duration Physiotherapists play a key role in prescribing and implementing
were calculated for each 1% of the push cycle. ANALYSIS: exercise programs during pulmonary rehabilitation; therefore, un-
Data were analyzed utilizing SPSS 11.0 software. Shapiro-Wilke derstanding the factors influencing the ability and willingness of
statistic determined data normality. Velocity data were normally people with COPD to perform exercise is necessary for maximising
distributed, thus paired t-test compared group means. EMG data the effectiveness of training interventions. PARTICIPANTS: People
were not normally distributed, therefore, medians were compared with COPD enrolled in a trial of PRE were invited to participate in
using Wilcoxon Signed Ranks test. A significance level of 0.05 two semi-structured qualitative interviews exploring factors affecting
was selected. RESULTS: Free velocity during level propulsion was program adherence. At the conclusion of the 12 week intervention,
similar between PAPAW (61.5+/−20.7 meters/minute) and standard 22 people (mean age = 66.7 ±6.8 years, mean FEV1%predicted =
WC (59.9 +/−20.8 meters/minute (p = 0.44). PAWPAW velocity during 51 ±25%) completed an interview, with 19 participants returning at
inclined propulsion (42.9 meters/minute) was significantly faster 24 weeks for a second interview. All participants provided written
than standard WC (31.0 meters/minute) (p = 0.01). Median EMG informed consent. METHODS: Ethics approval was granted prior
intensity during PAPAW level propulsion was significantly reduced to the investigation. All interview participants were enrolled in
for 3 of 4 muscles (AD level: 0% vs. 18.5% MVC; PEC level: 9.3% a 12 week PRE program, where training was undertaken three
vs. 42.5% MVC; INFRA level: 5.8% vs. 11.3% MVC; PAPAW vs. times per week (one supervised, two home-based). Six exercises
standard, respectively (p < 0.05)), and similar for SUPRA (SUPRA were performed against graduated elasticised resistance (three
level: 12.8% vs. 13.3% MVC, (p = 0.12), respectively). Median EMG sets at 8–12 repetitions maximum). A log-book was provided
intensity during PAPAW graded propulsion was significantly reduced to record details of all training sessions. At the conclusion of
for all muscles (AD graded: 10.8% vs. 48.5% MVC; PEC graded: the intervention participants were advised to keep their training
16.5%vs. 65.5%; INFRA graded: 10.5% vs. 37.3% MVC; SUPRA equipment, but ongoing exercise was a personal choice. Interview
graded: 16.5% vs. 40.8% MVC, respectively (p < 0.05)). Duration one explored facilitators and barriers to exercise during the 12
of EMG activity during PAPAW level and graded propulsion was week PRE intervention, whereas interview two examined factors
significantly reduced for all muscles, except SUPRA (ADELT level: influencing ongoing performance of the training program between
0% vs. 28% propulsion cycle (PC); ADELT graded: 27% vs. 62% 12 and 24 weeks. All interviews were audio-taped with permission
PC; PEC level: 15% vs. 44.0% PC; PEC graded: 45.5% vs. 71.5% of participants, and transcribed verbatim. ANALYSIS: Interview
PC; INFRA level: 18.0% vs. 29.5%PC; INFRA graded: 27.5% vs. data were coded independently by two researchers. Descriptive
57.5% PC; SUPRA level: 42%vs. 48.5% PC; SUPRA graded: 33.5% categories and broad themes relating to factors influencing short
and longer term adherence were then developed through discussion. principle was used. Balance, gait ability, and lower-limb strength: 2 x
RESULTS: Short-term PRE adherence (0–12 weeks) was facilitated 2 factorial ANCOVA. Falls: Negative binominal analysis and logistic
by expected outcomes, self-motivation, supervision, and group regression analysis. RESULTS: At 3 months, the exercise group had
support; whereas health and weather factors were the major barriers improved significantly in usual gait speed compared with the control
to adherence. The major barriers to exercise were unchanged at group (mean difference 0.04 m/s, P = 0.02). At 6 months, there
24 weeks despite a large decline in exercise adherence. Removal were significant improvements favoring the exercise group for Berg
of environmental support (supervision and group support) at 12 Balance Scale (1.9 points, P = 0.05), usual gait speed (0.05 m/s, P
weeks may have contributed to reduced exercise maintenance = 0.009), and lower-limb strength (10.8 kg, P = 0.03). No interaction
between 12–24 weeks. Participants identified group support and effects were seen between the exercise and nutrition interventions.
review as the most important strategies for maintaining exercise. When all participants were compared, no statistically significant
CONCLUSIONS: The provision of external support structures appear differences between groups were found for fall rate (exercise group
important for helping people with COPD overcome potential exercise 3.6 falls per person years and control group 4.6 fall per person years)
barriers during short and longer term training programs. Therefore, or the proportion of participants sustaining a fall (exercise 53% and
physiotherapists need to incorporate strategies to facilitate adherence control 51%). A subgroup interaction analysis revealed that among
during exercise program design. IMPLICATIONS: Further investiga- participants who improved their balance during the intervention
tion is required regarding effective strategies to maximise exercise period, the exercise group had a lower fall rate than the control
adherence in this population. The findings of this investigation group (exercise 2.7 falls per person years and control 5.9 falls per
and the research literature suggest that strategies to improve person years, incidence rate ratio 0.44, P = 0.03). CONCLUSIONS:
adherence may need to be individually tailored and incorporate A high-intensity functional exercise program has positive long-term
cognitive-behavioural techniques. KEYWORDS: COPD, pulmonary effects in balance, gait ability, and lower-limb strength for older
rehabilitation, adherence. FUNDING ACKNOWLEDGEMENTS: 1. people who are dependent in ADL. An intake of protein-enriched
Equipment Grant – Theraband Academy, Hygenic Corporation, energy supplement immediately after the exercises does not appear
USA. 2. Postgraduate Support Grants – School of Physiotherapy to increase these effects of the training. In addition, the high-intensity
and Faculty of Health Sciences, La Trobe University. CONTACT: functional exercise program may have an effect in preventing falls
[email protected] among those who respond to the intervention. IMPLICATIONS:
ETHICS COMMITTEE: La Trobe University; The Alfred Hospital; High-intensity functional exercise can be offered to improve phys-
Wodonga Regional Health Service, Northeast Health Wangaratta; ical functions among older people who are living in residential
Wagga Wagga Base Hospital care facilities and have severe cognitive or physical impairments.
KEYWORDS: Exercise, Frail Elderly, Accidental falls. FUNDING
ACKNOWLEDGEMENTS: This work was supported by grants from
the County Council of Västerbotten, the Vårdal Foundation, the
2376 Tuesday 5 June 17:15 Magnus Bergvalls Foundation, the Äldrecentrum Västerbotten, the
VCEC Meeting Room 16 Umeå University Foundation for Medical Research, the Gun and
HIGH-INTENSITY FUNCTIONAL EXERCISE PROGRAM FOR Bertil Stohne Foundation, Erik and Anne-Marie Detlof’s Foundation,
OLDER PEOPLE DEPENDENT IN ADL: AN RCT EVALUATING the Loo and Hans Ostermans Foundation, the Borgerskapet in Umeå
THE EFFECTS ON PHYSICAL FUNCTIONS AND FALLS Research Foundation, the Swedish Research Council K2002-27VP-
Rosendahl E1,2 , Lindelöf N1,2 , Littbrand H1 , Yifter-Lindgren E1 , 14165-02B, K2002-27VX-14172-02B, K2005-27VX-15357-01A, the
Nordin E1 , Lundin-Olsson L1 , Håglin L3 , Gustafson Y1 , Nyberg L2 ; Swedish council for working life and social research, the Ragnhild
1 Umeå University, Department of Community Medicine and and Einar Lundström’s Memorial Foundation, the Dementia Fund,
Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå, and Norrmejerier. CONTACT: [email protected]
Sweden; 2 Luleå University of Technology, Department of Health ETHICS COMMITTEE: The study was approved by the Ethics
Sciences, Physiotherapy Unit, Luleå, Sweden; 3 Umeå University, Committee of the Medical Faculty of Umeå University (§391/01).
Department of Public Health and Clinical Medicine, Family
Medicine, Umeå, Sweden Research Report Platform Presentation
PURPOSE: To determine if a high-intensity functional exercise 2301 Tuesday 5 June 17:15
program improves balance, gait ability, and lower-limb strength VCEC Meeting Room 17
in older people dependent in activities of daily living (ADL), EFFECTIVENESS OF THERAPEUTIC EXERCISE PROGRAMS
if an intake of protein-enriched energy supplement immediately IN LOW BACK PAIN. A CONTROLLED, COMPARATIVE FIVE
after the exercises increases these effects of the training, and YEARS FOLLOW-UP STUDY
if the exercise program reduces falls. RELEVANCE: Impairments
Mälkiä E1 , Kuukkanen T2 , Kautiainen H3 , Pohjolainen T4 ;
in physical functions among older people can lead to dramatic 1 Department of Health Sciences, University of Jyväskylä Finland;
consequences for the individual such as admission to nursing home, 2 School of Health and Social Care, Jyväskylä Polytechnic Finland;
falls and fractures. High-intensity exercise programs are effective to 3 Rheumatism Foundation Hospital, Heinola Finland; 4 Rehabilitation
improve physical functions among older people but knowledge is
unit of ORTON, Invalid Foundation, Helsinki Finland
limited concerning the effects for older people with severe cognitive or
physical impairments. PARTICIPANTS: 191 older people dependent PURPOSE: Therapeutic exercise has been shown to be beneficial
in ADL, living in residential care facilities, and with a Mini-Mental State in decreasing pain and in increasing functioning in chronic low
Examination (MMSE) score of 10 participated in this study (the back pain patients. However, the long lasting follow-up studies are
FOPANU Study). METHODS: The participants were randomized to small in number, and often limited in the number of subjects due
a high-intensity functional weight-bearing exercise program (the HIFE to dropouts. In addition, there is a shortage of real control groups
Program) or a control activity, including 29 sessions over 3 months, and the content of physical exercises in most cases. The purpose
as well as to protein-enriched energy supplement or placebo. Berg of this study was to describe the long-term changes in effectiveness
Balance Scale, usual and maximum gait speed, and one-repetition in low back pain intensity and the Oswestry Index in three study
maximum in lower-limb strength were followed-up at 3 and 6 months groups five years after therapeutic exercise programs. RELEVANCE:
by assessors blinded to group allocation. Fall rate and the proportion There is still great need for guidelines to cope low back pain
of participants sustaining a fall during the six months following in long run in professional practice. PARTICIPANTS: Eighty-five
the intervention were the outcome measures of the fall preventive subjects were reassessed with questionnaire five years after the
effect of the exercise program. ANALYSIS: The intention-to-treat initial recruitment for intervention study. METHODS: Interventions
were: three months intensive training group (n=28) with three weekly number of open-ended questions to collect data from participants.
exercise sessions and daily home exercises, the home exercise group ANALYSIS: Data were analysed with use of SAS version 8.
(n=29) training once a day and control group (n=28) without exercise Frequencies and percentages for participants’ demographics, mean
contained in this study protocol. The exercise and physical activities score values with standard deviations for each perception variable
in follow-up were registered and converted into metabolic equivalents were descriptively obtained. Mantel-Haenszel Chi-square (MHC)
(Mets). The primary outcome measures composed of questionnaire with inclusion of False Discovery Rate (FDR) at 5% for multiple
of low back pain intensity with CR-10 and Oswestry Index (ODI). test adjustment, Spearman’s correlation (r) and Kruskal Wallis H
The ethics committee of Jyväskylä Central Hospital approved this tests were used to identify significant influence of demographic and
study, and the subjects also gave their signed consents. ANALYSIS: background variables on perceptions. RESULTS: A response rate of
Differences between non-parametric characteristics were studied 85% was obtained. The average age was 26.4 years with SD of 3.8.
with c2 -tests and between parametric variables with t-tests and Males constituted 63% while females were only 37%. More than 70%
analysis of co-variance (Ancova). The changes in the CR-10 and were not participating in physical activity. A decline in physical activity
the ODI were analysed by the Last Observation Carried Forward participation was identified from primary through secondary school
(LOCF). RESULTS: CR-10 and ODI decreased during the first three level but tremendous decline was from secondary school level to
months period in all the three study groups. During the follow-ups, tertiary level. Psychological benefits of physical activity were some of
these values of intervention groups remained below the baseline the most important perceived benefits. Most of the important barriers
values. CR-10 was significantly lower in the home exercise group cited concerned equipments and time constraints to exercising. The
during the last five years follow-up session compared with the students felt that having a friend to participate with in physical activity
intensive training or control group. The physical activity had no was one of the most important helpful cues. Females perceived
association with CR-10 or ODI in follow-up. CONCLUSIONS: This more barriers than males. Students in education as a professional
study indicates that if at the initial phase of low back pain process the study course indicated more understanding of physical activity issues
subjects are predisposed to supervised, controlled home exercises, than the rest in other courses. Associations were found between the
the positive effects may preserve over years. The role of specific previous participation and the current perceptions of physical activity.
home exercises remain obscure. IMPLICATIONS: At the beginning of Most perceived barriers were negatively associated while perceived
the low back pain process there is a need for more intensive exercises benefits were positively associated with the previous participation
under supervision but in the long run the home exercise program in physical activity. CONCLUSIONS: The findings demonstrate an
may offer suitable devices to be used if the low back pain recurs influence of the demographic and background characteristics on
KEYWORDS: follow-up study, low back pain, exercise. FUNDING perceptions of physical activity among the students. IMPLICATIONS:
ACKNOWLEDGEMENTS: This study was financially support by the Physical activity promoting programs should put factors influencing
University of Jyväskylä, Jyväskylä University of Applied Sciences, physical activity behaviour into consideration during the interventions.
The Finnish Ministry of Education, the TULES graduate school in Physical activity programs should be emphasized right from child-
musculoskeletal diseases and Likes Research Center for Sport and hood. KEYWORDS: Physical activity, Non communicable diseases,
Health Sciences. CONTACT: [email protected].fi students, perceptions, demographic influence, sedentary lifestyle,
ETHICS COMMITTEE: The ethics committee of Jyväskylä Central Rwanda. FUNDING ACKNOWLEDGEMENTS: I acknowledge the
Hospital approved this study, and the subjects also gave their signed efforts made by the Rwandan government through the Ministry
consents. of education for financing my studies. My Supervisor Professor J.
Frantz and participants of this study are all acknowleged. CONTACT:
Research Report Platform Presentation [email protected]
ETHICS COMMITTEE: Ethics committe at the University of Western
Cape in South-Africa.
PERCEPTIONS OF PHYSICAL ACTIVITY AMONG TERTIARY IN-
STITUTION STUDENTS IN RWANDA:A NEED TO ADDRESS NON Research Report Platform Presentation
COMMUNICABLE DISEASES THROUGH PHYSICAL ACTIVITY 2400 Tuesday 5 June 17:15
Tumusiime D
PELVIC FLOOR MUSCLE ACTIVITY IN DIFFERENT SITTING
PURPOSE: Purpose of this study was to ascertain perceptions POSTURES: COMPARISON OF WOMEN WITH AND WITHOUT
of physical activity, specifically; perceived benefits of, perceived STRESS URINARY INCONTINENCE
barriers and perceived helpful cues (motivational factors) to physical
Sapsford R1 , Richardson C, Hodges P; 1 The University of
activity among tertiary institution students in Rwanda, and find out
Queensland, Brisbane, Queensland, Australia
whether there is an influence of the demographic and background
characteristics to the perceptions RELEVANCE: Physical inactivity PURPOSE: Tonic activity and appropriate strength of the pelvic floor
or sedentarism, is one of the leading causes of the major non- muscles (PFM) are required for organ support and continence at rest
communicable diseases, which contribute substantially to the global and during functional activities in all postures. Tonic PFM activity
burden of diseases, death and disability. The burden of mortality, has been demonstrated in lying, sitting and standing, but spinal
morbidity and disability attributable to non-communicable diseases is posture varies between those positions and amongst individuals,
currently greatest and continuing to grow in the developing countries. and is associated with prolapse. It is not known whether PFM
Some studies indicated that most of people know the benefits of activity changes with spinal posture (similar to that observed for
physical activity, but in countries around the world between 60% and the abdominal muscles) thus compromising pelvic support and
80% of adults are simply not physically active enough to benefit continence mechanisms. RELEVANCE: Understanding how the PFM
their health. It is estimated that by 2020, Non – communicable activity is affected by sitting postures in both continent and incontinent
diseases in sub-Saharan Africa will constitute almost 50% of the women may assist in the guidance of treatment of pelvic floor
burden of disease. Most declines in physical activity are during the dysfunction. PARTICIPANTS: Seventeen parous females, with one
transition of the students from high school to College or University or more vaginal deliveries (nine asymptomatic subjects and eight
PARTICIPANTS: 500 Tertiary institution students were randomly subjects with untreated symptomatic stress urinary incontinence
sampled from purposively selected departments and classes at each (SUI)) were recruited from volunteers and patients. METHODS:
of the five government educational tertiary institutions in Rwanda Electromyographic activity (EMG) of the PFM was recorded intra-
METHODS: A cross-sectional and descriptive study with quantitative vaginally with a Periform probe (Neen Healthcare, UK). EMG was
design used a pre-coded self-administered questionnaire with a small recorded from five abdominal muscles with surface electrodes.
Muscle activity was recorded in slumped supported sitting (SS) gathering data over time, triangulation of investigators took place as
(n=17), in upright unsupported sitting (UU) (n=17) and in a very five researchers collected and analysed the text. Data saturation
tall unsupported sitting position (VT)(n=13). The shape of the spinal occurred during the last interviews. Results were presented to
curves from S2 to C7 was monitored using a flexible ruler in SS participants, who verbally identified with the interpretation as
and UU postures ANALYSIS: Raw EMG data (5 s) was analysed for explained to them. RESULTS: The International Classification of
SS, UU and VT sitting. In the primary analysis EMG was compared Functioning (ICF) and the systems theory provided a theoretical
between postures and groups with a repeated measures ANOVA. A perspective. Input factors (before physiotherapy) included poor
secondary analysis compared EMG between the 3 postures using levels of activity and participation due to impairments, as well as
a repeated-measures ANOVA for the sub-set of subjects in whom internal factors (poor knowledge of what to expect, anticipating
the position was tested. RESULTS: When subjects adopted the UU improvement or cure, uncertainty leading to fear.)Five processes
posture the EMG activity of the PFM (P = 0.001) and right obliquus took place: exercises in a group setting, consultation with clients,
abdominis internus (OI) (P = 0.04) was greater than during the SS hands-on physiotherapy, health education and home programs. Three
position. There was also a trend for EMG of all the other oblique processes were identified as intermediaries between input and
abdominal muscles to increase. Women with SUI had decreased output: comprehensive client assessment, explanation of inportant
tonic activity of the PFM in both sitting positions (P = 0.046) compared concepts by the PT and (s)he acting in an open and reassuring
with control subjects. This was associated with a trend for increased manner. Clients enjoyed the processes, felt comfortable and complied
activity in rectus abdominis (RA) (P = 0.059) and left OI (P = 0.14) with advice.Output factors factors included higher levels of
in SUI. No lumbar lordosis was present in SS. In UU women with functioning and participation, more knowledge, understanding and
SUI had a lesser depth of lordosis compared with the controls acceptance about their conditions, more active lifestyles, and self-
(p = 0.04). In the VT posture PFM (P < 0.0001) and oblique abdominal responsibility. CONCLUSIONS: Clients at an inner-city clinic reported
EMG (P < 0.05) was increased in all subjects in comparison with that implementation of a community-based physiotherapy program
the SS posture. CONCLUSIONS: More upright sitting postures are inter alia improved their level of activity and participation. A follow-
associated with greater tonic activity of the PFM compared with up empirical study could quantify client-satisfaction. IMPLICATIONS:
slumped supported postures, irrespective of continence status, and Evidence from this study would assist in justifying resources allocated
this is accompanied by a trend to increased abdominal muscle to community physiotherapy to health policy makers and managers.
activity. However women with SUI had lower levels of tonic PFM The findings emphasise the importance of communication skills in
activity and a trend for greater OI and RA activity, irrespective of the undergraduate physiotherapy curriculum. Clinicians could note
position, than continent women. IMPLICATIONS: Tonic PFM activity that clients benefit from a comprehensive program including both
is affected by sitting posture. This should be taken into account one-on-one and group activities. Health education and counseling
during rehabilitation of these muscles and in the development of contribute to client satisfaction. KEYWORDS: community based,
programmes for long term maintenance of muscle function. Treatment client satisfaction. FUNDING ACKNOWLEDGEMENTS: Unfunded.
for incontinence should involve retraining activity of muscles of CONTACT: [email protected]
both the pelvic floor and abdominal wall. KEYWORDS: Pelvic floor ETHICS COMMITTEE: Ethics Committee of the Faculty of Health
muscles, sitting, incontinence. FUNDING ACKNOWLEDGEMENTS: Sciences, University of Pretoria
This study received funding from the National Continence and
Women’s Health Group of the Australian Physiotherapy Association.
ETHICS COMMITTEE: The University of Queensland ethics 3246 Tuesday 5 June 17:35
committee and the Mater Health Services ethics committee. PP Crystal Pavilion B & C
A SYSTEMATIC REVIEW OF THE DOSAGE EFFECTS OF
MANIPULATION AND MOBILIZATION ON MECHANICAL NECK
Research Report Platform Presentation DISORDERS
Burnie S1,2 , Gross A1 , Goldsmith C1 ; 1 McMaster University;
PP Crystal Pavilion A 2 Canadian Memorial Chiropractic College
PHYSIOTHERAPY AT AN INNER-CITY CLINIC PROVIDES A
POSITIVE CLIENT EXPERIENCE PURPOSE: The objectives of this review are to determine the optimal
Mostert K, Maritz L, Gerda S, Cathy P, Liesl G; University of dosage factors (frequency, intensity, etc) for the use of manipulation
Pretoria, Pretoria, South Africa and mobilization for neck pain; and whether manipulation and
mobilization improves pain, function, global perceived effect, patient
PURPOSE: Adopting the primary health care approach as a satisfaction or quality of life outcomes in adults with mechanical neck
philosophy for health care led to a shift from hospital-centered to disorder (MND). RELEVANCE: Neck pain is one of the most common
community-based care. What is the experience of clients utilising musculoskeletal conditions for which people seek help. The use of
community-based physiotherapy services at an inner-city clinic? manipulation and mobilization for MND is common, however evidence
RELEVANCE: The experience of customers is the final judge of based dosage recommendations are lacking. PARTICIPANTS:
the quality of a service. A shortage of research evidence exists Randomized trials of manipulation and mobilization in adults suffering
on the impact of community-based services at inner-city clinics, a MND with and without radicular findings or headache were
especially in the South-African context. PARTICIPANTS: A purposive selected. METHODS: A Cochrane systematic review methodology
sample of clients (n=14) utilizing an ongoing physiotherapy group was conducted. Computerized searches included Medline, Embase
program, for more than three months at a public inner-city community up to Sept 2006; and Manual Alternative and Natural Therapy,
clinic, were recruited. The relevant health authority and ethics Cumulative Index to Nursing and Allied Health Literature, Index to
committee authorised the study. METHODS: A grounded theory Chiropractic Literature, CCTR up to April 2006. Randomized trials
research design was used. Six individual interviews and two focus studying the effects of manipulation and mobilization in adults with
groups (n=5, n=6) were conducted. Each interview started with a MND were selected. Two independent reviewers extracted data while
broad open question: “How is physiotherapy for you?”, followed by three assessed trial quality. ANALYSIS: Standard mean differences
probe questions. ANALYSIS: Line-by-line analysis of transcripts was were calculated using random effects model. Meta-analyses and
done. Codes were grouped into broad categories. Similar categories subgroup analysis were planned but not possible. RESULTS: Five
were grouped into conceptual domains. An independent researcher selected trials of low quality generally differed in study design
re-coded the texts. Where differences occurred, consensus was methodology, however all used pain as a main outcome measure.
reached through discussion. Apart from triangulation of methods and Other outcomes had limited reporting. Thoracic spine manipulation
(1 to 2 sessions) appeared to provide significant improvements of the 5 stretches, were done 3 times daily. Exercise adherence was
in patients with (sub)acute and chronic mechanical neck pain. No encouraged by provision of an exercise log, by viewing and giving
studies were available to analyze the effects of thoracic spine feedback regarding individual exercise performance at the time of
mobilizations on neck pain. Although two studies showed a small the 6-week testing, and via telephone follow-up on alternate weeks
clinical advantage to cervical spine manipulation for neck pain (5 and 7). ANALYSIS: Data were analyzed using a one-way, repeated
over 1 to 4 sessions, results were not statistically significant. The measures analysis of variance. Post hoc pairwise comparisons were
combination of neck manipulation and mobilization showed no benefit made using the Holm-Sidak method, when the omnibus F statistic
over an active control or wait-list control. No studies were available to was significant. RESULTS: Ribcage excursion (antero-posterior,
analyze the effect of cervical spine mobilizations alone on neck pain. lateral, total) increased (p < 0.01) and fatigue decreased (p < 0.01)
A dose effect could not be established from these data. Side effects only during the intervention period. On the other hand, dyspnea and
were inconsistently documented. CONCLUSIONS: The evidence total HRQL demonstrated significant improvements (p < 0.01) both
for manipulation and mobilization dosage recommendations in the during the baseline (week 2) and intervention (week 8) periods. CRQ
treatment of neck pain is inconclusive. This review of controlled mastery, high (5/7) on entry, remained unchanged over the study.
studies found that evidence exists to support the use of thoracic Pulmonary function also demonstrated no change. CONCLUSIONS:
spinal manipulation for (sub)acute and chronic MND. Although not These results provided evidence that stretching exercises do increase
statistically significant, cervical manipulation may have a small clinical ribcage mobility in people with COPD, contributing acutely to
advantage for MND that needs to be explored in larger trials. One symptomatic relief and improved overall HRQL. However, long-term
small trials suggests cervical mobilization has no pain reducing effect. exercise compliance and sustainability of the observed acute benefits
There was insufficient information to provide insight into dosage remain unknown. IMPLICATIONS: Chest wall stretching may provide
effects of any of these treatments. Further studies with strong individuals with COPD with an easy, inexpensive, self-administered
methodological design are needed to establish optimal dosage. technique to improve ribcage stiffness and overall HRQL, and is
IMPLICATIONS: This systematic review highlights the dearth of further consistent with emerging evidence of the beneficial effects
evidence available to guide physical therapists on the optimal number of self-management strategies in this population KEYWORDS:
of manipulations and mobilizations required to achieve an optimal ribcage mobility, dyspnea. FUNDING ACKNOWLEDGEMENTS: The
effect for the treatment of MND. KEYWORDS: Systematic review; Lung Association, Ontario Respiratory Care Society. CONTACT:
Manipulation; Mobilization. FUNDING ACKNOWLEDGEMENTS: [email protected]
Canadian Institutes of Health Research; Foundation for Chiropractic ETHICS COMMITTEE: The University of Western Ontario Research
Education and Research; Problem Based Research Award, Sunny- Ethics Board for Health Sciences Research Involving Human
brook Foundation. CONTACT: [email protected] Subjects (HSREB)

CHEST WALL REHABILITATION: IMPROVING HEALTH- WHAT DO PATIENTS CONSIDER TO BE A CLINICALLY
RELATED QUALITY OF LIFE IN PEOPLE WITH CHRONIC WORTHWHILE IMPROVEMENT FOR INTERVENTIONS OF LOW
OBSTRUCTIVE PULMONARY DISEASE BACK PAIN?
Lucy S, D’Amore Larsen T, Overend T; School of Physical Therapy, Ferreira M1,2 , Ferreira P1,3 , Herbert R1,4 , Latimer J1 ; 1 School of
The University of Western Ontario, London ON, Canada Physiotherapy, University of Sydney, Sydney, Australia; 2 Pontificia
Universidade Catolica de Minas Gerais – Depto. Fisioterapia,
PURPOSE: To investigate the effects of a chest wall stretching
Belo Horizonte, Brazil; 3 Universidade Federal de Minas Gerais,
home exercise program on maximal ribcage excursion, health-related
Belo Horizonte, Brazil; 4 Centre for Evidence-Based Physiotherapy,
quality of life (HRQL), and pulmonary function in people with chronic
University of Sydney, Sydney, Australia
obstructive pulmonary disease (COPD). RELEVANCE: Worldwide,
COPD is the fourth leading cause of death and estimated by PURPOSE: To assess intervention-specific perceptions of minimal
the year 2020 to be fifth among health conditions causing the clinically important effects of intervention in patients with non-specific
highest burden to society. Activity induced dyspnea is a universal low back pain. RELEVANCE: Interpreting the clinical significance
and disabling symptom of COPD, ascribed to an increased work of estimates of the effect of interventions provided by randomised
of breathing, likely due in part to a hyperinflated and rigid chest clinical trials and meta-analyses requires consideration of the minimal
wall. Whether chest wall rigidity can be ameliorated and morbidity clinically important effect. To date, most estimates of minimal
decreased in this population poses an important question for clinically important effects are based on clinicians’ perspectives or
pulmonary rehabilitation. PARTICIPANTS: Twenty-four volunteers patients’ perceptions of change that are not intervention-specific.
(15 male) of mean (SD) age 71(8.2) y, height 170.8 (33.3) cm, PARTICIPANTS: 77 consecutive patients with non-specific low back
and body mass index 27.0 (4.6) kg·m−2 , with mild to very severe pain participated. METHODS: Before treatment was initiated, five
(FEV1 14% – 91% % predicted) COPD participated. METHODS: physiotherapy interventions commonly administered for non-specific
The study incorporated a single group repeated measures design low back pain (exercise, spinal manipulative therapy, ultrasound,
consisting of 2 phases; a 4-week non-intervention (baseline) period local heat, massage) were described to each patient. Patients were
over which to evaluate stability/variability of study outcomes and a asked two standardised questions concerning what they considered
4-week intervention period. Maximal rib cage excursion measured to be the minimum change in symptoms that would make each
diametrically (antero-posterior, lateral) with chest calipers at the level intervention worthwhile. ANALYSIS: Responses were summarised
of the xiphisternal junction, Chronic Respiratory Questionnaire (CRQ) with descriptive statistics. ANOVA was performed to investigate
scores (dyspnea, emotional function, fatigue, mastery subscales and differences in response among the five interventions on continuous
total), and pulmonary function assessed by forced spirometry using a measures of effect. Friedman’s test was performed to analyse differ-
dry-rolling seal spirometer were measured on study intake (week 0), ences in response across interventions of ordinal variables. Multiple
with repeat evaluations at biweekly intervals (week 2, 4, 6, 8). A chest linear regression was used to predict the minimal worthwhile global
wall stretching home exercise program consisting of 5 stretches (trunk perceived change, percentage perceived change and percentage
side flexion/elongation, thoracic rotation, neck side flexion, overhead improvement based on the predictive factors. For each one of the
arm reach and stretching of the anterior chest) was performed over three outcomes, explanatory variables included in the model were:
the final 4 weeks of the study. Three repetitions (15 sec holds) of each past experience with all treatments (total number of sessions across
all interventions), severity of symptoms in the past seven days, age used to model the change in meeting physical activity guidelines
and duration of symptoms (in weeks). The significance level was from baseline to 12-month follow-up. RESULTS: Moderate leisure
set at 0.05. RESULTS: On average, patients believed that therapy physical activity increased by 86.8 minutes per week more in the
should make them “much better” to be considered worthwhile. This intervention than control group (p = 0.007). More participants in
corresponded to a mean percentage perceived change in symptoms the intervention group reached 2.5 hours of moderate or vigorous
of 42% (SD: 23%).There was no significant difference between treat- leisure physical activity per week after 12 months (42% versus
ments for global perceived change (p = 0.09), percentage perceived 23% respectively, OR 2.9, 95% CI = 1.33-6.32, p = 0.007). No
change (p=1.0), or percentage improvement (p = 0.52) considered differences on SF-36 measures were observed between the groups
to be worthwhile effects. Of four possible predictive factors (past at 12 months. CONCLUSIONS: Telephone-based physical activity
experience with treatments, severity of symptoms, age and duration counseling is effective in increasing physical activity over 12 months
of symptoms) only severity of symptoms was significantly associated in previously low-active older adults. IMPLICATIONS: Physical
with perception of worthwhile effects of treatment CONCLUSIONS: therapists and other primary health care practitioners should be
Even though a large variation in responses was observed, on cognizant of their role in preventative health care strategies for
average patients considered a 42% (SD: 23%) change in symptoms the ageing population. KEYWORDS: Physical activity, Older adults,
would make therapy worthwhile. IMPLICATIONS: Researchers and Non-communicable diseases. FUNDING ACKNOWLEDGEMENTS:
clinicians interpreting the results of randomised clinical trials and National Heart Foundation of New Zealand (Grant Number 1017).
systematic reviews might be underestimating patients’ expectations. CONTACT: [email protected]
KEYWORDS: Low back pain, treatment, smallest important effect. ETHICS COMMITTEE: Auckland Ethics Committee
FUNDING ACKNOWLEDGEMENTS: The study was funded by The
Arthritis fundation, Motor Authority Association and the University of
Sydney SESQUI grant. CONTACT: [email protected] Research Report Platform Presentation
ETHICS COMMITTEE: University of Sydney Ethics Committee 2646 Tuesday 5 June 17:35
POSTURAL RESPONSE OF THE PELVIC FLOOR MUSCLES IS
DELAYED IN WOMEN WITH STRESS URINARY INCONTINENCE
Smith M, Coppieters M, Hodges P; Division of Physiotherapy,
School of Health and Rehabilitation Sciences, The University of
THE TELEWALK TRIAL: PHYSICAL ACTIVITY COUNSELING Queensland, St. Lucia, Queensland, Australia, 4072
FOR SEDENTARY OLDER ADULTS
PURPOSE: The aim of this study was to determine whether the
Kolt G1,2 , Schofield G2 , Kerse N3 , Oliver M2 , Garrett N2 ; 1 School
onset and amplitude of postural activity of the pelvic floor (PF)
of Biomedical and Health Sciences, University of Western Sydney,
and abdominal muscles differs between continent and incontinent
Sydney, Australia; 2 Centre for Physical Activity and Nutrition
women during rapid arm movements. RELEVANCE: Previous studies
Research, Auckland University of Technology, Auckland, New
of continent women have shown that PF muscle activity increases
Zealand; 3 Department of General Practice and Primary Health
prior to that of deltoid during rapid arm movements. This increased
Care, University of Auckland, Auckland, New Zealand
activity has been argued to be important for the maintenance of
PURPOSE: Graded health benefits have been demonstrated for continence and lumbopelvic stability. Although timing of postural PF
physical activity in reducing the risk of many non-communicable muscle activity has not been evaluated in women with stress urinary
diseases. However, a large proportion of the population remains incontinence (SUI), activation of the PF muscles is delayed during
sedentary. The purpose of the present study was to assess the coughing. If a similar delay is present during rapid arm movement,
effectiveness of a telephone counseling intervention (TeleWalk) on this may have negative consequences for continence and lum-
physical activity and health-related quality of life in low-active older bopelvic stability. PARTICIPANTS: Sixteen women with stress urinary
adults recruited through their primary care physician. RELEVANCE: incontinence (SUI) and 14 continent women matched for BMI, activity
Across the world, the population is ageing and physical activity levels level and parity volunteered to participate in this study. METHODS:
are declining. Physical therapists and other primary care practitioners Electromyographic activity (EMG) of the PF, internal obliquus
should therefore investigate preventative health strategies for the abdominis, obliquus externus abdominis, rectus abdominis and
rising prevalence of non-communicable diseases. PARTICIPANTS: erector spinae muscles were recorded with surface electrodes during
Participants were 186 (123 females and 63 males) low-active adults rapid shoulder flexion and extension. ANALYSIS: Onset of trunk and
(65 years and older) recruited from their primary care physicians’ PF muscle EMG activity relative to onset of deltoid muscle EMG were
patient databases. Inclusion criteria were having participated in detected for each muscle. Data were further analysed by comparison
less than 30 minutes of activity on 5 or more days per week for of root mean square raw (between groups comparisons) and
6 months or longer, and no unstable major health problem that normalised (postural response comparison) EMG amplitude recorded
meant increased activity would be contraindicated. METHODS: A 150-250 ms before (baseline) and 0-100 ms after (response) the
randomized controlled trial was used to investigate the effectiveness onset of deltoid EMG. RESULTS: Normalised EMG activity of all
of the telephone-based counseling intervention aimed to increase muscles was increased in association with arm movement (all:
physical activity. Participants were recruited from databases of 3 p0.001). Unlike the abdominal and erector spinae muscles (all:
primary care medical practices in Auckland, New Zealand. Those in p < 0.004), the onset of PF muscle EMG relative to that of deltoid did
the intervention group took part in 8 telephone counseling sessions not differ with respect to direction of movement (p = 0.70). However,
over 12 weeks based on increasing physical activity. Control patients the onset of postural activity of the PF muscles differed between
received usual care. Physical activity (as measured by the Auckland continent and incontinent women (p = 0.002). During both shoulder
Heart Study Physical Activity Questionnaire) and quality of life (as flexion and extension, the onset of PF muscle activity occurred prior
measured by the Short Form-36 Health Survey) were assessed to that of deltoid for continent women, but after deltoid in women with
at baseline, 3 months (end of intervention), and at 6 and 12 SUI. A novel finding was that in many women with SUI, background
months post-baseline as follow-up. ANALYSIS: Differences between PF EMG decreased prior to the PF muscle postural response (flexion:
intervention and control groups in change of outcome variables p = 0.004, and extension: p = 0.024). Unexpectedly, amplitude of
were analyzed by using repeated measures mixed model with raw PF EMG associated with rapid arm movements was greater
an unstructured covariance matrix. Models were adjusted for age, among women with SUI (p = 0.010). CONCLUSIONS: This study has
sex, clinic of origin, and baseline effects. A generalized estimating demonstrated that women with SUI have altered postural activity of
equation (GEE) for binary data with a logit link function was the PF muscles during rapid arm movements that is characterised by
delayed onset of PF muscle activity, an initial decrease in PF EMG Research Report Poster Display
and increased amplitude of PF EMG following activation of deltoid. 02-14 Tuesday 5 June 09:00
IMPLICATIONS: The altered postural response of the PF muscles VCEC Exhibit Hall B & C
in women with SUI appears counterintuitive to the premise that EFFECTS OF EXERCISE INTENSITY ON SALIVARY LEVEL
these muscles are required to maintain continence in a situation of OF SECRETORY IMMUNOGLOBULIN A IN PATIENTS WITH
increased intra-abdominal pressure and stabilise the spine and pelvis CHRONIC OBSTRUCTIVE PULMONARY DISEASE
in preparation for movement. As demonstrated during coughing, this Taito S1 , Sekikawa K1 , Kawaguchi K1 , Inamizu T1 , Morita N2 ;
may contribute to the loss of urine commonly experienced during 1 Graduate School of Health Sciences, Hiroshima University; 2 Kure
postural tasks. Furthermore, this finding may help to explain the Kyosai Hospital, Tadanoumi Branch
association between SUI and back pain that has been identified
in epidemiological studies. KEYWORDS: Electromyography, Postural PURPOSE: Upper respiratory tract infection (URTI) is a cause
control, Back pain. FUNDING ACKNOWLEDGEMENTS: This study of acute exacerbation of chronic obstructive pulmonary disease
was funded by the National Health and Medical Research Council of (COPD). Secretory immunoglobulin A (sIgA), the predominant
Australia. CONTACT: [email protected] immunoglobulin in mucosal secretions of the upper respiratory tract,
ETHICS COMMITTEE: The University of Queensland Medical is a major effector of resistance against pathogenic microorganisms
Research Ethics Committee causing URTI. It has been shown that the decline in salivary sIgA
levels after high intensity exercise is associated with the increased
susceptibility to URTI in ordinary people. Low intensity exercise does
Poster Displays, Tuesday 5 June not appear to change sIgA levels. However, for patients with COPD,
changes in sIgA levels after exercise are unknown. This study aimed
Research Report Poster Display to examine the effect of exercise intensity on salivary levels of sIgA
01-06 Tuesday 5 June 09:00 in patients with COPD. RELEVANCE: This study helps to explain
VCEC Exhibit Hall B & C the effect of exercise intensity in respect to immunity for patients
with COPD. PARTICIPANTS: Five outpatients with COPD (3 males
METHOD FOR PROGNOSIS OF THE WALKING CAPABILITY
and 2 females, mean age 76.4 [SD: 2.7] years and mean %FEV1.0
CONCERNING PATIENTS WITH UNILATERAL TRANSTIBIAL
54.9 [SD: 9.0] %). METHODS: Maximum walking speed for each
AMPUTATIONS
subject was determined by incremental shuttle walking test (ISWT).
Ganchev D; National Sports Academy, Bulgaria Exercise was for 20 minutes walking on a treadmill. Exercise intensity
was walking at a speed of 40% or 80% of ISWT (40% or 80%
PURPOSE: During my long practice as a physical therapist I found ISWT). Saliva samples were collected before and after exercise.
a significant discrepancy between the great desire of the patient to Salivary sIgA concentrations (mg/ml) were measured by enzyme-
have a prosthesis and his real functional capacity. The purpose was linked immunosorbent assay. ANALYSIS: Salivary sIgA secretion
to create and apply a method that would give doctors and therapists rates (mg/min), or the total amount of sIgA appearing on the oral
a more objective way for prognosticating if the patient would be able surface per unit time, were calculated by multiplying the salivary
to successfully walk with the prosthesis or not. RELEVANCE: A sIgA concentration by saliva flow rate (ml/min) for each subject.
certain economical effect was achieved by limiting the experimental RESULTS: After 40% ISWT, the salivary sIgA secretion rate of
prosthesising of contraindicated patients, and they were protected three patients decreased but the other two increased. After 80%
from the unnecessary, and sometimes dangerous physical pressure. ISWT, the salivary sIgA secretion rate of four patients decreased and
PARTICIPANTS: For the period between February and December, the remaining one increased. CONCLUSIONS: This study suggests
2002, 67 patients with unilateral transtibial amputation, that were that local immunity of the upper respiratory tract deceased after
hospitalized for primary prohtesis at the Special Clinic for Prosthe- low intensity exercise, and that even low intensity exercise may
sising and Rehabilitation of the Skeleto-Muscular System in Sofia, increase susceptibility to URTI for COPD patients. IMPLICATIONS:
were studied. The choice of the patients did not depend on their This study is useful for understanding the risk of URTI after exercise
sex or diagnosis but they all had to be above 50 years of age. and disease management for patients with COPD. KEYWORDS:
METHODS: The following indices that are of great importance for the chronic obstructive pulmonary disease, secretory immunoglobulin A,
walking capability with a below-knee prosthesis were traced: stump exercise intensity. FUNDING ACKNOWLEDGEMENTS: This study
length (SL); muscle strength of the extensors of the hip and the was unfunded. CONTACT: [email protected]
knee (MS); balance abilities (BA); and body weight (BW). ANALYSIS: ETHICS COMMITTEE: The ethics committee of the Hiroshima
From the data obtained by the indices was created a formula University Graduate School of Health Sciences and Kure Kyosai
that defines the index of probability of walking (IPW) for men and Hospital, Tadanoumi Branch
women. The formula is the following: IPW = [BA×SL×MS(hip+knee)]/
BW. RESULTS: The values obtained by using the formula in the
beginning of the treatment of the patients were substantiated in 88% Research Report Poster Display
of them at the end of the rehabilitation process. CONCLUSIONS: 02-18 Tuesday 5 June 09:00
Patients for whom the IPW is below 25% of the possible result, have VCEC Exhibit Hall B & C
no chance of starting to walk even using two supporting devices. REPRODUCIBILITY, VALIDITY AND RESPONSIVENESS OF A
Experience shows that they should stay in a wheelchair and be GROCERY SHELVING TASK – A MEASURE OF UPPER LIMB
given the appropriate physical therapy and training in self-service. FUNCTION FOR PATIENTS WITH COPD
IMPLICATIONS: The suggested method was successfully used in the
Hill C1,2 , Denehy L2 , McDonald C3 ; 1 Department of Physiotherapy,
clinical practice of the Special Clinic for Prosthesising – Gorna Banya,
Austin Hospital, Heidelberg, Australia; 2 School of Physiotherapy,
Sofia. The idea was approved by a large group of orthopedists,
The University of Melbourne, Carlton, Australia; 3 Department
prosthesists and physical therapists during my defence of PhD.
of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg,
KEYWORDS: Transtibial amputation, walking, formula. FUNDING
Australia
ACKNOWLEDGEMENTS: During my practical research I had the
moral and professional support of my colleagues – physical therapists PURPOSE: The aim of this research was to develop an outcome
and orthopedists. CONTACT: 1619 Sofia, BULGARIA,Kniajevo, Bial measure of arm function for patients with chronic obstructive
narzis Str. 3 E-mail: [email protected] pulmonary disease (COPD) – the grocery shelving task (GST).
ETHICS COMMITTEE: Special scientific council to NATIONAL RELEVANCE: Patients with COPD commonly report breathlessness
SPORTS ACADEMY “Vasil Levsky”, Sofia, BULGARIA that limits the performance of routine daily activities requiring
Poster Displays, Tuesday 5 June S383
unsupported arm activity. The strength of evidence for the use 27 male and 7 female with an average age of 64.8±7.1years old.
of upper limb training is not as great as lower limb training in Exclusion criteria of this study were impaired vision, hearing or
these patients, contributed to by the lack of a simple, reliable, valid musculoskeletal impairments which might interfere with the ability to
and responsive outcome measure of arm function. PARTICIPANTS: perform the exercise tests, significant pulmonary disease, history of
59 patients with moderate-severe COPD were recruited from the cerebral vascular disease, clinically unstable condition and resting
pulmonary rehabilitation waiting list at a tertiary teaching hospital. percutaneous oxygen saturation less than 90% when breathing
METHODS: The GST is a timed task that involves standing up from room air. Other exclusion criteria of this study were presence of
a chair, bending over, lifting two bags of groceries from the floor and cardiac shock and mechanical ventilation for more than 24 hours
placing the contents on a shelf set 15 cm above shoulder height. after surgery, Written, informed consent was obtained from all
Repeated measures design was used to determine reproducibility of patients prior to testing. METHODS: Once patients reached their
the GST over six weeks without intervention in 12 subjects. Pre-post functional capacity to be able to walk without any medical supervision
design was used to investigate the responsiveness of the GST and in the ward after operation, patients were asked to perform the
the UULEX following a six-week pulmonary rehabilitation program in three tests (Cardiopulmonary exercise test, pulmonary function
47 subjects. In 25 of these subjects, the pattern and magnitude of test and respiratory muscle strength test), and again performed
cardiorespiratory responses during the GST were compared with the these tests after about 2-week supervised exercise training. As
unsupported upper limb exercise test (UULEX) as the gold standard. a pulmonary function test, we measured the forced vital capacity
The UULEX is an incremental test performed in sitting, which has (FVC), the forced expired volume in one second (FEV1) and
reported reproducibility and validity as an outcome measure of upper slow vital capacity (SVC). Maximal inspiratory pressure (Pi-max)
limb work. ANALYSIS: Test-retest reliability was analysed using and maximal expiratory pressure (Pe-max) was also determined.
intraclass correlation coefficients (ICC). Cardiorespiratory responses ANALYSIS: Comparisons of data before and after 2-week supervised
during the two tests were compared using paired t-tests and cor- exercise training were performed using a paired t-test. The spearman
relations. Responsiveness pre-post intervention was analysed using rank correlation coefficient was used as a measure of correlation.
paired t-tests and sensitivity and specificity to responders. RESULTS: A value of p < 0.05 was considered significant. RESULTS: The
The time taken to perform the GST was highly reproducible over a FVC, FEV1, SVC, Pi-max, Pe-max, anaerobic threshold and the
six-week period, ICC = 0.98. Moderate to strong correlations were slope of minute ventilation (VE) and carbon dioxide output (VCO2)
found between the GST and the UULEX for all peak cardiorespiratory (VE/VCO2 slope) showed significant improvement after 2-week
responses (p < 0.01). Peak VO2 was significantly higher for the aerobic exercise training. However, no relationships were found
GST (541 versus 481 mL/min), whereas peak VCO2 (489 versus between the improvement rate of the VE-VCO2 slope and the
544 mL/min) and VE (20.0 versus 22.9 L/min) were significantly improvement rate of Pi-max, Pe-max, FVC, FEV1 and SVC. Only
higher for the UULEX (p < 0.05). Time taken for the GST improved end-tidal CO2 pressure (PETCO2) at the respiratory compensation
following pulmonary rehabilitation by 7.6±9.0% (n = 33, p < 0.05). point significantly and strongly correlated with the VE-VCO2 slope.
The minimum clinically important difference was identified as 5% CONCLUSIONS: Recovery of pulmonary function such as vital
improvement. CONCLUSIONS: The GST was found to be a simple, capacity and respiratory muscle strength did not affect to increased
inexpensive, reproducible, valid and responsive functional outcome exercise ventilation after CABG. Improvement of increased exercise
measure that incorporates unsupported arm activity for patients with ventilation after CABG may be due to improvement of cardiac
COPD. IMPLICATIONS: The availability of the GST as an outcome output that represented by improvement of PETCO2 during exercise.
will allow future investigation of the clinical significance of upper limb IMPLICATIONS: The purpose of post-operative physiotherapy to
training for patients with COPD. KEYWORDS: upper limb function; improve respiratory function such as respiratory muscle strength and
COPD; outcome measure. FUNDING ACKNOWLEDGEMENTS: vital capacity should be clarified. KEYWORDS: increased exercise
None. CONTACT: [email protected] ventilation, cardiac surgery, pulmonary function, cardiac function.
ETHICS COMMITTEE: Human Research and Ethics Committee at FUNDING ACKNOWLEDGEMENTS: N.A.
the Austin Hospital, Heidelberg, Australia. ETHICS COMMITTEE: Gunma Cardiovascular Center ethics com-
mittee

02-22 Tuesday 5 June 09:00
VCEC Exhibit Hall B & C 04-10 Tuesday 5 June 09:00
RECOVERY OF INCREASED EXERCISE VENTILATION AND
PULMONARY FUNCTION AFTER CORONARY ARTERY BYPASS DIFFERENT TYPES OF COMPETENCE IN PHYSIOTHERAPY
GRAFT SURGERY Bredland E
Takahashi T, Kumamaru M, Taya M, Miyazawa H, Nishikawa J,
PURPOSE: Professional competence consists of different parts,
Shitara T, Adachi H, Sakurai S, Oshima S, Taniguchi K; Gunma
often described as propositional knowledge (theoretical), non-
Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
propositional knowledge (professional craft and personal knowledge).
PURPOSE: Rapid and shallow breathing and perceived dyspnea are The aim of the present study was to investigate whether a group
often observed during exercise in patients underwent cardiac surgery, of under-graduate students have their strengths at different parts
in particular, when patients are in recovery stage. These symptoms of the professional competence, and to find out if the two types
associated with reduced exercise tolerance and retarded their phys- of knowledge correlate. RELEVANCE: In order to be a good
ical reconditioning after cardiac surgery. This study was designed physiotherapist it is important to understand, and to be aware of,
to determine the relationship between increased ventilation during one‘s different types of professional strengths. This is important to be
exercise and decreased respiratory function such as decreased aware of both for the student and for the teacher during the education.
respiratory muscle strength and decreased vital capacity after Later on as a physiotherapist it is also important to know where
coronary artery bypass graft surgery (CABG). The specific objective the professional strengths and weaknesses are. PARTICIPANTS:
was to identify the factor which relates to the increased ventilation The total population (n=98), comprised two final year classes of
during exercise in patients underwent cardiac surgery. RELEVANCE: students that had qualified at Sør-Trøndelag University College. All
An effective evidence-based cardiopulmonary physiotherapy program the exams assumed to measure propositional or non-propositional
after CABG can be found from this research result. PARTICIPANTS: knowledge were selected, totalling seven for each student. Five of
We investigated 34 patients following CABG in this study. Median the exams were written (propositional knowledge) and two were
sternotomy were performed in all patients. Patients consisted of practical exams (non propositional). Of the two latter, one involved
demonstrating practical physiotherapy on a fellow student, and spacing. ANALYSIS: Skin color, BMI, skinfold thickness, skinfold
in the final exam the students were required to treat an actual site, diode coupling, wavelength, age, and gender effects were
patient. METHODS: A descriptive quantitative approach was taken analyzed using a mixed effects linear model, after determining that
to analyse(in SPSS) the data consisting of seven grades for each of the data set met the underlying assumptions of the model. Residual
the 98 students. ANALYSIS: Using the data program SPSS, firstly distributions were not normally distributed and all responses were
a comparative analysis of the mean of the two practical exams with log-transformed to ensure valid p-values. Significance was set at
the mean of the two last theoretical exams for each student was p < 0.05. RESULTS: Detected light was expressed as a percentage
performed. Secondly the final exam (with a patient) was analysed of incident light. Transmission using diodes in contact with skin, with
and compared with the three other exams to determine the relative pressure, was 1.5 times of that when using diodes in contact, but
ranking of grades. Lastly Spearman‘s correlation test was used to without pressure and was 1.9 times of that using a 2-mm skin-diode
find correlations between the exams. RESULTS: Preliminary results: distance (p < 0.0001). Transmission of infrared light was 2.5 times
1. Nearly half of the students had a difference of more than one that of red light (p < 0.0001). Transmission of red light decreased
grade between the practical and the theoretical exams. 2. More than as skin color darkened stepwise from Category I to IV, by 30%,
three-quarters of the students had their final exam as their best or 35% and 57%, respectively (p < 0.0001). Skin color did not affect
worst exam of the four. 3. While the theoretical exams correlated transmission of infrared light. As BMI increased stepwise from 1 to
significantly, only very low, non-significant, correlations were found 3, transmission through skinfolds decreased by 49.6% and 45.9%
between the final exam and the theoretical exams. CONCLUSIONS: for red light and by 44% and 43% for infrared light, respectively
There was a significant difference between students‘ propositional (p < 0.0001). There were gender effects on penetration of infrared
vs non propositional knowledge. The final exam, with a real light at normal and low BMI values (p < 0.01). CONCLUSIONS: When
patient, emphasizes a different kind of competence from the other using divergent light sources, individual physical characteristics (skin
exams. It can be argued that a clinical exam is better suited color, BMI and gender), wavelength and skin-diode coupling must
to measure non-propositional knowledge compared with any other be taken into account. IMPLICATIONS: This study demonstrates
exams. IMPLICATIONS: For physiotherapists it is important to know convincingly that a ‘one dose for all’ approach when applying
that as a professional you need to be aware of where you have light therapy is likely to provide suboptimal treatment for many
your weakness and where you have your strength. For the newly patients. Surface radiant exposure should be adjusted to ensure
qualified physiotherapists it is important to be aware of this to delivery of effective fluence rates to subcutaneous tissue sites for all
further develop their competencies.A clinical exam with a patient categories of patients. KEYWORDS: laser therapy, light penetration,
will highlight a different side of the professional development for the physical characteristics. FUNDING ACKNOWLEDGEMENTS: We
students. KEYWORDS: Propositional knowledge – non propositional gratefully acknowledge support from the 2004 Schnurr Memorial
knowledge, education. FUNDING ACKNOWLEDGEMENTS: No Fund Research Grant, administered by the Physiotherapy Foundation
funding. CONTACT: [email protected] of Canada.
ETHICS COMMITTEE: Mount Sinai Hospital Research Ethics Board,
Toronto, Canada
TRANSMISSION OF LIGHT: DOSIMETRY ADJUSTMENT 08-18 Tuesday 5 June 09:00
FOR EFFECTS OF SKIN COLOR, BODY COMPOSITION, VCEC Exhibit Hall B & C
WAVELENGTH AND LIGHT COUPLING TO SKIN HELIUM-NEON LASER IN VIABILITY OF RANDOM SKIN FLAP
Nussbaum E1,2 , Van Zuylen J3 ; 1 Mount Sinai Hospital, Toronto, IN RATS
Canada; 2 Department of Physical Therapy, University of Toronto, Pinfildi C, Prado R, Liebano R, Hochman B, Ferreira L; São Paulo
Canada; 3 PhotonX Health Corporation, Mississauga, Canada Federal University – UNIFESP – EPM
PURPOSE: To identify factors that influence transmission of light PURPOSE: The purpose of this study was to determine the role
through human skin. RELEVANCE: There has been no systematic of helium-neon laser (He-Ne) random skin flap viability in rats.
investigation of factors that affect transmission of therapeutic light. RELEVANCE: The LLLT has been used more often in plastic
Failure to adjust radiant exposure to compensate for attenuating reconstructive surgery and this study showed that the red laser with
factors might explain some contradictory findings in the laser the punctual contact technique on the surface and surrounding the
literature. PARTICIPANTS: 107 healthy volunteers, 20-85 years. skin flap can be an excellent technique to increase the vascular
METHODS: Age, sex, height, and weight were recorded. Age was perfusion and the postoperative tissue viability. PARTICIPANTS:
categorized as 20-30, 31-40, 41-50, 51-60, 61-70, or>71 years. Forty-eight Wistar-EPM rats were used, weighed and divided into
Body mass index (BMI) was calculated (kg/cm2 ) and was coded 4 groups with 12 rats each METHODS: This study was approved by
0 (underweight), 1 (normal), 2 (overweight), and 3 (obese) for Commission of Ethics in Research of São Paulo Federal University
values of <18.5, 18.5-24.9, 25-29.9, and 30, respectively. Skin color going in the current apt legislation. Forty-eight Wistar-EPM rats were
was measured using a spectro-colorimeter and was displayed as a used, weighed and divided into 4 groups with 12 rats each. The
number from the Pantone® Formula Guide Coated for solid colors. random skin flap was performed measuring 10 X 4 cm, with a
Color was categorized based on relative light/dark values, Category plastic sheet interposed between the flap and the donor site. The
I having the least and Category IV the most pigmentation. Skinfold Group 1 (control) underwent sham irradiation with He-Ne laser. The
thickness was measured using digital calipers at standardized sites Group 2 was submitted to laser irradiation, using the punctual contact
over biceps and triceps muscle bellies, and at the anterolateral technique on the skin flap surface. The group 3 was submitted to
waistline. Light was generated at 840nm and 660nm using 23- laser irradiation surrounding the skin flap, and the group 4 was
diode arrays with surface areas of 7.0cm2 . Transmission through submitted to laser irradiation both on the skin flap surface and
skinfolds was measured using a power-meter comprising a 1x1- around it. The experimental groups were submitted to He-Ne laser
cm2 light detector. A custom-designed jig was used to hold the irradiation with 3 J/cm2 energy density immediately after the surgery
skinfold and to position the detector in the centre of the 7-cm2 and for the four subsequent days. The percentage of necrotic area
illuminated spot. Incident light was taken as the measurement of the four groups was calculated at the seventh postoperative
with zero skinfold thickness. Transmission was measured using day, through a paper template method. ANALYSIS: This study
three skin-diode coupling conditions: a) contact with non-painful used an qualitative analysis with the ANOVA (analysis variance)
pressure, b) contact without pressure, and c) with a 2-mm skin-diode with a fix factor and the Bonferroni Test to find the differences
among the groups. RESULTS: Group 1 reached an average necrotic Research Report Poster Display
area of 48.86%, Group 2–38.67%, Group 3–35.34%, and Group 10-02 Tuesday 5 June 09:00
4–22.61%. After the statistic analysis, results showed that all VCEC Exhibit Hall B & C
experimental groups reached statistically significant values when SEX DIFFERENCES IN QUADRICEPS AND HAMSTRING
compared to the control group, and Group 4 was the best one, when MUSCLE TORQUE ACCURACY AND STEADINESS
compared to all groups of this study (p < 0.001). CONCLUSIONS:
Bizzini M1,2 , Maffiuletti N1,2 ; 1 Neuromuscular Research Laboratory,
The laser He-Ne irradiation was efficient to increase random skin flap
Schulthess Clinic, Zürich, Switzerland; 2 Research Department,
viability in rats IMPLICATIONS: The skin flap is the most frequent
Schulthess Clinic, Zürich, Switzerland
surgical procedure used in the plastic and reconstructive surgery.
The main and most feared complication responsible for failure of PURPOSE: The purpose of this study was to analyse the effect
procedures with skin flaps is ischemia. The LLLT can be an important of sex, action mode, and contraction intensity on torque control
therapeutic modalities to increase the tissue viability. KEYWORDS: (accuracy and steadiness) during dynamic contractions of the
Low level laser therapy. Skin flap. Necrosis. Rats. Helium-neon laser. quadriceps and hamstring muscles. RELEVANCE: Muscle torque
FUNDING ACKNOWLEDGEMENTS: São Paulo Federal University – accuracy and steadiness are typically measured in static (isometric)
UNIFESP/EPM. CONTACT: cepinfi[email protected] conditions. In this study, dynamic contractions were performed,
ETHICS COMMITTEE: Commission of Ethics in Research of São which imply more complex movement control patterns. Additionally,
Paulo Federal University there is little knowledge in the literature about the interactions
of sex, action mode, and contraction intensityon quadriceps and
hamstring muscle torque accuracy and steadiness. PARTICIPANTS:
Thirty healthy individuals (15 males, 15 females), with no known
08-22 Tuesday 5 June 09:00 orthopaedic or neurological problems volunteered to participate in
VCEC Exhibit Hall B & C the study (mean age ± SD: 30.5±4.9 yr; height: 1.75±0.08 m;
EFFECTS OF LOW-POWER LASER THERAPY (ASGA) ON THE mass: 70.1±13.4 kg). METHODS: After a standardized warm-up and
REGENERATION OF SCIATIC NERVE INJURY IN THE RAT a series of familiarization trials, quadriceps and hamstring muscle
Mello J, Sales N, Alves J, Guilherme J, Lima J; LABMORF/UNISUAM torque accuracy and steadiness were determined using a torque
target-tracking task (±15º/s on an isokinetic device), at two different
PURPOSE: Laser irradiation is one of the therapeutic methods contraction intensities (low: 0.5 Nm/kg of body mass; high: 1 Nm/kg
for the recovery of degenerated peripheral nerves. The aim of of body mass). Accuracy was quantified as the mean absolute
the present study was to determine if low-power laser treatment error relative to the target torque (torque error) and steadiness was
(LLLT) stimulates the regeneration process of damaged nerves. computed as the standard deviation of torque fluctuations divided
RELEVANCE: After total lesions of a peripheral nerve, the neural by the mean target torque (torque variability). ANALYSIS: A 4-way
ways suffer degeneration or atrophy, including the loss of the central ANOVA (sex × action mode × contraction intensity × muscle group)
connections. In partial lesions the reestablishment of lost functions with repeated measures on the last three factors was performed.
is possible. The level of recuperation depends of some factors RESULTS: No significant differences between men (−6.65 Nm) and
as, number of axonic injured, effect of edema provoked by the women (−6.11 Nm) were observed for torque accuracy (P = 0.7).
crushing and finally the maintenance or not of the epineurium. On the other hand, a tendency toward significance (P = 0.083) was
PARTICIPANTS: Twenty wistar rats were used (weigh 200-250 observed for steadiness, with women showing higher values (2.87)
g). METHODS: anesthetized with ketamina (100 ml/g), and a compared to men (2.53). More interestingly, a significant sex ×
standardized crush to the sciatic nerve (SN) was applied to cause muscle group interaction was observed on steadiness (P < 0.05),
extensive axonal degeneration. After this procedure, low-power and the post-hoc tests indicated that quadriceps torque variability
infrared laser irradiation was administered transcutaneously to the was significantly higher in women (3.37) than in men (2.86),
injured sciatic nerve, daily to each of three differents treatment while no sex differences emerged for hamstring muscle (women:
groups, 4, 8, 12 joules for 15 days. ANALYSIS: The animals were 2.36; men: 2.20). CONCLUSIONS: Significant sex differences were
sacrificed and the SN was dissected with the preservation of the found for quadriceps but not for hamstring torque variability. The
dorsal root ganglion and the medullar segment corresponding. The higher steadiness values of the females indicate a more difficult
SN slices were stained with hematoxylin and eosin, antigap 43 quadriceps muscle control compared to their male counterparts. This
and the nerves were plated small crystals of DIA in the distal finding may add an interesting aspect in neuromuscular properties
extremity. RESULTS: In the laser treated rats showed a bigger differences between men and women. Further research is needed
remyelinization, increase of the axonal extension after the injury to further study this topic in injured and post-surgical individuals.
site, greater speed of axonal growth and increase the number of IMPLICATIONS: This study shows that healthy women have an
axonic for area of section of a peripheral nerve. CONCLUSIONS: impaired ability to steadily produce submaximal quadriceps forces.
These results suggest that low-power infrared laser irradiation can Neuromuscular sex differences are considered one of the key factors
relieve the mechanical damage of sciatic nerves and stimulate for the higher incidence of knee injuries among females. These data
the regeneration of peripheral nerves. IMPLICATIONS: This study may add a new aspect in the understanding of the quadriceps and
is too important for physical therapy practice because the Low- hamstring muscle sex differences and offer a basis for new training
level laser therapy is a clean, fast and efficient treatment form of or treatment strategies. KEYWORDS: quadriceps/hamstring, muscle
sciatic nerves injury. KEYWORDS: Laser therapy, sciatic nerves, torque, accuracy/steadiness. FUNDING ACKNOWLEDGEMENTS:
injury. FUNDING ACKNOWLEDGEMENTS: UNISUAM. CONTACT: This study received no funding. CONTACT: [email protected]
[email protected] ETHICS COMMITTEE: This study was approved by the Local
ETHICS COMMITTEE: UNISUAM ethics committee approved this Committee on Human Research (Schulthess Klinik Zürich).
study.
Research Report Poster Display healthy adults (4 males and 7 females, mean age 22.7±3.3 yr)
10-06 Tuesday 5 June 09:00 participated in this study. None of the subjects had a history of
VCEC Exhibit Hall B & C neurological or orthopedic disorders in their lower extremities or
THE DIFFERENCE BETWEEN KNEE EXTENSOR STRENGTH back. Each subject was informed of the purpose, possible risk,
AND POWER WHEN MEASURING AT DIFFERENT VELOCITIES and benefits of the study prior to giving one’s written consent to
AFTER PATELLOPLASTIA participate. METHODS: Each training session consisted of 4×30 s
bouts at 70% of the maximal load obtained by the maximal power
Rahko L, Siira P, Laine V; Oulu University Hospital
test with a bicycle ergometer. Thirty seconds of rest were given
PURPOSE: The purpose of this study was to determine the between each boat. The subjects maintained pedaling at 90 rpm
differences between operated and nonoperated limb in isokinetic for 30s and train for 8 weeks, 3 days per week on the bicycle
knee extensor strength and power three, six and twelve months after ergometer. Muscle strength, cross-sectional area of thigh muscles,
patelloplastia. The second purpose was to find out the differences pedaling power and functional performance were measured before
between strength and power results in isokinetic measurements at and after the 8 weeks of pedaling training. Maximum muscle strength
the velocity 90º/s and 180º/s and that way clarify which velocity would tests of hip extensor, hip abductor, knee extensor, knee flexor,
be more appropriate to strength measurements for patelloplastia ankle plantar flexor and ankle dorsiflexor were performed using an
patients. RELEVANCE: The use of the strength and the reliability isokinetic dynamometer. The cross-sectional area of thigh muscles
of the strength measurements are often reduced because of the was measured by magnetic resonance imaging. Four unilateral
pain or the fear of the pain. More force causes more pressure in hopping tests (figure-of-8 hop, side hop, up-down hop, and single
the joint and therefore more pain. In the isokinetic strength test hop) and one-legged vertical jump test were used as functional
the faster velocity requires less force to produce the same power, performance tests in this study. For the first 3 tests, the total time
and the power is the thing used in daily living when jumping or was recorded with a handheld stopwatch to the nearest 0.01 second,
standing up, for example. Typical power tests, hop tests, require for the last 2 tests, the distance was recorded to the nearest 0.01 m.
more skills and fearlessness, and the fear of the pain is often the ANALYSIS: Student’s t test for a paired data was used to compare
reason for the low results. However the patient has better motivation mean values before and after training. Significance was set at <0.05.
to do the exercises properly and regularly when the improvements RESULTS: A significant increase in muscle strength was observed in
are clearly established, so a reliable power test is a valuable tool hip extension, knee extension, knee flexion, ankle plantar flexion and
for the rehabilitation. PARTICIPANTS: Nineteen patients (female 13, ankle dorsiflexion, but not in hip abduction. Muscle hypertrophy was
male 6), mean age 27.2 years (range 17- 40) took part in this 1- seen in quadriceps, but not in hamstrings. Pedaling power showed
year follow-up study. Each of them had undergone Elmslie-Trillat- a significant increase during the 8-week training period. Functional
patelloplastia. METHODS: The knee extensor strength and the power performance improved significantly except in the side hop test.
was measured by the isokinetic dynamometer at the velocity 90º/s Improvements in muscle strength and pedaling power gained by the
and 180º/s. ANALYSIS: The Paired- Samples T-test between the training resulted in better functional performance. CONCLUSIONS:
results of the operated and nonoperated limb was used as a statistical High intensity pedaling training is an appropriate exercise for young
method. RESULTS: The mean extension peak torque at the velocity healthy subjects to improve both muscle strength in open kinetic
90º/s in the operated side was 116±36 Nm (deficit 30%, p < 0.001) chain and performance in closed kinetic chain. IMPLICATIONS:
at 3 months, 142±45 Nm (deficit 20%, p < 0.001) at 6 months and High intensity pedaling training should be regarded as a useful
150±51 Nm (deficit 15%, NS) at 12 months. At the velocity 180º/s training method. KEYWORDS: Pedaling training, Muscle strength,
that was 95±31 Nm (deficit 29%, p < 0.001), 117±39 Nm (deficit Functional perfomance. FUNDING ACKNOWLEDGEMENTS: This
19%, p < 0.001) and 129±43 Nm (deficit 12%, NS) respectively. study was unfunded and independently performed. CONTACT:
The mean extension power at the velocity 90º/s between the knee [email protected]
angles 65º and 55º in the operated side was 164±59 W (deficit
34%, p < 0.001) at 3 months, 208±72 W (deficit 21%, p < 0.001)
at 6 months and 222±83 W (deficit 16%, NS) at 12 months. At
the velocity 180º/s that was 291±108 W (deficit 30%, p < 0.001), 11-14 Tuesday 5 June 09:00
362±129 W (deficit 20%, p < 0.001) and 392±139 W (deficit 12%, VCEC Exhibit Hall B & C
NS) respectively. CONCLUSIONS: The results indicated that the PREVALENCE OF OBESITY IN SCHOOL CHILDREN IN
differences in the knee extensor strength and the power between the DURBAN,SOUTH AFRICA
limbs were not anymore significant at 12 months. In the isokinetic Puckree T, Naidoo P, Pillay P, Naidoo T; University of KwaZulu
measurements the faster velocity gave the better power results, Natal, Durban, South Africa
probably because the faster velocity reduces the pressure in the joint.
IMPLICATIONS: When measuring 180 deg/s is more appropriate PURPOSE: The primary purpose of this study was to determine the
velocity for patelloplastia patients. KEYWORDS: strength, power, prevalence of obesity and overweight in school children in Durban,
patelloplastia. FUNDING ACKNOWLEDGEMENTS: None. South Africa. Secondly, a comparison of Pediatrician and Dietetic
indices to determine prevalence of obesity and overweight was made.
RELEVANCE: Obesity in children has become a worldwide problem.
Research Report Poster Display Physiotherapists can play a vital role in health promotion in children
10-10 Tuesday 5 June 09:00 by determining the extent of the problem and initiating strategies
VCEC Exhibit Hall B & C to curb obesity and its co morbidities PARTICIPANTS: A random
THE EFFECTS OF HIGH INTENSITY PEDALING TRAINING USING sample of 120 children aged 10 to 12 years of age from a population
A BICYCLE ERGOMETER ON LOWER EXTREMITY MUSCLES of 300 children from 6 schools in the Durban region participated in
the study by fully informed voluntary consent. METHODS: A cross
Ichihashi N, Ohata K, Ikezoe T, Tsuboyama T; Department of
sectional population based survey with quantitative and qualitative
Physical Therapy, School of Health Sciences, Faculty of Medicine,
components was used. A validated questionnaire with open and
Kyoto University, Kyoto, Japan
closed ended questions captured information on dietary habits,
PURPOSE: The purpose of this study was to investigate the effects activity levels and medical history. Body Mass Index was calculated
of the 8-week high intensity pedaling training on muscle strength, using measured heights and weights of each child. The scale used
cross sectional area of thigh muscles and functional performance. to measure body weight was calibrated prior to use. ANALYSIS:
RELEVANCE: This study evaluates high intensity pedaling training Calculated Body Mass Index was compared to the Pediatric and
for the improvement of motor function. PARTICIPANTS: Eleven Dietetic formulae to determine percentage of normal, underweight,
overweight and obese children. Paired t- tests with a probability of this study improved not only physical abilities but also in the social
p < 0.05 was used to determine statistical significance. Qualitative and psychological attitudes of the participants. Intervention with
information was described in categories. RESULTS: 120 children simple exercise programs had an effect on healthy elderly people
aged 10-12 years participated. 60% were female, 77% of Indian and expected to be highly promising for facilities and communities
origin, and the remining 23% African. Using both the Pediatric equipped with insufficient machines. If this kind of intervention would
and Dietetic indices, the majority of the children were underweight be adapted to the elderly who are not very active, redrafting of the
(74% and 63% respectively). However while the Pediatric formula exercise program and more frequent follow-ups by a physiotherapist
showed only 5% to be overweight, the Dietetic formula showed were considered to be important. IMPLICATIONS: Physical therapy
that 39% were overweight. CONCLUSIONS: Overweight is a practice KEYWORDS: Physical Fitness Measurement, Exercise
problem in the study population. Underweight also appears to be Instruction, Home Exercise. FUNDING ACKNOWLEDGEMENTS:
significant. The differences obtained with the Pediatrician and Dietetic We would like to express our sincere gratitude to users and staff
formulas require attention. A deviation from normal weight in the of Gunma Prefectural Fureai Sports Plaza who cooperated in this
school children could have implications for physiotherapy in the study. CONTACT: [email protected]
future. IMPLICATIONS: The results of this study show a need for
physiotherapists to emphasize health promotion both in education
and training and practice and research. KEYWORDS: children, Research Report Poster Display
over-weight, body mass index. FUNDING ACKNOWLEDGEMENTS: 13-02 Tuesday 5 June 09:00
None. CONTACT: [email protected] VCEC Exhibit Hall B & C
ETHICS COMMITTEE: University of KwaZulu Natal Human Ethics
Committee POSTURAL CONTROL AT THE INITIATION OF LATERAL STEP
MOTION IN PATIENTS WITH HIP OSTEOARTHROSIS
Tateuchi H, Ichihashi N, Tsuboyama T; Department of Physical
Therapy, School of Health Sciences, Faculty of Medicine, Kyoto
11-22 Tuesday 5 June 09:00 University, Kyoto, Japan
THE EFFECT OF A HEALTH PROMOTION PROGRAM PURPOSE: Coodinated control of the center of pressure (CoP) and
CONSISTING OF EASY AND SIMPLE EXERCISES FOR the center of gravity (CoG) is essential in the motion initiation, and
COMMUNITY LIVING ELDERLY PEOPLE analyzing this dynamic process provides insights into the postural
control in the patients with motor dysfunction. In patients with hip
Nakagawa K1,2 , Inomata N1,2 , Nakazawa R1 , Sakamoto M1 ; 1 Gunma osteoarthrosis, asymmetrical motor control caused by hip dysfunction
University Graduate School of Medicine; 2 Kamimoku-Spa. Hospital is often observed in the frontal plane. The purpose of this study was
PURPOSE: The purpose of this study was to test the efficacy of to clarify the mechanism underlying postural control at the initiation of
a health promotion program consisting of simple exercises among lateral step motion in patients with hip osteoarthrosis. RELEVANCE:
healthy elderly people in a community. RELEVANCE: As for the This study clarifies relationship between the hip dysfunction and the
exercise with training machinery, many advantages are obtained, but postural control, and gives the suggestion on the development of
have a problem to take a place and a cost. It is important to consider new evaluation and treatment strategy. PARTICIPANTS: Eighteen
simple methods and effective exercise to spread exercise intervention subjects with unilateral hip osteoarthrosis (mean age 59.5 years,
to the elderly people in community. PARTICIPANTS: The participants all female, OA group) and 10 healthy controls matched for age and
were healthy and elderly people (67.6±5.05 years old), who were sex (control group) were investigated. METHODS: The subjects were
picked out from the users of a sports recreation facility. They were instructed to step laterally (10 cm from the stepping foot) as fast as
divided into the control group (17 persons) and intervention group (20 possible and accurately following a visual cue. The displacements
persons). METHODS: We carried out physical fitness measurements of the CoP and the CoG in the frontal plane and horizontal ground
and instructed on exercises to participants. The evaluations for reaction force (GRF) were measured using dual force plates during
physical fitness were the grip strength, knee extensor strength, sitting the initiation phase (from the cue to the foot-off). The order of the
trunk flexion, falling-stick reaction time, one leg stance, Functional stepping direction was randomized and steps with the affected limb
Reach Test (FRT), Timed “Up and Go” Test (TUG), 10-m walking time, supporting were included in the analysis for OA group. ANALYSIS:
and 6 minutes distance (6MD). We also evaluated activity, social, Non-paired t-test was used in the statistical analysis of all kinetic
and psychological condition with a questionnaire which included variables. RESULTS: The OA and control groups showed a common
the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of pattern in the CoP and the CoG trajectories. During the initiation
Competence, Medical Outcomes Study Short-Form 36-Item Health phase, the CoP and the CoG were simultaneously shifted to the
Survey (SF-36), and Profile of Mood States (POMS). All the exercises stepping side and the supporting side, respectively, followed by a
we instructed were those can be easily performed at home. As large shift of the CoP to the supporting side to accelerate the
resistance exercise, rubber tube and one’s body weight of a subject CoG toward the stepping side. Although there was no difference in
were used. Prior to the start of this study, the director and staff of the the displacement of the CoG, the displacement of the CoP to the
sports recreation facility as well as the participants received adequate supporting side was larger in the OA group than in the control group
explanation and gave their consent, before the measurements and (p < 0.05). GRF was smaller in the OA group on both sides than
instruction were carried out. After this study, persons of the control in the control group (p < 0.05). CONCLUSIONS: The patients with
group were instructed on exercises. ANALYSIS: The Mann-Whitney OA appeared to accelerate the CoG to the stepping side by means
test was performed to compare the control and intervention groups of enlarging the distance between CoG and CoP. They probably
before the intervention, and a Wilcoxon signed-rank test for each adopted compensatory strategy for the insufficient abduction moment
group and for each item was performed for intragroup comparison produced by the affected limb. The finding that GRF was smaller
before and after the intervention. RESULTS: In the intervention in the patients not only on the supporting side but also on the
group, the improvements of leg strength (male; 54.1±13.41%BW stepping side seems to reflect inhibition of the rapid CoG shift
to 63.1±20.01%BW, female; 53.8±15.29%BW to 59.5±18.10%BW), toward the affected side. IMPLICATIONS: These strategies can
TUG (female; 6.1±0.91 s to 5.7±0.90 s), 10-m walking time possibly lead to bilateral dysfunction in the patients with unilateral
(male; 5.0±1.64 s to 4.7±1.47 s), 6MD (male; 614.1±137 m to hip osteoarthrosis in the long run. KEYWORDS: postural control,
643.6±140 m), physical function item of SF-36 (42.3±11.44 to step, hip osteoarthrosis. FUNDING ACKNOWLEDGEMENTS: This
46.7±10.80) and vigor item of POMS (53.4±6.40 to 55.8±5.75) study was unfunded and independently performed. CONTACT:
were significant (P < 0.05). CONCLUSIONS: Exercise instruction in [email protected]
Research Report Poster Display joints, with the consideration of securing safety for senior citizens
13-06 Tuesday 5 June 09:00 and handicapped persons. RELEVANCE: Previous studies reported
VCEC Exhibit Hall B & C on the effectiveness of descending stairs backwards for knee
EXAMINATION OF GAIT SPEED MEASUREMENT AT osteoarthritis. However, handicapped people and senior citizens often
HOME-BASED REHABILITATION IN JAPAN: GAIT ABILITY descend stairs sideways, but no reports on this subject were found
EVALUATION USING A 1.5 METER WALKING TEST in the literature. PARTICIPANTS: Subjects were 11 healthy adult
men. The mean age, height and body weight were 23.3±3.7 years,
Makizako H1,2 , Abe T2 , Yoshimatsu T3 , Koguchi R2 , Shimada H4 ,
169.0±5.1 cm, and 61.4±7.3kg, respectively. The subjects read
Kobayashi S5 , Kubo A3 ; 1 Graduate School of Sport Sciences
and signed the informed consent forms prior to their participation
Waseda University; 2 Itabashi Rehabili Home-Visit Nursing
in the study. METHODS: The angles of the lower limb joints and
Station; 3 Department of Rehabilitation, Jiseikaikinen Hospital;
4 Research Team for Promoting Independence of the Elderly, Tokyo moments when descending forward, backwards, sideways with the
swing leg diagonally forward (SF), and sideways with the swing
Metropolitan Institute of Gerontology; 5 Department of Rehabilitation,
leg diagonally behind (SB) were measured using a 3-dimensional
Jiseikai Tokumaru Hospital
motion analysis system combined with two force plates. Ten reflective
PURPOSE: To investigate the feasibility of functional gait measure- markers were attached to anatomical landmarks: the acromion,
ment at home-based rehabilitation, 1.5-m, 5-m, and 10-m walking greater trochanter, lateral malleolus, and 5th metatarsal head. The
tests were performed. The 1.5-m walking test’s validity was examined. peak angle and moment was selected for each joint. ANALYSIS:
RELEVANCE: Evaluating gait ability using a 10 m walking test for Differences between groups were detected by a one-way analysis
Japanese home-based rehabilitation is difficult. A short distance of variance, followed by Fisher’s PLSD post hoc test. For all tests,
walking test must be developed for the home-based physical therapy values of p < 0.05 were considered statistically significant. RESULTS:
field. PARTICIPANTS: Forty inpatients in a rehabilitation ward (18 It was found that the hip flexion angle and hip extension moment
females and 22 males, mean age 70.4±12.0 years) participated in the support leg decreased when descending forward and SF.
in this study. Diagnoses were cerebral infarction (n = 27), cerebral On the other hand, the ankle dorsiflexion angle and plantar flexion
hemorrhage (n = 11), and hip fracture (n = 2). Without assistance moment, and the knee flexion angle and extension moment in
and independently, 22 patients were able to walk, 10 patients the support leg decreased when descending backwards and SB.
required supervision during walking, and 8 patients required partial CONCLUSIONS: No difference was found in joint angle and moment
assistance. Patients’ consent to participate was obtained after the between descending forward and SF. On the other hand, there
purpose and methods of this study were explained. METHODS: is no difference in joint angle and moment between descending
Subjects walked 10 m at comfortable speed and maximum speed. backwards and SB. We suggest that SF may be a good alternative
The time required and the number of steps was measured when the for descending forward, and SB may be a good alternative for
subjects passed each line of 1.5 m, 5 m, and 10 m. ANALYSIS: descending backwards. When descending sideways, the direction of
Walking speed was compared between 1.5 m, 5 m, and 10 m using the swing leg changes the joint angle and moment in the stance
one-way analysis of variance. Pearson’s correlation coefficients were leg. We suggest that descending backwards and SB are suitable
used to confirm the association of the gait speeds for 1.5 m, 5 m, for knee and ankle dysfunctions. Descending forward and SF are
and 10 m. We calculated quartiles at walking speeds when passing suitable for hip dysfunctions. We confirmed that the difference in
a 1.5-m line. Significance was inferred for P < 0.05. RESULTS: No the method of stair descending influences the lower extremity joint
significant differences were found in walking speeds, walking rates, angles and moments, and the methods taught to patients should
or step lengths for 1.5 m, 5 m, and 10 m. At a comfortable waking be suitable to their situation. IMPLICATIONS: Appropriate methods
speed, significant correlations were found between 1.5 m and 5 m (r = of stair descending should be chosen for each patient to avoid
0.94), as well 1.5 m as 10 m (r = 0.92). Regarding maximum walking lower extremity joint stress and to increase safety. KEYWORDS:
speed, significant correlations were found between 1.5 m and 5 m 3-dimensional motion analysis, descending stairs, activities of daily
(r = 0.97), as well as 1.5 m and 10 m (r = 0.94). We classified four living. FUNDING ACKNOWLEDGEMENTS: Unfunded. CONTACT:
groups by quartiles in 1.5 m comfortable walking speed. The number [email protected]
of patients who were walking independently in a classified group were ETHICS COMMITTEE: Prefectural University of Hiroshima
as follows: four patients at 13.3 m/min or below, three at 13.3–24.7
m/min, five at 24.7–28.1 m/min, and ten at 28.1 m/min or above. At1.5
m maximum walking speed, three were at 18.3 m/min or below, six at
18.3–29.2 m/min, six at 29.2–38.7 m/min, and seven at 38.7 m/min 14-14 Tuesday 5 June 09:00
or above. CONCLUSIONS: A strong relationship was found between VCEC Exhibit Hall B & C
the 1.5 m walking speed and 10 m walking speed. The 1.5 m walking INFLUENCE OF LIGHT TOUCH FOR SIDE STEP
speed might be a useful indicator to distinguish between independent Sugi T1 , Ito H2 ; 1 Nishimagi Hospital, Ibaraki, Japan; 2 Ibaraki
and dependent walking. IMPLICATIONS: Results of this study might Prefectural University of Health Science, Ibaraki, Japan
be useful to evaluate gait performance using a 1.5 m walking test for
home-based physical therapy. KEYWORDS: 1.5 meter, gait, home- PURPOSE: Researchers have reported that the amount of swaying
based rehabilitation. FUNDING ACKNOWLEDGEMENTS: We are during static standing decreased as a result of light touches. This
grateful to all patients and therapists who agreed to participate in study investigated the influence of light touches which don’t result in
this study. CONTACT: [email protected] the movement of the body. RELEVANCE: The research study may
suggest the effect of physical therapist’s touch on patients, or provide
a useful guide to appropriate environments for effective treatment.
Research Report Poster Display PARTICIPANTS: 13 healthy adults (7 males, 6 females)participated.
13-10 Tuesday 5 June 09:00 The age range was 23.7 ±4.0 years old and the height range
VCEC Exhibit Hall B & C was 165.1 ±8.9 cm. METHODS: On the frontal plane, participants
INFLUENCE OF VARIOUS METHODS OF DESCENDING STAIRS spread their legs widely and stood on a force plate. Each foot
ON LOWER EXTREMITY JOINT ANGLES AND MOMENTS was on a different force plate. The obstacle was between the
legs. Participants brought their right leg closer to their left leg. The
Hasegawa M, Shimatani K, Kanai S, Shimizu M, Oki S, Otsuka A;
reverse side step was performed with and without their finger tip
Department of Physical Therapy,Prefectural University of Hiroshima
touching an object which was made to move synchronizing with the
PURPOSE: The purpose of this study was to examine what influence movement of the finger tip. Right heel displacement was recorded
different methods of descending stairs has on the lower extremity by 3-D movement analyzing apparatus, vertical (Fz) and lateral (Fy)
peak force were measured by using force plate and the movement temporal parameters. ANALYSIS: Reaching time, joint excursion
time was calculated from the data of the force plate and the 3- and muscle onset latency were calculated. Thereafter, comparison
D movement analyzing apparatus. Measurements were made 12 between conditions in each group was performed using the 95%
times, with touch and non-touch measurements being taken 6 times confident interval of the mean value of these outcomes at natural
each, according to repeated measures ANOVA. ANALYSIS: The speed. It was decided that important changes in the fast speed
purpose of the analysis was to examine the difference between condition occurred when at least 50% of the individual values fell
the touch and non-touch responses; a two (touch/non-touch) by outside this interval. A similar analysis was done to compare group
thirteen (subjects) analysis of variance (ANOVA) was conducted with performance in each condition using the healthy group as reference.
following data; the peak force of Fz and Fy of the right foot at RESULTS: In both conditions, the healthy subjects reached the target
the beginning of the task, the time from the start to the right heel in less time than the subjects with SI (mean differences: 76ms at fast
reaching its maximum height during the step over an obstacle (phase- speed; 100ms at natural speed). When comparing the two speeds,
A), the variability of phase-A between trials within each subjects, healthy subjects had larger wrist and elbow flexion and delayed
and the variability of the average speed of the right heel from recruitment of the middle deltoid during fast reaching compared to
the right heel off to contact between trials within each subjects. the natural speed condition. In the SI group, the same kinematics
The above variability characteristics were analyzed since it was adaptations occurred with speed in addition to an increase of trunk
determined that these characteristics can accurately demonstrate the rotation and an earlier recruitment of lower trapezius during fast
consistency of the movement trials. RESULTS: When participants reaching. When comparing the two groups in the natural speed
touched the object, Fz and Fy of the right leg were smaller than condition, the SI group had larger trunk and cervical rotation and
the non-touch responses (F(1,128) = 26.72, p < 0.01). Phase-A was sternoclavicular protraction and less elbow flexion compared to the
extended by touch (F(1,128) = 11.87, p < 0.01). The variability of phase- healthy group. In the fast speed condition, the same differences in
A (F(1,128) = 10.56, p < 0.01) and the average speed of the right heel kinematics took place. Moreover, upper and middle trapezius and
moving (F(1,128) = 8.58, p = 0.01) were reduced with touch compared anterior and middle deltoid were recruited earlier in the SI group.
to non-touch responses. CONCLUSIONS: From start to right heel CONCLUSIONS: Motor strategies used during fast reaching differed
reaching maximum height, movement got slowly and smoothly with from the ones used at natural speed in both populations. Subjects
touch. The consistency between repeated trials was improved by with SI had more involvement of trunk, neck and sternoclavicular
touch. It may be considered that light touch could make movement joints during reaching at both speeds and important changes were
trials to be consistent. IMPLICATIONS: The results suggest that light found in muscle activation timing at fast speed. IMPLICATIONS:
touch which cannot support the body may not only stabilize static Reaching speed should be considered when comparing motor
standing but also influence the stability and consistency of dynamic strategies between populations and over time. More changes in motor
performance. According to this hypothesis, light touch may be used to strategies were found in the fast speed condition suggesting the
learn or reacquire movement and to assess the ability of movement. importance of using such a demanding task to highlight the upper
KEYWORDS: Light touch, reverse side step, consistency. FUNDING limb impairment. KEYWORDS: Shoulder impingement syndrome;
ACKNOWLEDGEMENTS: This research was done for part of the Motor control; Kinematics. FUNDING ACKNOWLEDGEMENTS: The
author’s Master’s thesis at the Ibaraki Prefectural University of Health study was funded by a grant from the Ordre professionnel de la
Science. CONTACT: [email protected] physiothérapie du Québec. Jean-Sébastien Roy was supported by
ETHICS COMMITTEE: The Ibaraki Prefectural University of Health scholarships from the Institut de Recherche en Santé et Sécurité du
Science Ethics Committee approved the protocol and participants travail and the Fonds de recherche en Santé du Québec. CONTACT:
gave their informed consent. [email protected]
ETHICS COMMITTEE: Ethics Committee of the Quebec Rehabilita-
tion Institute (comité d’éthique de la recherche de l’IRDPQ)
THE EFFECT OF REACHING SPEED ON THE UPPER LIMB 14-22 Tuesday 5 June 09:00
MOTOR STRATEGIES IN PERSONS WITH AND WITHOUT VCEC Exhibit Hall B & C
SHOULDER IMPINGEMENT SYNDROME INFLUENCE OF SCAPULAR POSITION ON THE PRESSURE
Roy J1 , Moffet H1,2 , McFadyen B1,2 ; 1 Center for Interdisciplinary PAIN THRESHOLD OF THE UPPER TRAPEZIUS MUSCLE
Research in Rehabilitation and Social Integration; 2 Department Azevedo D1 , Pires T1 , Andrade F1 , McDonnell M2 ; 1 Department of
of Rehabilitation, Faculty of Medicine, Laval University Physical Therapy, Catholic University of Minas Gerais – PUC-Minas,
Belo Horizonte, MG, Brazil; 2 Program in Physical Therapy,
PURPOSE: Repetitive arm movements performed in elevation during
Washington University School of Medicine, St Louis, MO, USA
daily activities have been identified as a risk factor for shoulder
impingement (SI) syndrome. The biomechanical demand of these PURPOSE: Impairments in scapular alignment may contribute to
activities most likely varies with the speed of movement as in excessive stress on cervicoscapular muscles, resulting in pain
other human movements. The aims of the study are to characterize complaints. The hypothesis of this study was that a position of
the motor strategies during a reaching task at natural and fast scapular depression would maintain the upper trapezius (UT) in a
speeds in healthy persons and to compare their performances lengthened position, increasing stress on this muscle. Thus, people
to persons with SI. RELEVANCE: A better understanding of the with non-ideal alignment of scapular depression may have lower
impact of speed on reaching will help to identify variables that can pressure pain threshold (PPT) levels in the UT when compared to
be used to assess performances. PARTICIPANTS: Eight healthy subjects with normal scapular position. The purpose of this study
subjects (mean age 45.9 years) and eight subjects with SI (mean was to assess the influence of scapular position on the PPT of the
age 46.8 years) were recruited. Subjects with SI were selected UT in a young healthy population. RELEVANCE: Some physical
using standardized criteria. METHODS: Participants took part in therapy strategies for treatment and prevention of musculoskeletal
one evaluation session. In a seated position, they performed ten disorders are based on the relationship between posture and pain.
reaching movements toward a target located around 90º of elevation The knowledge of this relationship could support those strategies.
in the frontal plane at two speeds: natural and as fast as possible. PARTICIPANTS: 52 physical therapy students (mean age 22.0±1.2
The kinematics of the shoulder, elbow, wrist, sternoclavicular joint, years) of Catholic University of Minas Gerais-PUC-Minas, Brazil,
neck and trunk were evaluated using the Optotrak system. Muscle participated in this study. After a shoulder posture assessment
activation of seven shoulder muscles was recorded as well as using skin surface landmarks, subjects were allocated in one of
two groups: depressed scapular position (DS, n=26, 6 men and 20 times. ANALYSIS: The score of perceived function at discharge,
women), when the superior angle of the scapula and the acromion 6 weeks following discharge and immediately after performance
were below the spinal process of the second thoracic vertebra of the two tasks were compared. The scores for the two tasks
or normal scapular position (NS, n=26, 6 men and 20 women), were summed to give a total score of difficulty. The statistical
when the superior angle of the scapula and acromion were on analysis involved non parametric analysis (Freidman ANOVA) with
the same level or above the second thoracic vertebra. Previous planned contrasts thereafter. The significance level was set at 0.05.
research has demonstrated that skin surface landmarks are valid RESULTS: At discharge the mean score (/8) for perception of
reference points for determining the location of the scapula and function was 5.8/8. At six weeks following discharge the mean score
thoracic spine. All subjects signed a consent form to participate in was not significantly different (mean: 5.6/8), however, perception of
this study. This study was approved by the Ethics Committee of PUC- function increased significantly after performance of the two physical
Minas. METHODS: An electronic pressure algometer (J Tech Medical tasks (mean: 7.3/8). CONCLUSIONS: This study demonstrated that
Industries – USA) was used to measure the PPT of the UT. The performing functional tasks has benefit in providing patients’ with a
examiner marked the middle point of the UT (midway of a straight line greater perception of their function. Relying on perceived outcome
from spinal process of the second thoracic vertebra to acromion) on measurements as the only guide to evaluating a patient’s function
the dominant shoulder. The shoulders and neck of the subject were is likely to provide less accurate information concerning functional
than covered by a cloth with a gap which allowed the examiner to ability. IMPLICATIONS: This finding indicates that clinicians should
see only the marked point. A second examiner, blinded to the groups, reevaluate their discharge criteria particularly in relation to using
assessed the PPT on the marked point. The PPT was defined by outcome measurements. Functional tasks should be identified and
the subject when the sensation of pressure changed to pain. The performed physically prior to discharge to ensure that patients have
PPT measurement has demonstrated good intra-rater reliability in a better appreciation of their level of function. KEYWORDS: Outcome
a previous study (ICC=.86, p < 0.05) ANALYSIS: An independent T measurements, Patient Functional Ratings, Ankle sprains. FUNDING
test was used to compare PPT mean values between both groups. ACKNOWLEDGEMENTS: New Zealand Society of Physiotherapists
A 0.05 significance level was set. RESULTS: There was a significant Scholarship. CONTACT: [email protected]
difference on PPT mean values between groups. The DS group ETHICS COMMITTEE: This study was approved by the Auckland
(19.0±9.0 N/cm2) demonstrated lower values when compared to Ethics Committee on 24th February 2005 Reference number
NS group (26.1±9.6 N/cm2, p < 0.01). CONCLUSIONS: Our results AKY/04/12/344
demonstrated that healthy young subjects with a depressed scapular
position had significant lower UT PPT values when compared to
subjects with normal scapular position. Longitudinal studies are
necessary to assess the relationship between scapular alignment, 16-06 Tuesday 5 June 09:00
pain and pathology. IMPLICATIONS: Physical therapy strategies VCEC Exhibit Hall B & C
should focus on maintaining an ideal scapular posture to avoid THE BURDEN OF WAITING FOR KNEE REPLACEMENT
UT chronic strain. KEYWORDS: scapula, pain, posture. FUNDING SURGERY: A PRELIMINARY CROSS-SECTIONAL ANALYSIS OF
ACKNOWLEDGEMENTS: This study was unfunded. CONTACT: A PROSPECTIVE COHORT IN QUEBEC
[email protected] Desmeules F1 , Dionne C1,2 , Belzile É3 , Lauzier S1 ,
ETHICS COMMITTEE: Ethics Committee of Catholic University of Bourbonnais R2,4 , Abdous B1,5 , Frémont P2,3 , Grégoire J1,6 ,
Minas Gerais – PUC-Minas Maunsell E1,5 ; 1 Population Health Research Unit, Research Centre
of the Laval University Affiliated Hospital, Quebec, Qc, Canada;
2 Department of Rehabilitation, Faculty of Medicine, Laval University,
16-02 Tuesday 5 June 09:00 Quebec, Qc, Canada; 3 Laval University Hospital (CHUQ), Quebec,
VCEC Exhibit Hall B & C Qc, Canada; 4 Community Health Care Center (CSSS) de la
Vieille Capitale, Quebec, Qc, Canada; 5 Department of Social and
CHANGE IN PATIENT PERCEPTION OF FUNCTION AFTER Preventive Medicine, Faculty of Medicine, Laval University, Quebec,
PHYSICAL PERFORMANCE Qc, Canada; 6 Faculty of Pharmacy, Laval University, Quebec, Qc,
Larmer P1 , McNair P, Smythe L, Williams M; 1 Auckland University Canada
of Technology
PURPOSE: To measure pain, function and health related quality of
PURPOSE: To investigate the difference between patient’s perceived life (HRQoL) in patients waiting for knee replacement surgery and
level of function prior to and after actually performing tasks identified to identify demographic, clinical, socioeconomic and psychosocial
as being of difficulty after discharge from treatment for an ankle characteristics associated with these outcomes. RELEVANCE:
sprain. RELEVANCE: Physiotherapists use outcome measurements Waiting time for knee replacement surgery is an important problem
as a way of interpreting the patient’s health status and functional in the Canadian health care system. Preoperative function has been
ability. It is apparent that scores from perceived measures of function shown to predict postoperative function in knee replacement patients.
(eg: questionnaires) may not match actual performance levels Identification of factors associated with worse pain, function and
attained during physical tasks. Hence there is a need to investigate HRQoL while waiting for surgery could help target patients in need of
the concordance of these measures to ensure that both patients rehabilitation before surgery. PARTICIPANTS: From February to July
and therapists have similar perception levels during treatment and 2006, 66 subjects (18 men and 48 women) aged >40 years, newly
at discharge from treatment. PARTICIPANTS: Thirty two patients scheduled for primary total knee replacement, were recruited from
who had suffered an acute sprained ankle and had been treated the waiting lists of three large hospitals in Quebec City, Canada.
at private physiotherapy clinics. The mean age of participants was METHODS: Pain and function were measured with the Western
31.7 yrs and 50 percent of the participants were male. METHODS: Ontario and McMaster Arthritis Index (WOMAC) and HRQoL with the
Patients completed the Lower Limb Task Questionnaire (30 physical SF-36 Health Survey. Independent variables included demographic
tasks rated from 0-4, with 4 equalling “no difficulty” through to 0 characteristics (age, sex, marital status, living situation), clinical
rating as “unable to perform”) on three occasions: on discharge characteristics (body mass index – BMI, duration of symptoms, pain
from physiotherapy treatment, at six weeks following discharge in the contra-lateral knee, use of a walking aid), socioeconomic
when the patients presented at the Physical Rehabilitation Research characteristics (educational level, employment status, household
Centre for testing and then immediately following the testing of two income) and psychosocial characteristics (psychological distress,
tasks identified by the patient as being important and of notable social support). ANALYSIS: 95% confidence intervals (95% CI) were
difficulty. The patient performed the identified functional tasks three built around the mean WOMAC function score to compare the
subjects’ functional status to the Patient Acceptable Symptom State were performed three times for each subject and the average was
(PASS) using student t-test. PASS is the value below which patients recorded. ANALYSIS: Time-related changes of the detected angle
can consider their function as good (<31.0 on the WOMAC function were analyzed whether joint position sense on rotational movement
score). Means and 95% CIs of the SF-36 physical (PCS) and was deteriorated, and how late the impairment remains if it existed.
mental (MCS) component scales were compared to Canadian age- The data obtained from measurements during 4 weeks, and patient
matched normative data using t-tests. Stepwise multiple regression profile was analyzed using One-factor ANOVA. The Tukey-Kramer
analysis was used to assess the strength of the associations method was used for the post hoc test. All statistical analyses were
between the independent variables and the WOMAC and SF-36 performed using SPSS software. RESULTS: A significant shift to
scores. Age and sex were controlled for in all models. RESULTS: the internally rotated position was observed between the first 1
The mean WOMAC function score was significantly higher (worse) to 2 weeks and the next 3 to 4 weeks (p < 0.01~p < 0.05). There
[50.1; 95% CI: 47.0-54.0] than the PASS [31.0; 95% CI: 29.4- was no significant relation between the detected angle and either
32.9]. The mean PCS score was significantly lower (worse) [30.9; their age or amount of leg lengthening. These results may suggest
95% CI: 28.5-33.3] than the mean for the Canadian age-matched that intensive care should be taken for early dislocation especially
population [47.2; 95% CI: 46.8-47.6]. Higher BMI and the use of during 2 weeks postoperatively. CONCLUSIONS: The results from
a walking aid were significantly associated with worse function the present time course study on 108 patients suggested that hip
(p < 0.05) and explained 23% of the variance of the WOMAC function joint position sense of rotation after THA was deteriorated at 1
score (r2 =0.23). Female gender and higher BMI were significantly to 2 weeks but restored largely at 3 to 4 weeks postoperatively.
associated with worse physical health (p < 0.05) and explained 13% Postoperative dislocation of THA is one of the most disabling
of the variance of the PCS scale (r2 =0.13). Contra-lateral knee pain complications requiring emergency care. Many causative factors
and the use of a walking aid were associated with worse mental were suggested to be associated with dislocation. However, a lack of
health (p < 0.05) and explained 23% of the variance of the MCS proprioception as a causative factor for this complication especially
(r2 =0.23). CONCLUSIONS: Patients entering waiting lists for knee during the immediate postoperative period has rarely been reported.
replacement surgery have very poor function and HRQoL, especially Little information is available regarding proprioception of the hip joint
women, those who use a walking aid, those with a high BMI, and following THA. Based on previous cadaver dissections, there is little
those who have pain in the contra-lateral knee. IMPLICATIONS: doubt that the sensory innovation to the hip joint is disrupted during
Rehabilitation interventions before surgery should target individuals the surgical approach although the form and extent of re-innervation
with the characteristics that were found to be associated with following THA is not clarified. In view of these findings, intensive
poor function and HRQoL to reduce the burden of patients waiting care to prevent dislocation is recommended especially during the
for knee replacement surgery. Such interventions could potentially first 1 to 2 weeks. IMPLICATIONS: This study hopefully will help
have a positive impact on postoperative outcomes. KEYWORDS: facilitate sysytematic efforts to reduce the incidence of disloca-
Knee replacement surgery, waiting times, rehabilitation. FUNDING tion. KEYWORDS: THA,dislocation,joint position sense. FUNDING
ACKNOWLEDGEMENTS: F. Desmeules is supported by a training ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
fellowship from the Canadian Institutes of Health Research (CIHR). ETHICS COMMITTEE: Ethic committee of Kobe university
CE Dionne is a Quebec Health Research Fund (FRSQ) scholar.
ETHICS COMMITTEE: Laval University Medical Centre ethics
committees (SFA- HDQ-CHUL) 17-14 Tuesday 5 June 09:00
RELATIONSHIP BETWEEN ACCELERATION OF ABNORMAL
LATERAL KNEE MOTION AND ELECTROMYOGRAPHY OF
16-10 Tuesday 5 June 09:00 THE QUADRICEPS MUSCLES IN PATIENTS WITH KNEE
VCEC Exhibit Hall B & C OSTEOARTHRITIS
DETERIORATION OF POSITION SENSE AT THA HIP JOINT Nishigami T1 , Enoki H1 , Nakao S1 , Nomura T2 , Akutagawa T1 ,
FOLLOWING TOTAL HIP ARTHROPLASTY Ishida K1 , Tani T1 ; 1 Dept. of Physical Medicine and Rehabilitation,
Nakagawa N1 , Sakamoto R1 , Kano K2 , Tagomori K3 , Masuhara K4 , Kochi Medical School Hospital; 2 Dept. of Physical Therapy,School
Shimada T5 ; 1 Department of Physiotherapy, Kansai Medical of Comprehensive Rehabilitation,Osaka Prefecture,University
College; 2 Department of Medical Rehabilitation, Suita Municipal
PURPOSE: Lateral thrust of the knee on weight-bearing is frequently
Hospital; 3 Department of Medical Rehabilitation, Ryokufukai
seen in patients with medial compartmental osteoarthritis (OA) of
Hospital; 4 Department of Orthopedics, Osaka Kouseinenkin
the knee while walking. Lateral thrust may be considered a principal
Hospital; 5 Department of Physiotherapy, Kobe University
contributor to OA progression. Although patients with OA of the
PURPOSE: The purpose of this study was to clarify the effects knee often received quadriceps training, no improvement in the
of total hip arthroplasty(THA) on joint position sense at the hip. lateral thrust was observed. The purpose of this study was to
RELEVANCE: This study was conducted to make a customized characterize the acceleration of abnormal lateral knee motion and to
guide for risk management after THA. PARTICIPANTS: The 108 examine the relationship between lateral thrust and electromyography
subjects were not informed of the purpose or the results of the (EMG) of the vastus medialis (VM) and vastus lateralis (VL) muscles
present study. The age of the subject was 60.5 years old. The while level walking. RELEVANCE: If lateral thrust is not correlate
operation manner was unified to the posterolateral approach by with the EMG date of quadriceps muscles, we have to consider
which posterior joint capsule is entirely removed. For all subjects, other exercise to improve lateral thrust. PARTICIPANTS: Eight
the acetabular and femoral components were fixed without bone subjects with symptomatic knee OA (OA groups), eight asymptomatic
cement. The prosthesis used in the operation was the Spongiosa age-matched controls (elderly controls), and seven young controls
Metal II Hip Prosthesis (ESKA, Lubeck, Germany). METHODS: The participated in this study. The ordinal scale of Kellgren and Lawrence
test of joint position sense was performed by a method assessing (0–4) was used to determine OA status Three patients showed
whether or not the subjects detected the neutral position of hip grade 1; one, grade 2; three, grade 3; and one, grade 4 in the
rotation in passive movement. Each subject was tested weekly from index knee. METHODS: The acceleration and EMG measurement
the 1st to 4th week after surgery. The passive rotation movement were obtained during level walking. Three axis accelerometers were
was performed externally from an internally rotated position of 20º at placed on the skin over the caput fibulae and malleous lateralis. The
the speed of 2º/sec, and the angle detected to be the neutral position peak value of acceleration, the time by reaching the peak value of
of the hip rotation by the subject was recorded. The measurements it (peak time), and mean power frequency (MPF) were measured.
The EMG was recorded using bipolar surface electrodes placed on assessed using Spearman’s rank correlation and stepwise multiple
the VM and VL muscles. The inter-electrode distance was 20 mm. linear regression analyses, respectively. Statistical significance was
The signals from each muscle were sampled at a frequency of 1000 defined as P < 0.05. RESULTS: There were significant correlations
Hz. The onset of the EMG, the offset of the EMG, integrated EMG between JKOM and VAS of symptomatic side(R= 0.70), OA grade(R=
(IEMG) from the onset of the EMG to heel contact (On–HC), and 0.44), flexion ROM of symptomatic side(R=-0.41), flexion ROM of
IEMG from heel contact to the offset (On–Off) of the EMG were asymptomatic side(R=-0.38), quadriceps strength of symptomatic
measured. IEMG was normalized by IEMG of isometric maximal side(R=-0.45), quadriceps strength of asymptomatic side(R=-0.37),
voluntary contraction (%IEMG) ANALYSIS: Data from each group FTA of symptomatic side(R=0.32). By stepwise multiple linear
were compared with other groups for significance using Tukey’s regression analysis, VAS of symptomatic side (b = −0.55), quadri-
post hoc test for multiple comparisons. Pearson’s correlation was ceps strength of symptomatic side (b = −0.33) and FTA (b = 0.25)
used to examine the relationship between the acceleration and were determinants of the JKOM (R2 =0.58). In performance-related
the EMG date. The significant level of p < 0.05 was used for each outcome, there were significant correlations between gait speed
analysis. RESULTS: OA groups had a significantly short peak and VAS of symptomatic side(R=-0.31), quadriceps strength of
time of lateral acceleration in comparison with the age-matched symptomatic side(R=0.50), quadriceps strength of asymptomatic
controls. Further, the MPF of lateral acceleration for the OA groups side(R=0.32). By stepwise multiple linear regression analysis,
was significantly less than that of the young controls. The peak quadriceps strength of symptomatic side(b = 0.32) and VAS of symp-
time and MPF of lateral acceleration were not correlated with the tomatic side(b = −0.26) were determinants of the habitual gait speed
EMG date. CONCLUSIONS: Lateral acceleration parameter of the (R2 =0.20). CONCLUSIONS: There were differences of determinants
knee showed no significant correlation with the EMG date. These between self-reported and performance-related outcome in Japanese
results suggest that the lateral thrust of the knee did not improve people with knee OA. Self-reported outcome was more influenced
despite quadriceps training. IMPLICATIONS: We have to consider by the amount of pain. On the other hand, performance-related
other exercise to improve lateral thrust. KEYWORDS: osteoarthri- outcome was more influenced by quadriceps strength than pain, but
tis;walking;lateral thrust. FUNDING ACKNOWLEDGEMENTS: This these factors were not sufficient to predict the performance-related
work was supported with Matsushita Electric Works,Ltd. CONTACT: outcome. IMPLICATIONS: Strategies to improve self-reported and
[email protected] performance-based outcomes in people with knee OA should include
ETHICS COMMITTEE: The ethics committee of Kochi University strengthening and pain control. But these interventions would not
be sufficient, and other factors should be assessed such as
psychosocial variables. KEYWORDS: knee, osteoarthritis, outcome
measure. FUNDING ACKNOWLEDGEMENTS: N.A. CONTACT:
17-18 Tuesday 5 June 09:00 [email protected]
VCEC Exhibit Hall B & C ETHICS COMMITTEE: The ethics committee of Kitasato University
DETERMINANTS OF SELF-REPORTED AND PERFORMANCE- Hospital
RELATED OUTCOMES IN JAPANESE PEOPLE WITH KNEE
OSTEOARTHRITIS
Kamiya K1 , Obara S1 , Watanabe H2 , Suda K1 , Hamasaki N1 ,
Hentona T1 , Aikawa J3 , Fujita M3 , Urabe K3 , Itoman M3 ;
1 Rehabilitation Center, Kitasato University Hospital; 2 Department of VCEC Exhibit Hall B & C
Rehabilitation, School of Allied Health Sciences, Kitasato University; SIMPLE HOME-BASED STANDING BALANCE TRAINING AND
3 Department of Orthopaedic Surgery, Kitasato University School ISOMETRIC KNEE EXTENSION EXERCISE IMPROVE FUNC-
of Medicine TIONAL ABILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS
Chaipinyo K, Karoontrupjareoun O; Division of Physical
PURPOSE: The Japan Knee Osteoarthritis Measure (JKOM) is
Therapy, Faculty of Health Sciences, Srinakharinwirot University,
a self-reported outcome for patients with knee osteoarthritis (OA)
Nakhon-nayok, 26120 Thailand
developed to reflect a Japanese cultural background. Performance-
based measures and self-reported measures are complementary, PURPOSE: To examine the effects of 4 weeks home-based simple
but do not measure the same construct. The purpose of this study standing balance training and isometric knee extension exercise on
was to assess the difference of determinants between self-reported functional ability and knee muscle strength of patients with knee
and performance-based outcome in Japanese people with knee OA. osteoarthritis (OA). RELEVANCE: Exercise is crucial for patients
RELEVANCE: Understanding the extent to which each of clinical with knee OA. Goals of exercise are functional ability and muscle
factors plays a role in determining each outcome is important for strength. However, adherence to home-based exercise program
the development of effective interventions. PARTICIPANTS: The is a major problem. Simple and effective home-based program
participants were 95 subjects (81 women and 14 men, mean age 64.7 prescribed by physical therapist is required to encourage patients
±7.8 yrs, body mass index 24.1 ±3.9 kg/m2 ) with symptomatic and to continue exercise. PARTICIPANTS: 42 community volunteers
radiographic knee OA who participate in the Kitasato Knee classroom with knee OA according to the criteria of the American College of
in 2004 and 2005. METHODS: The self-reported outcome was Rheumatology (ACR) were randomly assigned to 2 groups: Group
evaluated using the JKOM consisting of 25 items questionnaire. The 1 Standing balance training with mini squat (n= 24; age 61.9±5.9)
JKOM are scored on a 5-point scale with lower scores representing and Group 2 Isometric knee extension training as control (n= 18; age
greater levels of each subscales, and can vary from 25 to 100. It 70.3±6.1). METHODS: Randomized controlled trial. Two groups of
was reported that the JKOM has sufficient reliability and validity. patients performed 1 of 2 home-based exercise programs for both
The performance-related outcome was evaluated using habitual gait sides, 5 days/week. Group 1 included stepping forward, backward,
speed defined as the comfortable walking speed. In addition to the sideward, and mini squat 30 times/day/side. Group 2 was isometric
these outcomes, degree of pain evaluated on a 100 mm visual knee extension exercise in sitting 30 times/day/side.Isokinetic knee
analogue scale (VAS), quadriceps strength, range of motion of the flexor and extensor strength were examined. Measurements of time
knee, radiographic grade (OA grade) and femorotibial angle (FTA) required for walking 50 feet, rising from chair and walk 50 feet,
evaluated in a standing radiograph were also evaluated. The quadri- stairs ascent, and stairs descent were made. Self-reported functional
ceps strength was measured by using a hand-held dynamometer ability with Knee Osteoarthritis Outcome Scores (KOOS) was used
that was fixed to a rigid bar. The quadriceps strength was analyzed to measure pain, other symptoms related to knee OA, function
and expressed as the ratio to body weight. ANALYSIS: Correlations in daily living, function in sport and recreation, and knee related
between JKOM, habitual gait speed and clinical characteristics were quality of life. Patients were tested at baseline and after 4 weeks
training. ANALYSIS: Paired t-test was used to compare the baseline 12-55; s.d. 8); mean HOOS 62 (range 38-170;s.d. 27)and mean
to after 4 weeks training. Independent t-test was used to compare UCLA was 6.6 (range 2-9; s.d. 1.6. 16% of patients reported
the different between 2 groups. RESULTS: Group 1 significant some continuing functional difficulties. These were predominantly
improvements were isokinetic knee flexor strength, walking time, in putting on/ taking off shoes and socks, bending to pick things
stair descent time, pain, other symptoms, and function in daily up from the floor, squatting and running. All could climb stairs.
living (p < 0.05). Group 2 significant improvements were rising from 63% could walk an unlimited distance but 6% were limited to
chair and walk time, stairs ascent and descent times, pain, other <500metres. 87% were satisfied with their HRA and 13% unsatisfied,
symptoms, function in daily living, function in sport and recreation, 80% still reported some pain in the operated hip. Ninety patients
and knee related quality of life (p < 0.05. Knee extensor strength (86%) experienced no complications, 15 others (14%) reported
showed no significant changes after 4 weeks in both group. No bleeding (6 cases), superficial wound infection (3), dislocation (1),
significant different was found when compared Group 1 to Group fracture (1) nerve injury (1) other (3). CONCLUSIONS: Whilst most
2 on isokinetic knee muscle strength, walking time, rising from patients achieved a good functional result from their HRA operation
chair and walk time, stairs ascent time, pain, other symptoms, and were very satisfied, for a significant percentage of patients
function in daily living, and function in sport and recreation. Improving joint mobility and selected functional activities remain a problem
in stair descent time and quality of life was significantly higher one year after surgery. IMPLICATIONS: The review of over a
in Group 2 than Group 1 (p < 0.05). CONCLUSIONS: This study 100 patients suggests that the current strategies for rehabilitating
showed effectiveness of 4 weeks home-based simple standing patients after hip resurfacing arthroplasty are producing suboptimal
balance training and isometric knee extension exercise on pain, results. It is suggested that a revised protocol is needed that
other symptoms related to OA knee, and function in daily living. takes into consideration the higher functional expectations of this
However, these exercise programs were not sufficient for increasing younger hip replacement population. The rehabilitation protocol also
knee muscle strength. Further study adding resistance exercise but needs to address the differing threats of the resurfacing prosthesis
still keep the program simple would benefit patients who have muscle to minimise rehabilitation associated complications. KEYWORDS:
weakness. IMPLICATIONS: Simple standing balance with mini squat hip resurfacing arthroplasty, rehabilitation, outcome. FUNDING
training or isometric knee extension exercise can be used as a simple ACKNOWLEDGEMENTS: Supported by a NOC Hip Walk project
home-based exercise for patients with early stage knee OA where grant. CONTACT: [email protected]
pain and functional ability are major problems and knee muscle ETHICS COMMITTEE: Oxford LREC
weakness is a minor problem. KEYWORDS: Knee, osteoarthritis,
exercise, functional ability. FUNDING ACKNOWLEDGEMENTS: This
project was supported by Srinakharinwirot University Research Fund.
CONTACT: [email protected] 19-10 Tuesday 5 June 09:00
ETHICS COMMITTEE: Faculty of Health Sciences, Srinakharinwirot VCEC Exhibit Hall B & C
University Human Reseach Ethics Comittee EFFECTS OF JOINT TRACTION OF UPPER LIMB ON SOLEUS
H-REFLEX IN MAN
Research Report Poster Display Koyama T1 , Yanagisawa K2 , Aizawa J3 ; 1 Department of Physical
19-06 Tuesday 5 June 09:00 Therapy, Surugadai Nihon University Hospital, Tokyo, Japan;
2 Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo,
Japan; 3 Department of Rehabilitation, Tokyo Medical and Dental
HIP RESURFACING AT ONE YEAR POST SURGERY – DO University Hospital, Tokyo, Japan
PATIENTS HAVE GOOD FUNCTIONAL RECOVERY AND ARE
THEY SATISFIED? PURPOSE: Joint traction is used to increase range of motion and
muscle strength, or to reduce joint pain in physical therapy. Traction
Barker K1 ,
Newman M1 ,
Jenkins C1 ,
Reilly K1 ,
Pandit H2 ,
Beard D2 ;
1 Physiotherapy also acts as a stretch stimulus by elongating the muscles. It is not
Research Unit, Nuffield Orthopaedic Centre NHS
certain what influence the traction of the upper limb facilitates on
Trust, Oxford, UK; 2 Nuffield Department of Orthopaedic Surgery,
the motoneuron of the lower limb. The purpose of this study is to
University of Oxford, Oxford, UK
examine the effects of joint traction of upper limb on soleus H-reflex.
PURPOSE: The purpose of this study was to evaluate functional RELEVANCE: This study relates to the physiological evidence base
status at one-year post surgery in a group of patients and to identify of physical therapy. PARTICIPANTS: Sixteen healthy male subjects
outstanding rehabilitation needs. RELEVANCE: Currently there is no who had no orthopedic or neurological disease, ranging in age from
concensus about the most appropriate method to rehabilitate patients 20 to 28 years, participated in this study. This study was approved
following hip resurfacing arthroplasty (HRA). Most are rehabilitated by the Ethics Board of Tokyo Metropolitan University, and written
following a protocol for total hip arthroplasty. Assessment of any informed consent was obtained from all subjects before testing.
limitation in functional recovery at one year is important to determine METHODS: In supine position, the subjects were passively kept at
whether rehabilitation protocols need to be modified for this group upper limb neutral position and the combined position that was 30º
of patients. PARTICIPANTS: 125 consecutive patients receiving extended, 20º abducted, 70º internal rotated position of the shoulder
a Conserve resurfacing arthroplasty at one orthopaedic hospital. respectively, and their upper limb was pulled distally by a pulley.
METHODS: Patients were reviewed one year post surgery. All Traction force was set to four kinds of loads (no-load, 3kg, 6kg and
patients completed three validated questionnaires the Oxford Hip 9kg). The combined position was used as one of the starting positions
Score (OHS), the Hip Osteoarthritis Outcome Score (HOOS) and of motion patterns in proprioceptive neuromuscular facilitation (PNF)
the UCLA activity score. Data on range of motion and strength was approach. Derivation of soleus H-reflex was performed to record to
collected by clinical examination together with timed performance electromyography (NEUROPACK II+, Nihon Kohden inc, Japan) using
tests of walking, balance and sit to stand. ANALYSIS: Data was surface electrodes with trancecutaneus stimulation to tibial nerve.
summarised and scores for individual questionnaire items calculated. Stimulus intensity was set to 1.12 fold of H-reflex threshold. Single-
Any differences between the operated and control limb were explored square wave, 1 msec pulses, 1 Hz were delivered by a stimulator.
using student t-tests. RESULTS: Patients ranged in age from 24– Averaging of 32 pulses was measured as H-reflex amplitudes (peak
76 years, mean 56 years. 40% were female and 60% male. At to peak) at each testing position. ANALYSIS: A two-factor (two upper
one year there were significant decreases in the range of motion limb positions × four kinds of traction force) with repeated measure
of the operated limb compared to the control limb for abduction ANOVA was used to identify significant effects. All data analyses were
(p < 0.001); extension (p < 0.001) and flexion (p < 0.001). 11% had performed using SPSS for windows 13.0 (SPSS Inc, Chicago). Level
a positive Trendelenburg sign. The mean OHS was 17.5 (range of statistical significance was set at the 0.05 alpha level. RESULTS:
The traction of upper limb significantly increased the amplitude of IMPLICATIONS: Attention should be directed toward that motor
the soleus H-reflex. There were no significant differences between behavior may be task specific and vary with presence or absence
the two positions, and no interaction between positions and traction of pain. KEYWORDS: motor behavior, EMG, knee. FUNDING
forces. Multiple comparisons showed that traction of 6kg and 9kg ACKNOWLEDGEMENTS: Funding: Trygg Hansa’s Research Foun-
significantly increased H-reflex amplitudes compared with no-load. dation, Kempe Memorial Foundation, and The Swedish Research
CONCLUSIONS: This finding suggests that the traction of upper Council (no. 220-3-302). Acknowledgements: Technical assistance:
limb might influence the excitability of soleus motoneuron, and Helena Grip, Biomedical Engineering & Informatics, Norrland’s Uni-
that the more traction force is increased, the more the excitability versity, Umeå, Sweden. CONTACT: [email protected]
enhanced. IMPLICATIONS: This result may be the physiological ETHICS COMMITTEE: Umeå University Medical Faculty Research
base that can be applied to facilitation approach to the lower limb. Ethics Committee, Umeå Sweden. (§245/01, dnr 01-166)
KEYWORDS: joint traction, motoneuron, soleus H-reflex. FUNDING
ACKNOWLEDGEMENTS: None.
ETHICS COMMITTEE: the Ethics Board of Tokyo Metropolitan
University 21-02 Tuesday 5 June 09:00
EVALUATION OF AN ARTHRITIS SELF-MANAGEMENT
PROGRAM: IMPACT ON LIVING
VCEC Exhibit Hall B & C Chan A1,2 , Heck C2,3 , McCullough C1,2 ; 1 Baycrest Centre for
Geriatric Care, Toronto, Canada; 2 University of Toronto, Toronto,
QUADRICEPS EMG IN OPEN AND CLOSED KINETIC CHAIN IN Canada; 3 University Health Network, Toronto, Canada
WOMEN WITH PATELLOFEMORAL PAIN
PURPOSE: To evaluate the impact of an arthritis self-management
Stensdotter A1 , Hodges P, Öhberg F, Häger-Ross C; 1 Department
program on managing pain, goal setting abilities, activities of daily
of Community Medicine and Rehabilitation, Physiotherapy, Umeå
living (ADL) and health status of participants. RELEVANCE: Lorig
University, Umeå Sweden
(2001) reported that a self-management program is effective in
PURPOSE: The aim of this study was to determine whether quadri- long-term improvement in the health status in people with chronic
ceps control is altered (i.e. decreased activity and delayed onset diseases. Developing self-efficacy is a key self-management strategy.
of vastus medialis obliquus (VMO)) in persons with patellofemoral Literature informed us that participating in self-management program
pain (PFP), if this occurs in both open (OKC) and closed (CKC) results in gaining control and positively influencing health status and
kinetic chain tasks when executed similarly, and if this can explain the future health behaviours. Baycrest’s Program for Arthritis Control
discrepancies in the literature regarding observed changes in quadri- through Education and Exercise (PACEEx) is an evidence-based
ceps coordination in PFP. RELEVANCE: PFP may be associated with self-management program for community dwelling individuals with
a decreased activity and a delayed onset of electromyographic activ- arthritis. This 10-week program (20 sessions) includes non-didactic
ity of VMO relative to the lateral part of the quadriceps muscle. How- education, exercise in warm water and a comprehensive educational
ever, there has been considerable debate regarding the presence of resource package. Participants and caregivers engage in interactive,
such changes in coordination. This may be explained by differences experiential discussions, problem solving and personal goal setting.
in the experimental task, such as whether the task is performed in a A physical therapist coordinates and co-facilitates this program.
functional or non-functional manner, and with respect to biomechan- PARTICIPANTS: Data collected from all participants of PACEEx
ical parameters, for instance whether the task is performed in OKC from 1998 to 2005. METHODS: Data was collected at two time
or CKC. In general, functional tasks have been performed in CKC, periods: admission (T1) and discharge (T2) using the following
whereas many studies have investigated nonfunctional OKC tasks. outcomes measures: Health Assessment Questionnaire (HAQ),
Changes in quadriceps muscle function in PFP have most commonly Program for Rheumatic Independent Self-Management (PRISM) and
been identified in CKC functional tasks. No studies have directly com- Goal Attainment Scaling (GAS). Group data on admission (T1) and
pared quadriceps activation between CKC and OKC tasks in PFP. In discharge (T2) for the outcome measures studied were analyzed.
order to understand the efficacy of physiotherapy interventions it is ANALYSIS: Descriptive statistics were used to characterize the
critical to understand the underlying mechanisms. PARTICIPANTS: demographic profile of the subjects. T-tests were performed to
Seventeen females with PFP without pain at the time of testing determine changes in outcomes over time using SPSS software.
(age 27.7±6.6 years) and 17 healthy controls (age 26.0±4.6 years) RESULTS: Between 1998 and 2005, 23 PACEEx programs with a
participated. METHODS: They performed isometric quadriceps con- total of 327 participants completed the program. The participants
tractions in a reaction-time task in OKC and CKC with matching joint were on average 69.9±12.2 years (range from 27 to 92) and had
angles. Only the resulting force vector was manipulated by moving been living with arthritis for 14.1±13.3 years (range from 1 to
the application of resistance. Surface electromyographic activity 74). The following significant changes were noted between T1 and
(EMG) was recorded from the four heads of quadriceps. ANALYSIS: T2: HAQ, pain scores from 1.8±0.8 to 1.5±0.8 (p = 0.00), health
Onset of EMG activity was determined by a computer algorithm status from 41.9±82.1 to 21.9±97.2 (p= 0.00), Alternate Disability
which served as a guide for manual inspection and correction. Data Index reflecting activities of daily living from 1.1±0.7 to 0.9±0.6
was presented to the examiner without reference to muscle or order (p = 0.00), PRISM self-efficacy for managing pain from 65.1±29.6 to
of repetition. Peak root mean square (RMS) EMG amplitude was 73.5±35.9. As measured by GAS, 97% of participants’ goals were
averaged for each subject over each series of trials and normalized. met or exceeded. CONCLUSIONS: The current study with a larger
Statistical analyses were performed using a repeated-measures- sample size confirms previous findings (pilot study, 1995; goal review,
ANOVA with 1 repeated measure (kinetic chain) and 2 independent 2005) that participation in PACEEx resulted in statistically significant
factors (group and muscle). RESULTS: PFP subjects had slower re- improvements in participants’ ratings of health status, reduction in
action time in both CKC and OKC, and activated quadriceps relatively pain, improvement in performing activities of daily living, improved
more in CKC than OKC, but did not differ from controls in relative confidence in managing pain and setting goals. A review of goal
coordination of the different quadriceps heads. CONCLUSIONS: attainment showed high levels of goal achievement (97%). This study
Differences between people with PFP and healthy controls showed provides evidence that Baycrest’s PACEEx is successful in supporting
task specific changes in motor behavior. As there was no difference participants to gain self-management skills, positively influencing
in relative coordination of the quadriceps muscles in the PFP group health status and future health behaviours. IMPLICATIONS: The
the present study suggests that differences between OKC and CKC chronic disease self-management approach demonstrates a shift
are unlikely to explain the discrepancies between previous studies. from provider based health care delivery to a learning partnership
model. The health professional acts as a facilitator as participants Research Report Poster Display
undergo a knowledge transfer and behaviour change process. This 22-10 Tuesday 5 June 09:00
approach meets the self-directed information and skill acquisition VCEC Exhibit Hall B & C
needs of current health care users, contributes to a cost effective THE EFFECT OF AEROBIC EXERCISE ON FATIGUE AND
model of health care delivery and has been shown to reduce QUALITY OF LIFE IN MULTIPLE SCLEROSIS
emergency room visits (Lorig 2001). KEYWORDS: Arthritis; Self-
management; health status. FUNDING ACKNOWLEDGEMENTS: Sayers K1 , Baer G2 , Salisbury L3 ; 1 School of Physiotherapy, Royal
Unfunded work. CONTACT: [email protected] College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin
2, Republic of Ireland; 2 School of Physiotherapy, Queen Margaret
University College, Duke St, Leith, Edinburgh, EH6 8HF, Scotland,
Research Report Poster Display United Kingdom; 3 School of Health and Social Science, University
21-06 Tuesday 5 June 09:00 of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG,
VCEC Exhibit Hall B & C Scotland, United Kingdom
EARLY RANGE OF MOTION AFTER SHOULDER PROSTHESIS: PURPOSE: The purpose of this pilot study was to investigate the
FRACTURE VERSUS ARTHRITIS effect of a 6-week aerobic exercise programme on fatigue and quality
Faessler D1 , Rocourt M2 ; 1 Orthopedic Physiotherapy; of life in a Multiple Sclerosis population. A secondary aim of the study
2 Physiotherapy Research, University of Berne, Inselspital, 3010
was to investigate the correlation between the two chosen fatigue
Berne, Switzerland measures. RELEVANCE: Fatigue is one of the most commonly
PURPOSE: The aim of this retrospective study was to analyse the reported and disabling symptoms of MS (Smith et al, 2005). The
range of motion of the operated shoulders at discharge, 6 and 12 beneficial use of exercise therapy in MS is well documented (Rietberg
weeks after prosthesis for fracture versus arthritis in order to give the et al, 2004). Effects of aerobic exercise on fatigue and how best this
surgeon and physiotherapist an indication of “normal” progress in fatigue is measured remain unclear. People with MS report a lower
mobility. RELEVANCE: One of the main goals of rehabilitation after quality of life than people with other chronic illnesses (Rudick et
shoulder prosthesis is regaining maximum ROM. Motion exercises al, 1992, Hermann et al, 1996). Aerobic exercise appears to have
are started at the first postoperative day in order to reduce the risk a beneficial effect on quality of life (Petajan et al,1996, Mostert
of postoperative shoulder stiffness. There is, however, a concern and Kesselring 2002). The type and amount of exercise required
regarding subscapularis failure after shoulder prosthesis for arthritis in order to glean benefit, however, requires further exploration.
or tuberosity migration and malunion after fracture prosthesis. PARTICIPANTS: 10 ambulatory MS subjects (Expanded Disability
PARTICIPANTS: We have analysed the postoperative course of Status Scale EDSS 0-6) participated in the study. Subjects meeting
98 persons with shoulder prosthesis between 1995 and 2005. 16 inclusion criteria were identified from the MS database and were sent
Persons with early complications such as tuberosity migration or sub- an advertisement and advised to contact the researcher if interested.
scapularis failure were excluded. A total of 82 persons were divided METHODS: Subjects were randomly allocated to intervention or
into two groups. Group 1(G1): 30 persons(11 men, 19 women, mean control group. The intervention group attended a 6-week, circuit-
age 67 ±13 years) treated with a hemi prosthesis for a complex frac- based, aerobic exercise class and undertook independent home
ture of the proximal humerus. Group 2 (G2): 52 persons (14 men, 38 exercise sessions. The control group attended 6 MS related
women, mean age 67 ±13 years) treated with a hemi or a total shoul- information sessions over the same period. Patient perceived fatigue
der prosthesis for primary or secondary osteoarthritis or rheumatoid was measured pre and post intervention by the Fatigue Severity
arthritis. METHODS: The rehabilitation followed two different proto- Scale (FSS) and Modified Fatigue Impact Scale (MFIS). Quality Of
cols for the first 6 weeks: group 1 was allowed passive elevation to Life was evaluated using the Multiple Sclerosis Scale-29 (MSIS-
90º and passive external rotation up to 20º. For group 2 full range of 29). ANALYSIS: Differences pre and post intervention between the
assistive active elevation and active external rotation up to 20º less two groups were assessed using descriptive statistics (Microsoft
than the opposite side was allowed. Active resistance against the M. Excel) and Mann Whitney U Test (SPSS). Spearman’s rank order
subscapularis was not allowed. After 6 weeks active motion exercises correlation coefficient was used to investigate the relationship
were encouraged. Passive global elevation in the scapular plane and between the two chosen fatigue measures. RESULTS: Mann Whitney
passive glenohumeral external rotation were measured at discharge, U tests show there were no statistically significant differences
6 and 12 weeks after surgery. ANALYSIS: Descriptive statistics and in scores between the groups following the intervention period
differences within samples (Friedman-test; post-hoc Wilcoxon) and
for FSS (p = 0.264), MFIS (p = 0.074) or MSIS-29 (p = 0.402). The
between groups (Mann-Whitney-U-test) were computed using SPSS.
FSS and MFIS scales were poorly correlated with Spearman’s
RESULTS: For both groups a significant increase in passive elevation
rank order correlation co-efficient of 0.489. Descriptive statistics
from discharge to 6 and 12 weeks (p < 0.001)was seen. There was
showed tendancies towards improvement in fatigue, as measured
no significant difference between the two groups at discharge (G1:
by the FSS, but the opposite pattern when measured by the MFIS.
85º 1; G2: 90º, p = 0.266), but after 6 weeks (G1: 95º, G2: 110º,
Quality of life in the intervention group remained largely unchanged
p = 0.019) and 12 weeks (G1: 110º, G2: 120º, p = 0.001). There was
also a significant increase in external rotation for both groups from whereas it deteriorated slightly in the control group. The psychological
discharge to 6 and 12 weeks (p < 0.001). Groups did not differ at subscale of MSIS-29, showed a tendancy towards improvement in
discharge (G1: 10º, G2: 0º, p = 0.294) and after 6 weeks (G1: 10º, G2: both groups. CONCLUSIONS: Results suggest the FSS and MFIS
15º, p= 0.087), but after 12 weeks they differed significantly (G1: 15º, may be measuring different aspects of fatigue. The high levels
G2: 30º, p= 0.001). CONCLUSIONS: Both groups have significant of fatigue and significant impact of MS on QOL in this sample,
increases in range of motion for elevation and external rotation from suggests a longer intervention period may be necessary in order to
discharge to 6 and 12 weeks, but the course between the groups gain significant benefits from aerobic exercise. IMPLICATIONS: The
differ significantly. The arthritis group seems to progress faster in addition of quantitative physical activity measures and measurement
elevation at 6 and 12 weeks, and in external rotation mainly at 12 of concurrent changes in aerobic fitness would give further weight
weeks. IMPLICATIONS: Our results give the physiotherapists an idea to these preliminary research findings. Replication of the trial with
of normal progress in passive mobility after shoulder prosthesis for larger sample size and longer intervention period is recommended
fracture versus arthritis without causing damage to the tuberosities or to further investigate changes and to determine the most valid and
M. Subscapularis. KEYWORDS: Prosthesis, fracture versus arthritis, sensitive measure of patient perceived fatigue in exercise trials.
outcome. FUNDING ACKNOWLEDGEMENTS: none. CONTACT: KEYWORDS: Aerobic Exercise Fatigue Quality of Life. FUNDING
[email protected] ACKNOWLEDGEMENTS: This research was undertaken as part
fulfillment of an MSc Physiotherapy and was unfunded. CONTACT: Research Report Poster Display
[email protected] 22-18 Tuesday 5 June 09:00
ETHICS COMMITTEE: Queen Margaret University College, Edin- VCEC Exhibit Hall B & C
burgh, Scotland; Cork Teaching Hospitals, University College Cork, EFFECTS OF GROUP EXERCISE TRAINING ON PATIENTS
Republic of Ireland WITH MULTIPLE SCLEROSIS
Mutluay F, Caglar A, Siva A; Neurology Department, Cerrahpasa
Research Report Poster Display School of Medicine, Istanbul University, Turkey
22-14 Tuesday 5 June 09:00 PURPOSE: Group training may be considered an alternative to
VCEC Exhibit Hall B & C individual multiple sclerosis (MS) rehabilitation. This study investi-
RAPIE COGNITIVE SCREENING IN MULTIPLE SCLEROSIS AC- gates the effectiveness of group exercise sessions on the disability,
COMPLISHED BY THE FREE RECALL AND RECOGNITION TEST impairment and quality of life of MS patients. RELEVANCE: The
Claesson I1 , Ytterberg C2 , Johansson S2 , Almkvist O3 , efficiency of group exercises in physical therapy sessions for MS
von Koch L2 ; 1 Department of Physical Therapy, Karolinska patients has not yet been investigated and may be of considerable
University Hospital, Stockholm, Sweden; 2 Department of Clinical interest to neurological rehabilitation practice. PARTICIPANTS: 28
Neuroscience, Karolinska Institutet, Karolinska University Hospital, MS patients (mean age 41.7±9.1 years) with an average Expanded
Stockholm, Sweden; 3 Neruotec Department, Karolinska Institutet, Disability Status Scale (EDSS) score of 5.2±1.3 were included
Stockholm, Sweden to the study. METHODS: This study was designed as a before-
after trial. One-hour exercise classes with groups of four patients
PURPOSE: This study sought to investigate the feasibility of the Free of a similar disability level were trained by a physiotherapist once
Recall and Recognition Test (FRRT) as a practical screening tool per week for six weeks. Individual baseline measures of disability
for cognitive impairment in multiple sclerosis (MS). RELEVANCE: and impairment were recorded, including functional independence
Detailed assessment of cognitive function is generally not routinely measurement (FIM), fatigue severity scale, total muscle strength,
performed in MS, since using a battery of neuropsychological tests is perceived exertion level (Borg), and 10m and 20m walking times.
time-consuming and requires expert skills. Yet, rehabilitation outcome Quality of life was assessed using the MSQOL-54 survey. Individual
is negatively affected by cognitive impairment, and therefore, should assessments were repeated after the training period. ANALYSIS:
be taken into account. Thus, work is ongoing to find a screening Student’s paired-t and Wilcoxon signed rank tests were used to
tool for cognitive impairment in MS, for use in clinics by personnel test difference hypothesis. Analysis of variance (ANOVA) on inter-
with proper training and knowledge in neuropsychological testing. group post-training variations was used to detect group differentiation
This tool should be rapid and easily administered, have good in training effects. RESULTS: 15 patients in four groups complied
reliability, validity and sensitivity for different severities of MS, and fully with the training schedule. Highly significant increases (p < 0.01)
be accepted by the patients. PARTICIPANTS: Persons with MS were recorded for the FIM motor section (+9.5%), and 10m and
(n=227), outpatients at the Neurological Department in Karolinska 20m walking speeds (+15%), while significant (p < 0.05) progress
University Hospital. METHODS: Persons with MS were consecutively was observed for total muscle strength (+5.0%), Borg (−9.6%)
recruited and assessed with four cognitive tests; FRRT, Symbol and MSQOL-54 physical health composite (+10.3%) scores. The
Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test improvements observed were statistically equal for all groups,
(PASAT), and the Mini-Mental State Examination (MMSE). Disease which were at significantly different neurological status (EDSS)
severity was assessed by the Expanded Disability Status Scale levels. CONCLUSIONS: Group exercise training can reduce motor
(EDSS)and grouped into mild, moderate and severe MS. ANALYSIS: impairments, increase mobility and improve the quality of life of
The Spearman Rank Correlation Coefficient was used. One-way MS patients of various disability levels. IMPLICATIONS: Group
analysis of variance with Scheffe’s post-hoc was used to assess training can replace cost-effectively individual training especially
differences in cognitive performance between the EDSS groups. for less disabled MS patients. KEYWORDS: Multiple sclerosis,
Sensitivity, specificity and optimum cut-offs for the FRRT were exercise classes, impairement, disability, quality of life. FUNDING
calculated using Receiver Operator Curves. Statistical analyses were ACKNOWLEDGEMENTS: No special funding has been received for
conducted using SPSS 13.0. RESULTS: The FRRT, which was this work. CONTACT: [email protected]
completed by 99% of the cohort in approximately 5 minutes per
assessment, correlated significantly with the other cognitive tests,
as well as with the disease severity rating. A cut-off of 4 for the Research Report Poster Display
FRRT recall rendered 90% sensitivity and 25% specificity, and a cut- 24-02 Tuesday 5 June 09:00
off of 4.2 for the FRRT recognition resulted in 70% sensitivity and VCEC Exhibit Hall B & C
51% specificity. CONCLUSIONS: We conclude that the FRRT proved EFFECT OF CONSTRAINT INDUCED MOVEMENT THERAPY ON
feasible as a practical screening tool for cognitive impairment in MS HEALTH RELATED QUALITY OF LIFE
within a clinical setting. IMPLICATIONS: Rehabilitation personnel
with proper training and knowledge in neuropsychology may use the Davis S1 , Chiu Y2 , Richards L3 , Fritz S4 ; 1 Brain Rehabilitation
FRRT as a simple and rapid screening tool for cognitive impairment Research Center, NF/SG VA, Gainesville, FL, USA; 2 Department
in MS. The result of the FRRT might serve as an indicator of when of Physical Therapy, University of Florida, Gainesville, FL, USA;
3 Department of Occupational Therapy, University of Florida,
special concern is appropriate and when a more detailed cognitive
assessment is necessary. KEYWORDS: assessment; cognition; Gainesville, FL, USA; 4 Department of Exercise Science, University
multiple sclerosis; neuropsychological tests; validity. FUNDING of South Carolina, Columbia, SC, USA
ACKNOWLEDGEMENTS: This study was supported by grants from PURPOSE: The purpose of this study was to examine long term
the Swedish Research Council, Karolinska University Hospital, and effects of Constraint Induced Movement Therapy (CIMT) paired
The Swedish Association of Persons with Neurological Disabilities. with Donepezil or Transcranial Magnetic Stimulation (r-TMS) on
CONTACT: [email protected] health related quality of life (HRQOL) in individuals with chronic
ETHICS COMMITTEE: The ethical committee att Karolinska stroke. RELEVANCE: The efficacy of CIMT on motor function has
University Hospital been widely studied. However, its influence on HRQOL has not
been extensively explored. The Stroke Impact Scale (SIS) is one
standardized measure of HRQOL that can address the perspectives
of patients post-stroke in multiple domains. PARTICIPANTS: In two
independent studies, twenty-nine participants with chronic stroke
were randomly assigned into the following groups: Donepezil (N= 9; bearing was estimated using Bertec forceplate. Bergs Balance Scale
age range: 23-75 years; mean age: 60.8 years; 6M/3F; 4R/5L hemi- measuring postural control during functioning and five-meter walk test
side), Placebo (N= 7; age range: 32-80 years; mean age: 57 years; (5mWT) was measured with three trials. ANALYSIS: Spearman’s
3M/4F; 2R/5L), r-TMS (N= 9; age range: 54-78 years; mean age: rho assessed the degree of agreement between COP and BBS,
68.4 years; 5M/4F; 6R/3L), and Sham r-TMS (N=4;age range: 55-72 between COP and 5mWT and between BBS and 5mWT. RESULTS:
years; mean age: 65.5 years; 2M/2F; 4L). METHODS: Participants The correlation between COP and BBS showed no correlation when
in the Donepezil study received placebo or Donepezil 5 mg/day tested and when re-tested there was moderate correlation with –
for 2 weeks increasing to 10 mg/day for 4 weeks. After the first 2 0.51 with p < 0.1. There was no correlation between COP and
weeks of drug/placebo administration, CIMT was provided in the lab 5mWT. Spearmann’s rho between BBS and 5mWT was 0.85 and
6 hrs/day for 10 days. For the r-TMS study, participants received 0.58 with p > 0.05. CONCLUSIONS: This study show no correlation
30 minutes/day of r-TMS/sham with 1 hour of CIMT in the lab and between symmetrical weight bearing during comfortable stance and
5 hours of home practice for 10 days. The SIS total and physical postural control in functioning. There is no relationships between
domain (PD) scores (i.e. Strength, ADL, Mobility and Hand Function) improving symmetrical weight bearing and functioning. This results
were used to measure HRQOL. ANALYSIS: Multivariate analyses on supports other studies concluding no relationships when assessing
the change scores (pre – 6 months) were used to analyze changes relationships between symmetrical weight bearing and other tests
in total SIS and PD scores of SIS. The initial Fugl-Meyer upper measuring functioning despite the small number of participants.
extremity (FMUE) motor scores and the Geriatric Depression Scale Future studies might investigate if there is relationship between
(GDS) were covariates. Significance level was set at 0.05. RESULTS: patients symmetrical weight bearing assessed dynamically and BBS
Statistically significant differences for the total SIS score were found and a walk test. IMPLICATIONS: The conclusions of the study imply
between pre- CIMT and the 6th month post [F(1,23) = 10.15; p < 0.05]. that training the patients ability to symmetrical weight bearing in
The PD scores did not show significant differences from pre-CIMT to stance don’t improve the patients postural control in functioning. It
6th month post [F(1,23) = 0.153; p > 0.05]. There were no significant is still o good thing to improve the symmetrical weight bearing during
group effects in the total SIS [F(3,23) = 0.34; p > 0.05] and PD scores stance if it is the need of the patient. KEYWORDS: correlation,
[F(3,23) = 0.206; p > 0.05]. Furthermore, there were no interactions apoplexia, symmetrical weight bearing, BBS, 5mWT. FUNDING
between SIS scores and FMUE or GDS. However, there was a ACKNOWLEDGEMENTS: The work was unfunded. CONTACT:
positive linear relationship between the initial FMUE scores and SIS [email protected]
scores (F = 11.81; P < 0.01). CONCLUSIONS: CIMT demonstrated ETHICS COMMITTEE: The work was awarded by Den videnska-
long term overall improvements in HRQOL. This study showed belige komite for Århus Amt at the 13/7 2005. Denmark
that the adjuvant therapies did not enhance scores on the SIS.
CIMT may be a promising treatment for improving quality of life in
individuals with chronic stroke. IMPLICATIONS: Therapists may be
contributing to HRQOL in the rehabilitation process and yet rarely 25-18 Tuesday 5 June 09:00
measure this outcome. Although qualitative research is an expanding VCEC Exhibit Hall B & C
aspect of rehabilitation, adding HRQOL assessments may enhance NURSING STAFF’S ATTITUDE AND REPORTED BEHAVIOR
current quantitative studies. Making a difference functionally with long IN PATIENT TRANSFER – AN EDUCATIONAL INTERVENTION
term quality of life changes may contribute significantly to stroke WITH CONTROL GROUP
rehabilitation. KEYWORDS: constraint induced movement therapy, Kindblom-Rising K1 , Wahlström R2 , Nilsson-Wikmar L1 , Buer N3 ;
quality of life, stroke. FUNDING ACKNOWLEDGEMENTS: This was 1 Dept. of Neurobiology, Caring Sciences and Society, Div. of
funded by the Brain Rehabilitation Research Center of the NF/SG Physiotherapy, Karolinska Institutet, Stockholm, Sweden; 2 IHCAR,
Veterans Affairs and VA RR & D. CONTACT: [email protected] Dept. of Public Health Sciences, Karolinska Institutet, Stockholm,
ETHICS COMMITTEE: Institutional Review Board Sweden; 3 Dept. of Health Sciences, Örebro University, Örebro,
Sweden
PURPOSE: To explore and describe nursing staff’s attitudes and
24-06 Tuesday 5 June 09:00 reported behavior before and after an educational intervention in
VCEC Exhibit Hall B & C patient transfer (course in Natural Mobility). RELEVANCE: Decrease
STANDING AND POSTURAL CONTROL IN PERSONS WITH nursing staff’s musculoskeletal strain and promote patients to move
HEMIPLEGIA independently. PARTICIPANTS: Ninety nine nursing staff in an
intervention group and twenty seven in a control group voluntary
Dall L; JCVU- Center of Higher Education, Jutland, Denmark
participated. Their age ranged between 24-64 in the intervention
PURPOSE: Rehabilitation after acut apoplexia often focus on ability group and 21-61 in the control group. The average time of work in
of symmetrical weight bearing in standing balance as well as postural health care was 25 years in the intervention group and 17 years
control during functioning. The objective of this study were to in the control group. Both the intervention group and the control
determine the correlation between the patients symmetrical weight group answered a questionnaire before and one year after the
bearing, postural control during daily activities and a walk test. intervention. METHODS: A purposely developed questionnaire was
This in order to determine if improving symmetrical weight bearing used, based on the results from a previous study, collaboration with
might cause a better postural control during functional activities. experienced health care staff and relevant literature. A modified
RELEVANCE: This study assesses the relevance of training Delphi procedure was used for content validity and a test re-test for
symmetrical weight bearing in standing balance in order to improve reliability. There were both closed and open-ended questions. The
functional activities. PARTICIPANTS: 12 subjects experiencing their items were related to ability, body and movement awareness and
first unilateral stroke with mean age of 59 years (range 32-73). communication. Natural Mobility is an educational course in patient
The subjects were included if they were able to stand alone in transfer to facilitate nursing staff’s learning process through self-
20 sec., walk with or without a cane under close supervision and experience. The aim is to promote patients to move independently,
able to understand and follow simple instructions. All subjects were inspired by the physiotherapist’s manner of supporting the patient
inpatients at a rehabilitation unit. METHODS: a prospective non- to move. The course is based on theories of movements, fear,
experimental cross sectional and longitudinal design. Test–retest communication and learning. Simple exercises and role changes are
within a month with three tests for balance were conducted. The used to increase understanding. The course lasted for two half days
weight bearing during comfortable stance was measured over three with two weeks interval. There were between 8-18 participants in
trials. Center of pressure (COP) representing symmetrical weight each course. ANALYSIS: Descriptive statistics was used to present
the distribution of outcome variables. A modified sign test has Scale (EMS) were assessed pre and post-intervention by a blinded
been used to evaluate significance within the intervention group assessor. ANALYSIS: Paired sample T-tests were used to examine
and compare confidence intervals between the intervention and the differences within and between groups. Significance level was set
control group. Open ended questions were analysed qualitatively. at p < 0.05. RESULTS: The experimental group showed a mean
RESULTS: The preliminary findings indicate that the issue assessed 22.6% decrease in Timed STS compared with 0.2% in control group.
as “the most important in patient transfer” before the intervention Within-group analysis for the experimental group showed a significant
was to “lift correctly”, one year later this changed significantly within increase in EMS scores pre and post-intervention (p = 0.017). Strong
the intervention group to “make the patient move independently”, trends of improvement within the experimental group were noted
or “to plan the transfer”. The control group was not significantly in all other outcomes (FAC p = 0.051, BERG p = 0.09, Timed STS
influenced. The questionnaire was significantly influenced to six other p = 0.17). The progression made by the experimental group was
questions “body awareness related to pain, fear related to movement, not shown to be significantly greater than that of the control group.
the use of one’s hands, activating the patient during patient transfer, When considering these results, the heterogenous population and
showing the patient with one’s body how to move independently and small sample must be acknowledged. Due to the clinical nature of
certainty in performing patient transfer”. There were no significantly this trial, several variables were not controlled between subjects,
changes between the groups. In the open questions the staff reported particularly that of chair height. CONCLUSIONS: Improvements
changes in their verbal instructions in the intervention group, this were demonstrated in STS success and function status. However,
was found only in a restricted number of persons in the control further investigation is warranted in the form of a larger, randomised,
group. CONCLUSIONS: It may be of important value to be aware controlled trial. A more sensitive measure of functional change such
of and understand nursing staff’s attitudes and reported behaviour as the Timed 10m Walk might also be considered. IMPLICATIONS:
when designing the structure and content of patient transfer training. This study would appear to support the use of STS repetitions as
IMPLICATIONS: To inspire physiotherapist’s in developing new a simple and effective means of achieving improved STS success
learning strategies in communicating their knowledge, by taking and function in clinical practice. KEYWORDS: Sit-to-Stand, training,
advantage of nursing staff’s recourses, attitudes and behavior in pa- function. FUNDING ACKNOWLEDGEMENTS: No funding received.
tient transfer. KEYWORDS: Education, body knowledge. FUNDING
ACKNOWLEDGEMENTS: FAS Swedish council for working life and
social research, box 2220, 103 15 Stockholm, Sweden; Research
and Development Centre, County Council, Sörmland, Eskilstuna, 27-02 Tuesday 5 June 09:00
Sweden. CONTACT: [email protected] VCEC Exhibit Hall B & C
ETHICS COMMITTEE: Research Committ’e Örebro University DEPRESSION, COGNITION, AND FUNCTIONAL STATUS IN
hospital, Örebro County Council, Örebro, Sweden Dnr 210/03; SARCOPENIC COMMUNITY-DWELLING ELDERLY IN TAIWAN
Regional Ethical Review board, Uppsla, Sweden Dnr 2004:M-250 Chien M1 , Huang T2 , Kuo H3 , Wu Y1 ; 1 School and Graduate
Institute of Physical Therapy, College of Medicine, National Taiwan
Research Report Poster Display University, Taipei, Taiwan; 2 Department of Radiology, Hoping
26-22 Tuesday 5 June 09:00 Branch, Taipei City Hospital, Taiwan; 3 Department of Internal
VCEC Exhibit Hall B & C Medicine, National Taiwan University Hospital, Taiwan
AN INVESTIGATION INTO THE INFLUENCE OF SIT-TO-STAND PURPOSE: To investigate the prevalence of sarcopenia in
REPETITIONS IN ACUTE REHABILITATION community-dwelling elderly in Taiwan and to compare the depression
scale, cognitive function, functional status, and quality of life
Flynn H; St. James’ Hospital, Dublin 8, Ireland
between elderly with sarcopenia and normal skeletal muscle mass.
PURPOSE: To examine the training effect of Sit-to-Stand (STS) RELEVANCE: Several studies have reported that sarcopenia was
repetitions as an adjunct to routine mobilisation on functional status significantly and independently associated with functional impairment
in an acute rehabilitation service. RELEVANCE: STS is a vital and disability among the elderly, but there has been no systematic
prerequisite to independent mobility. Difficulty with STS has been study in Taiwan. Such knowledge is essential for the development
linked with increased risk of falls in the elderly and is correlated of public health programs for community-dwelling elderly persons.
with the need for long-term care1. It has been proven that STS PARTICIPANTS: Five hundred and two participants aged 18 and
is more biomechanically demanding than gait or stair climbing, older (257 men and 245 women). METHODS: This study was
requiring greater moments of force at the hip and knee1. Carr & a cross-sectional investigation. The presence of sarcopenia was
Shepherd (2005) have argued the need for more task-specific examined in 302 community-dwellers aged above 65 years. Skeletal
practice in physiotherapy with focus on repetition. However, in acute muscle mass (SM) was estimated from bioelectric impedance
rehabilitation, the provision of supervised exercise programmes is analysis measurements. Subjects were considered as sarcopena if
often not possible due to heavy caseloads and time constraints. STS their skeletal muscle mass index (SMI=SM/height2) was less than
would appear to be a simple and effective strengthening exercise that 2 standard deviations below the mean for young healthy reference
could be easily administered at a patient’s bedside. PARTICIPANTS: values which were derived from 200 young adults aged 18-40
Two groups randomly allocated into a control group (n=4, mean age years. In addition to anthropometric measurements, the collected
83) or experimental group (n=4, mean age 86) from a convenience variables included: depression scale by Chinese version of the
sample of those referred for routine mobility physiotherapy. Subject Geriatric Depression Screening Scale, cognitive function by Mini
consent was obtained. Inclusion criteria: 1) Ability to follow simple Mental State Examination, functional status by Groningen Activity
instructions, 2) Ability to stand with at least maximal assistance of 2. Restriction Scale, quality of life by Short-Form-36 Health Survey
One subject from the control group was lost to follow-up. METHODS: questionnaire, and physical activity by 7-d recall questionnaire in
Each group underwent routine mobility practice as prescribed by the elderly with sarcopenia and normal muscle mass. This study
their physiotherapist. In addition, the experimental group carried was approved by the Human Research Ethic Committee of the
out 10 STS repetitions with appropriate supervision and cues. The National Taiwan University Hospital. ANALYSIS: Quantitative data
number of repetitions was increased as able and task- context & were analyzed using the Statistic Package for Social Science (SPSS
environment were varied where possible. Training continued for 4 for Windows release 11.0). Student t-test was used to examine the
weeks. Due to the clinical nature of this trail, variables such as chair differences of measured variables between sarcopenic and normal
height and use of upper limbs were not controlled between subjects. muscle mass group. The relationship between skeletal muscle mass
Outcomes measures: STS section of BERG balance scale, Timed and measured variables was examined using Pearson’s correlation
STS, Functional Ambulation Category (FAC) and Elderly Mobility coefficient test. RESULTS: The prevalence of sarcopenia was 18.5%
in women and 23.4% in men, which were not different from the figures (SD:48.6). Considerable floor or ceiling effects were observed in 4/9
observed in the western population. The functional limitation was PPT tests. The MTMM analysis identified those components of the
significantly higher only in men elderly with sarcopenia (p < 0.05). FFT and PPT-9 representing similar physical domains including: arm
Depression scale, cognitive function, and quality of life were not curl (FFT) with the chair stand (FFT) (r = 0.48); simulated eating (PPT-
statistically different between sarcopenic and normal muscle mass 9) with writing a sentence (PPT-9) (r = 0.64); 8 foot up and go (FFT)
groups in both genders (p > 0.05). SMI was correlated significantly with the 50 foot walk (PPT-9) (r = 0.81) and the chair stand (FFT) with
with body mass index and energy expenditure of daily physical activity time to climb stairs (PPT-9) (r = −0.43). Those components showing
in men (r= 0.633 and 0.410, respectively, p < 0.01) and women (r= 602 higher effect sizes following an exercise intervention included FFT
and 0.556, respectively, p < 0.01). In women, grip strength was also components (chair stand; 8 foot up and go and 6 minute walk
significantly correlated with skeletal muscle mass (r= 0.236, p < 0.05). test) and the PPT components (lift a book and time to climb
CONCLUSIONS: Sarcopenia exists among the elderly in Taiwan stairs). CONCLUSIONS: In this community dwelling population,
with the similar risk in white persons. Low skeletal muscle mass four of the PPT-9 components were more affected by floor/ceiling
in the elderly was significantly associated with low physical activity. effects than those of the FFT and a number of test components
IMPLICATIONS: These results suggest that intervention to target measure similar domains while others show good responsive to
increase in physical activity should be emphasis to prevent muscle change. IMPLICATIONS: Understanding psycho-metric properties
loss with aging. KEYWORDS: Aging; Sarcopenia; Skeletal muscle. of tests and identifying the physical domains represented by test
FUNDING ACKNOWLEDGEMENTS: This research was supported components is important information on which clinicians/researchers
by grants from the National Science Council (NSC 94-2314-B002- select tools and interpret findings. KEYWORDS: Functional Fit-
089). CONTACT: [email protected] ness Test; Physical Performance Test; Older adults. FUNDING
ETHICS COMMITTEE: This study was approved by the Human ACKNOWLEDGEMENTS: Canadian Institutes of Health Research,
Research Ethic Committee of the National Taiwan University Hospital. University of Saskatchewan, College of Medicine.
ETHICS COMMITTEE: University of Sasskatchewan, Canada
27-06 Tuesday 5 June 09:00 Research Report Poster Display
EXPLORING TWO PERFORMANCE-BASED TESTS IN THE VCEC Exhibit Hall B & C
EVALUATION OF COMMUNITY DWELLING OLDER ADULTS STANDING BALANCE IN UNEXPECTED STIMULATION:A
WITH OSTEOARTHRITIS COMPARISON BETWEEN SUBJECTS WITH AND WITHOUT
Harrison L1 , Sheppard M2 , Zachar K1 , Haab R1 , Fisher K1 , OCCLUSION
Chad K1 , Reeder B1 ; 1 University of Saskatchewan, Saskatoon, Hosoda M1 , Isozaki K1 , Takayanagi K2 , Hara K2 , Inoue K2 ,
Canada; 2 Saskatoon Health Region, Saskatoon, Canada Kubota A2 , Moriyama H2 , Matsuda T1 , Morita S3 ; 1 Department of
Physical Therapy, Ryotokuji University, Chiba, Japan; 2 Department
PURPOSE: To explore psycho-metric properties of the Functional
of Physical Therapy, Saitama Prefectural University, Saitama,
Fitness Test (FFT) and Physical Performance Test – 9 (PPT-9)
Japan; 3 Department of Rehabilitation Medicine, Tokyo Medical
when evaluating community dwelling older adults with osteoarthritis.
and Dental University Graduate School, Tokyo, Japan,
RELEVANCE: Clinicians require tools for a variety of purposes
including: describing/categorizing patient populations, defining health PURPOSE: In the present aging society, falls have become serious
service needs, monitoring change in conditions; determining progno- social issues. Falls may cause femoral neck fractures, often making
sis or predicting outcomes. Understanding measurement properties people bedridden through reduced motor performance and inability
assists clinicians and researchers to select the right tool for the to walk, and eventually may result in loss of independence in ADL. A
right patient at the right time and for the appropriate purpose. study evaluated degrees of influence of various risk factors of falls,
PARTICIPANTS: Community dwelling subjects, 50 years or older, and demonstrated that compromised balancing ability was one of the
with one of five chronic conditions were recruited through health most highly influential factors. RELEVANCE: Therefore, to prevent
professional referral or self-referral to an exercise intervention falls, it is important to examine factors affecting balancing ability.
program. Fifty-two subjects with osteoarthritis (77% with 1 or 2 Thus, we examined whether occlusion associated to improvement
joints affected); primarily female (15% male, 85% female); mean of motor performance, also contributed to improvement of balance.
age 62.5 years (SD: 7.6); most living in their own home (81%) If occlusion provides improvement of balancing ability, appropriate
participated. METHODS: Subjects were assessed at baseline and 3, occlusion and fitting of teeth and dentures in the elderly would
6, and 12 months after initiation of an exercise program. Evaluators be more significant factors related to falls. PARTICIPANTS: Thirty
carried out standardized protocols with subjects completing the 6 healthy adolescents (15 males and 15 females; mean age, 20.3 SD
tasks in the FFT (chair stand, arm curl, chair sit and reach, back 1.6 years) with no abnormal equilibrium and stomatognathic functions
scratch, 8-Foot Up, 6 minute walk test) and 9 tasks of the PPT were included. METHODS: Occlusion status was evaluated by mea-
(write a sentence, simulated eating, lift a book onto a shelf, put suring masseter activities using the EMG system. Balancing ability
on and remove a jacket, pick up a penny from the floor, standing was evaluated using the EquiTest system® which measures sway
turn 360 degrees, 50 foot walk test, stair climb, climb one flight of the center of gravity of the subject produced by rapid translation
stairs). Subjects completed self-report questionnaires including: the of forceplates as external disturbance. Latency from directly after
Medical Outcomes Study Short Form 12 (SF-12) and Physical application of the external disturbance to initiation of recovery was
Activity Scale for the Elderly (PASE). ANALYSIS: Parametric and calculated by measuring displacement of the center of foot pressure.
non-parametric descriptive analyses were performed. Correlation Data were compared according to occlusion statuses. ANALYSIS:
coefficients identifying similar (convergent) and dissimilar (divergent) Obtained latency data were analyzed using a three-way repeated
domains within and across the different instruments and variables measures ANOVA. A significance level of p < 0.05 was considered
(multi-trait multi-method analysis (MTMM) were examined. Effect statistically significant. The statistical software SPSS version 13.0
sizes were calculated to evaluate the discriminative properties of (SPSS Inc., Chicago, Illinois, USA) was used. RESULTS: Little
these tools. RESULTS: Subjects presented with lower SF-12 physical difference was observed in latency following a small disturbance,
component scores (mean: 43.5; SD: 8.6) and slightly higher SF- while changes toward completely opposite directions were observed
12 mental component scores (mean: 52.5; SD: 8.1) than norm- after larger disturbances between with and without occlusion. In
based population data (mean:50). Physical activity levels ranged other words, the greater the disturbance, the shorter the latency
considerably as demonstrated by a mean PASE score of 96.9 arose with occlusion, and the longer the latency occurred without
occlusion. A statistically significant interaction (p < 0.001) between Research Report Poster Display
occlusion and external disturbance was also found. CONCLUSIONS: 28-18 Tuesday 5 June 09:00
This study suggested that occlusion contributed to maintenance of VCEC Exhibit Hall B & C
postural balance and to improvement of stability when unexpected THE EFFECT OF COGNITIVE TASK ON THE TIMED UP & GO
sway was applied in the standing position. IMPLICATIONS: It is IN ORTHOPEDIC OUTPATIENTS WITH AND WITHOUT A FALL
considered that occlusion contributes to better balancing abilities. In HISTORY
the future, development of an effective exercise therapy to enhance Asai T1−3 , Maekawa T2,3 ; 1 Faculty of Rehabilitation, Kobegakuin
bite force, and validation of the effects using this method are required. university; 2 Graduate School of Health Science, Kobe University
KEYWORDS: balance, masseter muscle, postural control, latency, School of Medicine; 3 Kita orthopedic Clinic
falls. FUNDING ACKNOWLEDGEMENTS: We would like to express
our sincere gratitude to all the subjects who participated in this study. PURPOSE: Previous studies have shown that dual task paradigm
CONTACT: [email protected] is useful to assess a risk of falls. In this study, we examined the
ETHICS COMMITTEE: Tokyo Metropolitan University effect of a concurrent cognitive task on the Timed up & Go (Dual
task TUG) performance in orthopedic outpatients with and without
a fall history. RELEVANCE: Dual task-related changes in TUG may
Research Report Poster Display be useful to assess a risk of falls. PARTICIPANTS: 32 women in
orthopedic outpatients participated in this study. Nineteen with no
fall history (mean age=77.4 years) and 13 with a history of one
or more falls in the previous year (mean age=80 years). Cognitive
THE EFFECTIVENESS OF A SIMPLE EVALUATION APPROACH function was assessed by Mini Mental State Examination and all
TO FALLS RISK ASSESSMENT IN ELDERLY PEOPLE subjects scored 25 points or more. Subjects who required a cane
Ming H, Dongmei C, Sumikazu A, Hitoshi M; International University or other walking aids were excluded. METHODS: Time taken to
of Health and Welfare perform TUG (single task condition) and TUG with verbal backward
counting (dual task condition) was measured using a stop watch.
PURPOSE: In this study, It developed a trial tool which is portable,
ANALYSIS: The TUG times under single and dual task condition
easy to perform and useful for the evaluation of risk of fall, and were compared using paired t-test. Furthermore, group comparison
discuss the connection of probe reaction time (P-RT), and the gait was performed for the TUG time difference(Dual TUG – Single TUG)
rhythm with risk of fall when subjects walking by a self-determined by ANOVA. The significant level was set at p < 0.05. RESULTS:
velocity. RELEVANCE: Fall often occur during walking, especially There was a significant difference in the time taken to perform TUG
when getting up from a chair or floor. It is difficulty to assess all between single task condition and dual task condition(11.3 sec vs.
factors of the risk of fall. In this study, we thought that the evaluation 14.9 sec, t=7.608, p < 0.05). Fallers showed significantly longer TUG
of the gait cycle rhythm and the probe reaction time is effective time difference than non-fallers (4.87 sec vs. 2.67 sec, F=6.213,
to the detection of the fall risk when subjects walking by a self- p < 0.05). CONCLUSIONS: For both groups, a concurrent cognitive
determined velocity. PARTICIPANTS: The subjects were divided into task increased the time taken to complete the TUG, with the greatest
two groups including 34 older subjects are those who have not effect in the othopedic patients with a fall history. IMPLICATIONS:
experienced falls (Old no-fall group; 8 males, 26 females) and 18 Prospective studies are needed to determine whether dual task TUG
are those who have experienced falls (Old fall group; 3 males, 15 predicts falls in orthopedic outpatients clinics. KEYWORDS: Timed
females). The mean age, were 66.4±7.0years and 68.6±7.3years, up & go, Dual task, Fall. FUNDING ACKNOWLEDGEMENTS: None.
respectively. METHODS: The subjects were asked to walk at a self- CONTACT: [email protected]
determined rate on a floor. The task was to measure the simple
phonatory reaction time to an auditory stimulation. In the flow of the
signal in the experiment device, an auditory cue box was attached Research Report Poster Display
to an abdominal region of the subjects. The response signal is 29-22 Tuesday 5 June 09:00
recorded with a digital audio player/recorder hung on the subjects’ VCEC Exhibit Hall B & C
chest from the neck. Another play/recorder is attached from the THE PSYCHOMETRIC PROPERTIES OF EVALUATION OF
medial malleolus on a little, collected the landing sound of the foot to SENSORY PROCESSING FOR CHILDREN IN TAIWAN
measure time of one gait cycle. One minute after a subject started
walking, the probe reaction time and the time of one gait cycle started Su C1 , Lin K2 , Wu M3 , Yang A4 ; 1 Department of Occupational
to be was measured continuously for 10 times in total at a self- Therapy, College of Medicine, National Cheng Kung University,
determined rate. The evaluation of the gait cycle rhythm was adopted Tainan, Taiwan; 2 Departments of Physical Medicine and
the coefficient of variation (CV) of the time for one gait cycle. Data Rehabilitation, Veterans General Hospital – Kaohsiung, Kaohsiung,
was taken into the personal computer, and the DigionSound5 sound- Taiwan; 3 Department of Psychology, National Chung Cheng
processing software was used for the analysis. ANALYSIS: Analysis University, Chia-Yi, Taiwan; 4 Department of Physical Therapy,
College of Medicine, National Cheng Kung University, Tainan, Taiwan
of variance was used to test for statistically significant differences
among Old no-fall group and Old fall group. RESULTS: A one-way PURPOSE: This study aimed to examine the reliability and validity of
analysis of variance for probe reaction time showed a significant a sensory history questionnaire, the Chinese Version of Evaluation
effect between Old no-fall group, and Old fall group (F(1, 50)= 5.344, of Sensory Processing (ESP), Version 4, for use in Taiwan.
p < 0.05). Also, coefficient of variation (CV) of the time for one gait RELEVANCE: Children’s postural control, which has been empha-
cycle was calculated. Ono-way analysis of variance between groups sized in the pediatric physical therapy, is influenced by their abilities
and the time for one gait cycle showed a significant effect between of processing sensory inputs. Thus, an appropriate assessment of
groups (F (1, 50)= 13.72, p < 0.01). CONCLUSIONS: The coefficient children’s sensory processing would be important. PARTICIPANTS:
variation of the time for one gait cycle increased, and the probe Forty-eight children with sensory processing disorder (SPD) and
reaction time is extended of the Old fall group. IMPLICATIONS: It ninety typically developing children (control group) were recruited
was thus found that the probe reaction time and the coefficient of in the area of Tainan, Taiwan. The children of SPD group were
variation of the time for one gait cycle are reliable and useful for recognized and referred based on parent interview and clinical
evaluation of the risk of falls. KEYWORDS: Probe reaction time, falls, evaluation by experienced occupational therapists from the pediatric
gait. FUNDING ACKNOWLEDGEMENTS: The study is not funded. clinics. The children of control group were recognized through parent
CONTACT: [email protected] interview by an experienced occupational therapist in the field of
ETHICS COMMITTEE: SPTS(society of physical therapy science) pediatric therapy. There was no significant difference in ages between
the two groups (average of age for each group: 6 years 8 months). children 88.84±3.80; in condition 2, adults mean values were
The Ethics Committee of Medicine at National Cheng Kung University 92.65±3.35 and children were 85.73±5.45. In condition 4, adults
approved all procedures, and informed consent was obtained from showed mean values of 85.01±8.68 and children, 64.02±17.48.
all patients for their participation in this study. METHODS: Sample And in condition 5 adults present mean equilibrium value score
of convenience was adopted in data collection. All of their parents of 66.56±12.90 and children, 38.16±15.54 CONCLUSIONS: On
(father or mother of the child) were required to fill up the ESP, our sample, seven years – old Brazilian children showed lower
a questionnaire designed to identify sensory processing problems equilibrium scores than adults in all conditions. This justify that
in children from preschool to elementary school age. It consists a special attention must underlined all rehabilitation process and
of 76 items divided into six sensory system categories: tactile (21 the training of motor skills for each specific age. IMPLICATIONS:
items), proprioceptive (12 items), vestibular (15 items), auditory (10 For physical therapy practice / management KEYWORDS: balance,
items), gustatory/olfactory (5 items), and visual systems (13 items). children, posturography. FUNDING ACKNOWLEDGEMENTS: None.
ANALYSIS: Internal consistency of the items within each of the CONTACT: [email protected]
6 sensory systems in the ESP was examined by Cronbach’s a. ETHICS COMMITTEE: Ethics Committe Psychiatry Institute HCF-
The discriminative validity was investigated by the Mann-Whitney MUSP
U test. The receiver operating characteristic procedure was used
to identify the cut-off score between the two groups. RESULTS:
Our findings indicated good internal consistency of the items within
each of the 6 sensory systems in the ESP (Cronbach’s a=0.70– 30-06 Tuesday 5 June 09:00
0.89). The result of Mann-Whitney U test showed that 55 of the 76 VCEC Exhibit Hall B & C
items (75.3%) significantly distinguished between parent ratings of THE EFFECT OF INTENSIVE PHYSIOTHERAPY PROGRAM
children with and without SPD. The average total score of two groups FOLLOWING SELECTIVE DORSAL RHIZOTOMY FOR CHILDREN
were significantly different (t= 7.111, p = 0.000, two-tailed). By using WITH CEREBRAL PALSY
receiver operating characteristic procedure, we found that the ESP Chan N1 , Yam K2 , Chan S3 , Poon C3 , Yiu B3 , Leung M4 ;
score of 286 demonstrating 73% sensitivity and 82% specificity in 1 Physiotheraphy Department, Tuen Mun Hospital, Hospital Authority,
predicting children with SPD. CONCLUSIONS: This study supported Hong Kong; 2 Department of Neurosurgery, Tuen Mun Hospital,
the reliability and validity of ESP for use in Taiwan. Furthermore, the Hospital Authority, Hong Kong; 3 Child Assessment Service,
results might be useful in further revisions and refinement of the ESP. Department of Health, Hong Kong; 4 Physiotheraphy Department,
IMPLICATIONS: For physical therapists, the ESP could be used in AHNH, Hospital Authority, Hong Kong
screening children’s capacity of sensory processing, as well as the
evaluation of children’s progress of behavioral reactions to sensory PURPOSE: Children with Cerebral Palsy (CP) encounter different
inputs. KEYWORDS: sensory processing, validity and reliability degrees of motor disorder which affect by spasticity. Tone manage-
analysis, parent questionnaire. FUNDING ACKNOWLEDGEMENTS: ment with Selective Dorsal Rhizotomy (SDR) follows by intensive
This study was partly supported by the National Science Council physiotherapy training is an option for improving the physical function
(Grant #94-2314-B-006-032) in Taiwan. of them. Evidence showed that the procedure of SDR weakens
ETHICS COMMITTEE: The Ethics Committee of Medicine at the muscle and it needs almost one year to return to preoperative
National Cheng Kung University level (Steinbok et al. 1995). The purpose of the present study is to
evaluate the effect of the intensive physiotherapy program following
SDR for improving the function and gait pattern in the early 6
Research Report Poster Display months post-operation. RELEVANCE: The success of SDR is very
30-02 Tuesday 5 June 09:00 much depends on the intensity of training after the procedure. An
VCEC Exhibit Hall B & C intensive training program with emphasis on the body alignment
COMPUTERIZED DYNAMIC POSTUROGRAPHY IN SEVEN was introduced and this study will provide some references for post-
YEARS – OLD BRAZILIAN CHILDREN AND YOUNG ADULTS SDR training. PARTICIPANTS: Children with CP who matched with
the selection criteria were recruited in the SDR clinic. Screening
Sá C1,2 , Perrote R1 , Boffino C2 , Ramos R2 ; 1 IMES University;
2 São Paulo University was performed by the interdisciplinary team including neurosurgeon,
paediatrician and physiotherapist. 27 childrens with CP were enrolled
PURPOSE: This study was designed to verify how similar are in the SDR program. METHODS: A single group prospective study
postural and balance control between Brazilian seven years-old was adopted. Pre-operative baseline assessment was performed
children and young adults. RELEVANCE: The postural and balance by different therapists who were not involved in the ongoing
control system is of great value to motor skill acquisition. Seven treatment. Outcome measures included measurement of muscle
years-old children have finished the development of motor control tone by Modify Ashworth Scale (MAS), passive range of motion
structures in nervous system and have already their body segments of lower limbs, Gross Motor Function Measure (GMFM) and 3-
and biomechanical parameters similar to adults, regarding relations dimentional gait analysis. SDR procedure was performed under intra-
in size. Some authors argument that these can be sufficient operative trigger EMG guidance by neurosurgeon. Rehabilitation
reason to explain similarities in postural and balance control started immediately post-operation from day one onward including
between these two groups. But, we can’t forget that the individual’s in-hospital training for 2 weeks follow by an intensive program
motor activity helps the development and organizes this control. on out-patient basis for 8 weeks, patient would then go back to
PARTICIPANTS: 19 children (7 years old) and 38 young adults (age community and continue training in school setting until 6 month
mean=23.42 years) agreed to participated of the study METHODS: post-operation. Reassessment on the outcomes was performed
They were submitted to the Modified Sensory-Organization Test at 3 and 6 months post-surgery. ANALYSIS: Repeated Measure
(MSOT), which is a dynamic computer-based posturography test ANOVA with SPSS 11.0 was used to analysis the change on pre-
(NeuroCom™). Their performance was compared in four different operation, 3 month and 6 month post-operation. RESULTS: The
conditions: (1) eyes open–fixed surface, (2) eyes closed–fixed overall mean age of the 27 clients was 8.4 in which 23 of them
surface, (4) eyes open–sway referenced surface, (5) eyes closed– were spastic diplegia. The change of muscle tone by MAS decreased
sway referenced surface. ANALYSIS: Student t-test was used significantly throughout the time of assessment (p < 0.001, power
to compare groups (children X young adults). Significance was = 1). The passive range of motion of hip abduction (p < 0.001,
given by p < 0.005. RESULTS: All four performances conditions power=1) and ankle dorsiflexion (p = 0.015, power = 0.752) also
showed adults equilibrium score higher than children (p < 0.001). showed significant improvement. Functional improvement by GMFM
In condition 1, adults showed (mean ± SD) 94.03±2.18 and (p = 0.006, power = 0.824) was noted. Significant changes were also
found at 3 months for hip abduction (p < 0.001) and ankle dorsiflexion achievement. Infants who preferred playing in the prone position
(p = 0.024) on contrast analysis. For the 3-D gait analysis measured got higher gross motor DQs and total motor DQs. CONCLUSIONS:
at pre-operation and 6 month post-surgery, significant improvement Early prone wakeful positioning experiences and duration would
was found in kinematics change with knee extension in initial contact affect the achieved-ages of position specific motor milestones, such
of stance phase (p = 0.004) and ankle dorsiflexion in mid-stance as forearm support, roll and crawl. In addition, wakeful prone
(p = 0.009). Kinetic change with ankle power quotient (p = 0.004) preference would account for gross motor DQs and motor DQs.
and ankle moment quotient (p = 0.001)were also detected with IMPLICATIONS: The “prone to play” could be advocated in clinics to
good improvement. CONCLUSIONS: The intensive physiotherapy enhance the early gross motor development for infants. KEYWORDS:
program post SDR surgery is effective in improving the function infant, prone position, motor skills, growth & development. FUNDING
and gait of children with CP. Functions could be regained or even ACKNOWLEDGEMENTS: Bureau of Health Promotion, Department
improved in 3 month post operation. IMPLICATIONS: The intensity of Health, R.O.C. CONTACT: hfl[email protected]
of the rehabilitation program can act as a reference for post-SDR ETHICS COMMITTEE: Bureau of Health Promotion, Department of
training. Further study by comparing different rehabilitation program Health, R.O.C
after SDR will be beneficial to this client group. KEYWORDS:
Physiotherapy;Selective Dorsal Rhizotomy;Cerebral Palsy. FUNDING
ACKNOWLEDGEMENTS: The work was not supported by any
funded sources. CONTACT: [email protected] 31-14 Tuesday 5 June 09:00
DECREASED SENSITIVITY OF COMPLEX VISUAL PERCEPTION
IN CHILDREN AFTER A MILD TRAUMATIC BRAIN INJURY
VCEC Exhibit Hall B & C Forget R1,2 , Brosseau-Lachaine O3,2 , Gagnon I4 , Faubert J3,2 ;
1 École de réadaptation, Faculté de Médecine, Université de
THE INFLUENCE OF WAKEFUL PRONE POSITIONING ON Montréal (Québec), Canada; 2 Centre de recherche interdisciplinaire
MOTOR DEVELOPMENT DURING THE EARLY LIFE en réadaptation du Montréal Métropolitain (CRIR); 3 École
Kuo Y1 , Liao H1 , Hwang A1 , Chen P2 , Hsieh W3 ; 1 School and d’optométrie, Université de Montréal, Montréal (Québec), Canada;
4 Montreal Children Hospital, McGill University Health Center
Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University, Taipei, Taiwan; 2 Institute of Occupational
PURPOSE: Visual disturbances are often reported after Traumatic
Medicine and Industrial Hygiene, College of Public Health, National
Brain Injury (TBI). Moreover, our studies have shown visuo-motor
Taiwan University, Taipei, Taiwan; 3 Department of Pediatrics,
deficits at 1, 4 and 12 weeks post-trauma in children with mild TBI
National Taiwan University Hospital, Taipei, Taiwan
(Gagnon et al, 1998; Gagnon et al, 2004). However, no studies
PURPOSE: Recently studies found that wakeful prone positioning have documented the presence of complex visuo-spatial information
was significantly correlated to infant motor development. However, processing deficits in children after a mild TBI. The purpose of
little was known about the causal effects of prone positioning on the present study was: 1) to compare the sensitivity to complex
motor development. The purpose of this prospective longitudinal visual information processing of children who have sustained a mild
study was to investigate the influences of early prone wakeful TBI to that of non-injured children matched for age and gender
positioning on the acquisition of later motor milestones and the and 2) to asses the evolution of visuo-perceptual performance of
motor developmental scores for infants at 4 to 6 months of children with mild TBI during the first 3 months following the injury.
age after controlling personal or environmental factors that would RELEVANCE: It is important to assess children’s visual perception
affect motor development. RELEVANCE: As health care providers, after mild TBI to ensure a safer return to their activities and sports.
pediatric physical therapists are in an ideal position to address PARTICIPANTS: Sixteen children with mild traumatic brain injury and
health promotion issues with their clients even during the early 16 matched healthy controls (8 to 16 years of age). All injured children
life. The results of this study can be applied and recommended had been diagnosed with mTBI by professionals of a Pediatric
in the field of the health promotion for children. PARTICIPANTS: Trauma Program at the Montreal Children’s Hospital. All participants
There were 330 newborns (113 boys) enrolled from the National had normal or corrected-to-normal visual acuity and normal ocular
Taiwan University Hospital, and followed up at 4 and 6 months of health. METHODS: Sensitivity to static and dynamic forms of simple
age. METHODS: Two questionnaires were collected at the above (first-order, luminance defined) and complex (second-order, texture
2 ages to gather the information of personal factors (gestational defined) stimuli were assessed at 1, 4 and 12 weeks post-injury
age, birth weight, Apgar scores, neonatal complications, gender), and at equivalent time in healthy children. Orientation (vertical vs
environmental factors (the socioeconomic status of parents, sleeping horizontal) of static stimuli and motion-direction identification (left vs
positioning, the scores of Home Observation for Measurement of right) of dynamic stimuli were measured for all participants. A two-
the Environment Inventory(HOME)), wakeful positions and achieved- alternative forced choice procedure and method of constant stimuli
ages of developmental milestones. Among them, 166 infants also was used to find thresholds for all conditions. In addition, sensitivity to
received the developmental test – the Comprehensive Developmental optic flow, a complex motion stimulus with simulation of an observer
Inventory for Infants and Toddlers (CDIIT) at 6 months of age to moving in translation through a circular tunnel, was assessed with
obtain the results of motor developmental quotients (DQs), including coherence thresholds. ANALYSIS: Two way ANOVA comparing
gross motor and fine motor. ANALYSIS: Cox regression survival group and with repeated measures on the factor time (i.e. weeks
analysis and stepwise linear regression were used to evaluate the after injury) were used to analyze each condition RESULTS: No
influence of prone wakeful positioning on motor outcomes while difference in threshold between groups across all testing conditions
controlling potential confounding variables. The a level was set was found for simple, luminance-defined information. The sensitivity
at 0.05. RESULTS: After controlling the scores of HOME and to all complex stimuli (static and dynamic second-order and optic
gestational age, infants with early prone experience could achieve flow motion) was significantly reduced for the mild TBI children.
forearm support (odds ratio 1.78 [95% CI 1.09-2.88]) and crawl Sensitivity to complex moving stimulus was still affected 12 weeks
(odds ratio 2.56 [95% CI 1.10-5.96]) milestones earlier. Infants after the injury. CONCLUSIONS: Results from this study indicate
who were placed in prone position with higher duration achieved that children with mild TBI present selective processing deficits for
forearm support (odds ratio 1.34 [95% CI 1.01-1.79]), roll (odds ratio complex information starting at 1 week post-injury. IMPLICATIONS:
1.62 [95% CI 1.18-2.24]) and crawl (odds ratio 1.82 [95% CI 1.15- Such measures can be potentially used to compliment existing
2.88]) milestones at earlier ages. Neither the prone experience nor diagnostic measures to assess the cognitive status of children who
duration of prone positioning affected the fine motor milestones have sustained TBI. It remains to be determined if this deficit of
visual perception of moving stimulus impacts on the motor function. Research Report Poster Display
KEYWORDS: visual perception, static and dynamic stimuli, traumatic 33-02 Tuesday 5 June 09:00
brain injury. FUNDING ACKNOWLEDGEMENTS: Supported by a VCEC Exhibit Hall B & C
grant from the Canadian Institute of Heath Research # MOP-74504. COUNTERTRANSFERENCE TRIGGERS AND RESPONSES OF
CONTACT: [email protected] PHYSICAL THERAPISTS AFFECTING THE PATIENT/THERAPIST
ETHICS COMMITTEE: University of Montreal and Montreal Children RELATIONSHIP
Hospital
Allen R1 , Koshi L2 , Ashley O3 , Dreier D4 , Carter C5 ; 1 University
of Puget Sound, Tacoma, WA, USA; 2 Apple Physical Therapy,
Research Report Poster Display Tumwater, WA USA; 3 Bay State Physical Therapy, Newton,
31-18 Tuesday 5 June 09:00 MA USA; 4 Kadlec Medical Center, Richland, WA USA; 5 Harrison
VCEC Exhibit Hall B & C Medical Center, Bremerton, WA USA
PREVALENCE OF PAIN IN EMBU POPULATION, SAO PAULO, PURPOSE: The purpose of the present study was to identify internal
BRAZIL and external triggers that initiate countertransference responses in
Assumpção A, Cavalcante A, Sauer J, Chalot S, Capela C, physical therapists and resulting behavioral manifestations that may
Marques A; Physiotherapy, Speech and Ocupational Therapy impact quality of patient care. RELEVANCE: Countertransference
Department of Medicine School of University of Sao Paulo (CT) refers to a therapist’s emotional reactions to a patient and/or
the patient’s circumstances. These unconscious emotional reactions
PURPOSE: Pain is a frequent symptom controlled and produced may influence the therapist’s behavior, impacting success of the
by sensory, motivational and cognitive systems that have being patient/therapist relationship, as well as the quality and equity of
described as an unpleasant sensation. Pain can be classified by patient care. Abundantly addressed in the field of psychology, the
duration in chronic and acute pain and by location in regional and study of CT among other medical practitioners has been limited to
widespread pain. The aim of this study was to assess pain in the nurses and physicians. Studies exploring CT responses and behav-
Embu population of São Paulo, Brazil. RELEVANCE: Pain is the iors in physical therapy settings are not apparent in the literature.
most important symptom to physical therapy and often used like PARTICIPANTS: Participants included thirty-eight volunteer licensed
guidelines for effectiveness of treatment. Epidemiology pain studies physical therapists (experience range = 0.5–30 years, mean = 10.3
provide information on pain that can be used by physiotherapists years) attending a continuing education course on CT responses to
to propose prevention and treatment actions. PARTICIPANTS: The patients with systemic pathology. METHODS: During the CT course,
sample was selected from individuals in primary health care, aged subjects participated in four brainstorming sessions. Two of the
between 35 and 60 years in 2003, summing 3109 subjects. In four sessions were used for data collection regarding triggers and
this sample, 2269 people had a telephone number. METHODS: behaviors. During the first session, participants were asked to anony-
Of all 2269 subjects with phone number, we interviewed 768 with mously record patient characteristics associated with both successful
questions about presence of pain, location of pain and time of and uncomfortable patient/therapist interactions. The second session
pain. The subjects were classified in three groups related to pain involved small group discussion and the creation of an anonymous list
location: No Pain (NP), Regional Pain (RP) and Widespread Pain of behaviors influenced by, or the result of, their emotional responses
(WP), in accordance with the American College of Rheumatology. to the patient. ANALYSIS: Participants’ responses were entered
ANALYSIS: The data were analysed descriptive statistics. The into QSR N6 Non-numerical Unstructured Data Indexing, Searching
prevalence of chronic widespread pain was calculated by Bayesian and Theorizing (Nud*ist) software for data management and coded
Analyses. RESULTS: The mean age of sample was 48 years (7.2) a priori using pilot study generated codes. Responses were then
and women are predominant (77%). The SD group was composed subjected to a code/recode process by four raters. New codes were
by 185 subjects, the RP group by 388 subjects and WP groups generated according to the distinct content of participants’ responses.
by 195 subjects. In all groups women were more prevalent than Final themes were displayed as a hierarchical organizational tree.
men, but the major frequency of female gender was observed in RESULTS: Triggers that led to successful or uncomfortable patient-
the WP group. In people with pain, the chronic pain was more therapist interactions fell within seven distinct categories. The four
commom, 69.5%. The body parts more painful were thighs (37%), most frequently recurring themes included the therapist’s perception
legs (35%) and lumbar spine (34%). The prevalence of chronic of the patient, patient motivation, compliance, and associations
widespread pain was 24% [95% CI: 21-27%]. CONCLUSIONS: Pain the therapist made between the patient and a member of his/her
is frequent in Embu population and probably associated with socio- own family. Behaviors fell within five different categories. The most
demographic factors. The prevalence of chronic widespread pain frequently reported themes were personal openness, limiting inter-
was higher than in other published studies. The body parts more action to professional issues, and effort invested in the patient. The
frequently painful had already been described by other authors. following themes appeared as both triggers and behaviors: avoidance
IMPLICATIONS: This study showed that pain is common in the behaviors, treatment time, and body language. CONCLUSIONS:
Embu population and the public health system in general, and Findings indicate that physical therapists report manifesting CT
physiotherapists in particular, might propose forms to diminish it. responses to their patients. These responses may be triggered
In this way, it is important to recognize the characteristics of pain by patient characteristics, or by internal associations the therapist
population and the more frequent location of pain. KEYWORDS: projects onto the patient. Behavioral responses associated with
Chronic pain, Widespread pain, Pain, Epidemiology. FUNDING successful interactions tended to result in therapists providing more
ACKNOWLEDGEMENTS: Fundação para Amparo a Pesquisa e personal approaches to treatment including increased treatment
Desenvolvimento do Estado de São Paulo – FAPESP (Sao Paulo time, effort, and quality of care. Uncomfortable patient/therapist
State Fundation for Research and Development Support); Conselho interactions led to specific behaviors such as decreased treatment
Nacional de Desenvolvimento Cientı́fico e Tecnológico – CNPq time, effort, and personal involvement. IMPLICATIONS: Physical
(National Committee of Scientific and Tecnology Development). therapists’ CT responses impact the quality and equity of patient
CONTACT: [email protected] care. By becoming aware of their own CT reactions and behaviors,
ETHICS COMMITTEE: Ethics Committee for Analyses of Research physical therapists will be better equipped to provide equitable patient
Studies of Clinical Hospital of Medicine School of University of Sao care. From an understanding of CT dynamics, therapists may learn
Paulo (process: 161/2004) to convert frustrating circumstances into mutually productive clinical
interactions. KEYWORDS: Countertransference, Patient-therapist
Relationship. FUNDING ACKNOWLEDGEMENTS: This study was
supported by a Student Research Award grant from the University
Enrichment Committee of the University of Puget Sound, Tacoma, development of four additional ten-point hierarchical scales: Upper
WA, USA. CONTACT: [email protected] Extremity Fine Motor (UEFM) and Gross Motor (UEGM) Scales, and
ETHICS COMMITTEE: Institutional Review Board, University of Oral Motor Articulation (OMA) and Deglutition(OMD) Scales. This
Puget Sound, Tacoma, WA paper describes validation procedures to establish content validity
and reliability for these scales. PARTICIPANTS: Content Validity:
Three Expert Panels were selected to evaluate the 4 scales. They
Research Report Poster Display included 17 Physical Therapists and 13 Occupational Therapists
35-22 Tuesday 5 June 09:00 (UEGM), 28 Occupational Therapists (UEFM), and 28 Speech and
VCEC Exhibit Hall B & C Language Pathologists (OMA and OMD). All have doctoral degrees;
WHAT DO AUTHORS OF COCHRANE REVIEWS MEAN BY THE 70% have 20 or more years of experience. Reliability: 38 individuals
TERM ‘OLDER’ PEOPLE? (ages 6 mo to 20 years; 21 females, 17 males) with a range of cultural
backgrounds and diagnoses, including proteus syndrome, Smith-
Howe T1 , Elms J1 , Adler B2 , Creed G2 , Stott D2 ; 1 HealthQWest,
Lemli-Opitz syndrome, osteogenesis imperfecta, achondroplasia, and
Glasgow Caledonian University, Glasgow, UK; 2 2Academic Section
mucolipidosis were videotaped for the reliability trials. METHODS:
of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
Content Validity: Expert Panel members were asked to rate the BAMF
PURPOSE: To identify Cochrane reviews and protocols that focus by responding to six standard questions for each 0-10 skill level on
specifically on ‘older people’ and to describe the variations in a specific BAMF scale. Responses ranged from 1 = Disagree to 4
criteria used to identify this population. RELEVANCE: The Cochrane = Agree. Respondents were encouraged, not required, to provide
database of systematic reviews potentially contains valuable evi- additional written comments. Reliability: 3 physical therapists, 3
dence to support healthcare of older people. However its utility occupational therapists, 3 speech and language pathologists, and
depends on a consistent definition of what constitutes an ‘older’ per- 1 student in each discipline rated videotaped motor performances
son. PARTICIPANTS: N/A METHODS: We searched the Cochrane of ten children with scores 0-10 for each BAMF scale. ANALYSIS:
Database of Systematic Reviews (CDSR) 2006, Issue 1, using: Aged Content Validity: Central tendency and variability for individual BAMF
explode [MeSH] and key words: old$, elderly, adult$, people, veteran. items were evaluated with means, ranges and standard deviations.
Reviews and protocols were eligible if they included a minimum age Reliability: The Kappa Statistic was used to determine inter- and intra-
limit greater than 40 or stated that their focus was ‘older’ people. rater reliability for each BAMF scale. RESULTS: Content Validity:
The descriptions of types of participants were extracted from the Respondents reported that BAMF items were easily discriminated
text. ANALYSIS: Descritive analysis was undertaken and reported. (means 3.31-4.0), should be included (means 3.86-3.89), and were
RESULTS: The search identified 311 reviews and 67 protocols, of functionally relevant (means 2.93-3.82), with the exception of two
which 42 reviews and 9 protocols (published between 1998 and tasks on the UEGM (means 1.88 and 2.40). Standard deviations
2006) met the criteria, representing 1.6% of reviews and 0.6% of ranged from 0.26-0.97. Several modifications were made to the
protocols in the CDSR 2006, Issue 1. Twenty-six reviews and all BAMF Scales in response to the quantitative data as well as 443
nine protocols stated a minimum chronological age, mode 60 years written comments on the questionnaires (UEGM 117, UEFM 86,
(n=17), range 40 (n=1) to 65 (n=12). The descriptors that authors OMD 114, OMA 116). Inter-rater reliability values were 0.60(OMA),
used included: ‘elderly’ (n=12), ‘geriatric’ (n=8) and ‘older adults’ 0.83(OMD), 0.92(UEGM) and 0.98(UEFM). Intra-rater reliability
(n=8) in addition 18 reviews focused on reduced cognitive function values were 0.66(OMA), 0.84(OMD), 0.98(UEGM), and 0.99(UEFM).
in their descriptors. CONCLUSIONS: There are very few Cochrane CONCLUSIONS: 17 Physical Therapists, 28 Occupational Ther-
reviews or protocols indexed for terms equivalent to ‘older people’. apists and 28 Speech and Language Pathologists helped refine
There is variation in the descriptive terms used to indicate ‘older’, and the content of four BAMF motor scales through their quantitative
in the age restrictions applied. IMPLICATIONS: To optimize the utility and qualitative feedback. Kappa reliability values indicate the BAMF
of future reviews the development of a consensus of taxonomy for this upper extremity scales are highly reliable for screening and baseline
population is recommended. KEYWORDS: older people, Cochrane assessment of upper extremity motor skill. The oral motor scales
reviews. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: demonstrate moderate reliability for rapid assessment of oral motor
[email protected] skill, a limitation of this study. IMPLICATIONS: The BAMF Scales of-
fer rapid assessment of motor function in five domains, based on ob-
served capability, rather than disability. They are designed to indepen-
Research Report Poster Display dent of age and for use in any cultural setting. KEYWORDS: Gross
36-02 Tuesday 5 June 09:00 motor function, fine motor function, oral motor function. FUNDING
VCEC Exhibit Hall B & C ACKNOWLEDGEMENTS: Funded by the Intramural Program,
VALIDATION OF THE BRIEF ASSESSMENT OF MOTOR National Institute of Child Health and Human Development (USA).
FUNCTION (BAMF): RELIABILITY AND VALIDITY OF FOUR ETHICS COMMITTEE: Intramural Program, National Institute of
MOTOR SCALES Child Health and Human Development, USA
Cintas H1 , Parks R2 , Sonies B3 , Miller J4 , Gerber L5 ; 1 Physical
Therapy Section, Rehabilitation Medicine Department, National
Institutes of Health, Bethesda, MD, USA; 2 Occupational Therapy
Section, Rehabilitation Medicine Department, National Institutes of
Health, Bethesda, MD, USA; 3 Department of Hearing and Speech
Sciences, University of Maryland, College Park, MD, USA; 4 Physical
Disabilities Branch, Rehabilitation Medicine Department, National
Institutes of Health, Bethesda, MD, USA; 5 Center for Chronic Illness
and Disability, George Mason University, Fairfax, VA, USA
PURPOSE: To report validity and reliability of four of the five motor
scales which comprise the Brief Assessment of Motor Function
(BAMF) RELEVANCE: Modeled after the concept, but not the format
of the Apgar Neonatal Assessment (Apgar 1953), the BAMF is
designed for rapid motor assessment of a child’s demonstrated capa-
bility. It originated as the Lower Extremity Gross Motor (LEGM) Scale,
now validated and published. Usefulness of the LEGM led to the
36-06 Tuesday 5 June 09:00 37-10 Tuesday 5 June 09:00
DEVELOPMENT AND RELIABILITY OF A SYSTEM TO CLASSIFY IMPROVING THE SMILE FOLLOWING FACIAL NERVE PARESIS
HAND FUNCTION IN CHILDREN WITH CEREBRAL PALSY: DURING PHYSIOTHERAPY REHABILITATION WITH THE USE OF
MANUAL ABILITY CLASSIFICATION SYSTEM (MACS) VIDEO SELF-MODELING AND IMPLEMENTATION INTENTIONS
Eliasson A1 , Krumlinde Sundholm L1 , Rösblad B2 , Beckung E3 , Coulson S1 , Adams R1 , O’Dwyer N2 , Croxson G3 ; 1 School
Arner M4 , Rosenbaum P5 ; 1 Department of Woman and Child of Physiotherapy, Faculty of Health Sciences, The University of
Health, Karolinska Institute, Stockholm, Sweden; 2 Department of Sydney, Australia; 2 School of Exercise & Sport Science, Faculty of
Community Medicine and Rehabilitation, Physiotherapy, University Health Sciences, The University of Sydney, Australia; 3 Department
of Umeå, Sweden; 3 Queen Silvia Children’s Hospital, Sahlgrenska of otolaryngology, Royal Prince Alfred Hospital, Sydney, Australia
University Hospital, Göteborg, Sweden; 4 Hand Unit, Department of PURPOSE: The inability to smile effectively has been a primary
Orthopedics, Lund University Hospital, Sweden; 5 CanChild Centre motivator for getting physical therapy and surgical management of
for Childhood Disability Research, McMaster University, Hamilton the face after facial nerve paresis. However, spontaneous, automatic
ON Canada implementation of an effective smile at the appropriate moment
PURPOSE: To develop a system to classify how children with cere- in social situations often remains a problem in the long term. To
bral palsy use their hands when handling objects in daily activities. address this problem, as well as to examine ways to increase
The classification is designed to reflect the child’s typical manual transference of smile improvements following physical therapy and
performance, not the child’s maximal capacity. MACS is not intended surgical treatments, this study used a protocol of Video Self-
to explain the underlying reasons for limitations of performance or Modeling followed by structured Implementation Intentions in an
to classify types of cerebral palsy. MACS is analogous to the Gross attempt to rehabilitate a well-controlled, effective smile after long-
Motor Function Classification System (GMFCS) and can be used for term facial nerve paresis. RELEVANCE: Although there may be
children and adolescents 4-18 years. RELEVANCE: No classification measurable, visible improvements evident during a physical therapy
of hand function in children with cerebral palsy with a clear functional session or achieved following reanimation surgery, such gains
perspective has been available. MACS fills this gap and helps seldom translate into a well-controlled smile which can be used
to broaden the perspective of CP beyond gross motor issues. in the brief windows of opportunity that arise in social situations.
PARTICIPANTS: 25 parents and 25 therapists were interviewed This may be due to differences between a posed smile and
about the classification. 168 children/adolescents with cerebral palsy a spontaneous smile in terms of availability for implementation.
were classified independently by two therapists. Twenty-five children Techniques which improve the accessibility and performance of
were tested independently by their parents and one therapist. a motor skill thus have relevance to physical therapy practice.
METHODS: The validation was based on the experience within PARTICIPANTS: Ten subjects with a lower motor neurone facial
an expert group representing different professionals, review of the nerve paresis which was greater than 1 year post-onset participated
literature and also on thoroughly analysis of children with cerebral in this study. METHODS: Video Self-Modeling (video replay of only
palsy, across a spectrum of different functional levels. Discussions best Adapted smiles) and Implementation Intentions (planning and
continued until consensus occurred, first about the constructs, then visualising implementation of Adapted smiles in pre-determined,
at each level until these were clear and easily understood. The specific situations) were used in physiotherapy rehabilitation of an
next step in the validation involved parents and therapists who were Adapted (more symmetrical) smile in subjects with facial nerve
interviewed about the content and the description of levels. Thereafter paresis. The study design was a prospective, blinded clinical trial.
reliability was tested between parents and therapists and between Ability to produce the Adapted smile on cue was measured using
pairs of therapists. ANALYSIS: Textual analysis of the materials from a reaction time test. ANALYSIS: Analyses of variance (ANOVA)
the interviews of parents and therapists was performed separately with planned contrasts were used to examine the effects of smile
and based on three sets of questions, and for each level of type (Adapted or Everyday) on RT and MT data, VAS ratings,
MACS. The remarks were analysed to understand if the distinction and Facial Disability Index. The averaged scores of data 1 and
between levels were apparent or not. For analysis of interrater data 2 (pre-intervention) measurement sessions were compared
reliability Intra-Class Correlation Coefficient (ICC) was calculated. with the averaged scores of data 3 and data 4 (post-intervention)
RESULTS: The MACS is a valid measure reflecting “the children’s measurement sessions. A 6 month follow-up was also undertaken.
manual ability when handling objects in daily activities”. The reliability STATISTICA 7.0 for Windows was used to perform statistical analysis.
between parents and therapist was 0.96 calculated by Intra-Class RESULTS: After exposure to Video Self-Modeling: (i) reaction time
Correlation Coefficient (ICC) (95% confidence interval 0.89-0.98) (RT) to initiation of Adapted smiles became 202 msec faster whereas
indicating excellent agreement. The reliability between therapists was RT for Everyday (asymmetrical) smiles became 150 msec slower
0.97 (0.96-0.98). CONCLUSIONS: The Manual Ability Classification (ii) Adapted smiles were completed 521 msec faster (iii) Adapted
System is based upon self-initiated manual ability, with a particular smiles had higher Movement Control and Overall Quality ratings
emphasis on handling objects in daily activities. It is a valid and (iv) Self-report on Facial Disability Index social/wellbeing subscale
reliably classification for children and adolescents with cerebral palsy, improved. CONCLUSIONS: Following intervention there were sig-
between 4-18 years. Clinicians and parents seem to agree about nificant changes in availability, execution speed and quality of the
meaningful differences between levels resulting in excellent inter- smile. Implementation Intentions after Video Self-Modeling ensured
rater reliability. IMPLICATIONS: Physical therapy interventions for transfer of the Adapted smile to pre-determined everyday situations.
children with cerebral palsy have by tradition been focused on IMPLICATIONS: This study supports these rehabilitation techniques
gross motor function. Instruments as MACS highlight the importance as being methods that can maximise quality of smiling following
of including analysis of hand function in the planning of physical facial nerve paresis. KEYWORDS: facial paresis, edited video-
therapy interventions. KEYWORDS: Child, cerebral palsy, hand tape, self-modeling,. FUNDING ACKNOWLEDGEMENTS: Australian
function, reliability. FUNDING ACKNOWLEDGEMENTS: This project Government Postgraduate Award for Doctoral Studies. CONTACT:
was conducted in collaboration with collages in various places in [email protected]
Sweden and Melbourne, Australia with funding from Folke Bernadotte ETHICS COMMITTEE: Human Research Ethics Committee. The
stiftelsen, Jerringfonden and the Swedish Research Council. University of Sydney
ETHICS COMMITTEE: the Etics Research Committee at the
Karolinska Hospital, sweden and the state covernment, Victoria,
Australia.
Research Report Poster Display the individual spends sitting/lying, standing and walking as well as
37-14 Tuesday 5 June 09:00 the number of steps taken. ANALYSIS: Two sample paired t-tests
VCEC Exhibit Hall B & C were used to compare the four outcome measures between the two
SATURATION DURING VOLUNTARY APNOEA – groups. The level of significance was taken to be p < 0.05. RESULTS:
A COMPARATIVE STUDY Subjects with CFS spent a significantly greater part of the day sitting
or lying compared with the control group (p = 0.004). Consequently
Eriksson A1 , Wadell I2 ; 1 Respiratory Medicine and Allergy, University
the time spent standing and walking was greater in the control group
Hospital, Umeå, Sweden; 2 Physiotherapy, Department of Community
compared to the CFS group (p = 0.03 and p < 0.001 respectively).
Medicine and Rehabilitation, Umeå University, Umeå, Sweden
Those with CFS took an average of 3992 steps per day compared to
PURPOSE: The aim of this study was to investigate whether the 9626 steps taken by the control group (p < 0.001). CONCLUSIONS:
ability to tolerate lengthy voluntary apnoea and thereby hypoxemia, The results of this study support anecdotal and clinical impressions
vary according to VO2max, type of physical activity performed and/or that people suffering from CFS demonstrate a significantly lower
experience of hypoxemia. RELEVANCE: People with obstructive level of activity compared to their healthy peers. Further comparison
sleep apnoea syndrome are usually treated with CPAP. So far of the pattern of activity between the two groups is underway.
this group is not well studied with intervention of aerobic training. IMPLICATIONS: To avoid the secondary effects of deconditioning
PARTICIPANTS: Four groups consisted of (1) underwater rugby and to improve participation and function physiotherapists should
players (UW-group), (2) individuals conducting fitness training on include appropriate and guided activity management when treating
land (FT-group), (3) individuals that didn’t perform fitness training those with CFS. The activPAL device was an effective method of
(DFT-group) and (4) individuals with obstructive sleep apnoea determining activity levels in this group and might be a simple tool
syndrome (OSAS-group). Each group consisted of 11 participants. for monitoring and guiding therapy. KEYWORDS: Chronic Fatigue
METHODS: All participants underwent spirometer test, test of Syndrome, activity. FUNDING ACKNOWLEDGEMENTS: Unfunded.
maximal voluntary apnoea and submaximal fitness test on bicycle CONTACT: [email protected]
ergometer. ANALYSIS: The statistical analysis was carried out by ETHICS COMMITTEE: Ethics committee of the School of Health and
using Statistical Package for Social Studies (SPSS) 10.0, ANOVA Social Care of Glasgow Caledonian University
and Bonferroni post-hoc test was calculated. RESULTS: The UW-
group tolerated significantly longer periods of voluntary apnoea, lower
saturation and larger reduction of heart rate during apnoeas, than the
other groups.The FT-group showed significantly higher VO2max than 38-22 Tuesday 5 June 09:00
the other groups. The UW-group had significantly larger vital capacity VCEC Exhibit Hall B & C
than the OSAS-group. CONCLUSIONS: In this study it seems like GENDER DIFFERENCES IN HIGH SCHOOL COACH’S
the most important factor for tolerating lengthy voluntary apnoea and KNOWLEDGE AND ATTITUDES ABOUT THE FEMALE ATHLETE
hypoxemia is conscious experience of apnoea and thereby conscious TRIAD: A PILOT STUDY
experience of hypoxemia. It is also likely that physical training Pantano K; Cleveland State University, Cleveland, Ohio, USA
contributed in a positive way both regarding physiological as well
as psychological aspects. IMPLICATIONS: Aerobic training might be PURPOSE: Women’s participation in athletics has increased since
of benefit both for weight loss, to minimize oropharyngial obstruction, greater opportunities in sports have been provided. Female athletes
and to reduce the numbers of apnoeas. KEYWORDS: voluntary may intentionally or inadvertently restrict their dietary intake and
apnoea, saturation, heart rate, VO2max, obructive sleep apnoea over-train to gain a competitive edge,which may lead to a loss or
syndrome. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: abnormality of their menstrual cycle and the premature development
[email protected] of osteoporosis. This syndrome, known as the Female Athlete Triad,
ETHICS COMMITTEE: Ethical committe, Umeå University may be detrimental to the health of the athlete. Coaches are
instrumental in identifying the athlete with, or at risk of developing
the female athlete triad, but they must understand and be able to
Research Report Poster Display recognize its warning signs. High school coaches are important in
37-18 Tuesday 5 June 09:00 establishing healthy patterns of behavior early on but their skill in
VCEC Exhibit Hall B & C recognizing the disorder is not known. The purpose of this pilot study
A COMPARISON OF FREE LIVING ACTIVITY LEVELS BETWEEN was to describe the knowledge and attitudes high school coaches
THOSE WITH CHRONIC FATIGUE SYNDROME (CFS) AND in the greater Cleveland, Ohio area have about the female athlete
HEALTHY CONTROLS triad, and to determine if gender differences in knowledge or attitudes
about the female athlete triad exist. RELEVANCE: Understanding
Paul L, Marshall R, Rafferty D, Jacob F; School of Health and
the knowledge high school coaches have about the female athlete
Social Care, Glasgow Caledonian University, Glasgow, Scotland, UK
triad provides insight as to where gaps in knowledge exist, and
PURPOSE: Anecdotally CFS sufferers report that they are profoundly allows education to be focused in this direction. Raising awareness
less physically active and unable to participate in everyday activities and understanding about the syndrome in high school coaches
in comparison to their healthy counterparts. The aim of this study could lead to earlier intervention and prevention of osteoporosis.
was to objectively compare the level of activity in those with CFS PARTICIPANTS: 63 female and male high school coaches currently
and a control group, using an advanced accelerometer device. employed in the greater Cleveland, Ohio area. METHODS: A survey
RELEVANCE: An accurate measure of levels of activity in those with consisting of 30 questions was developed and administered to 63
CFS would help guide physiotherapists in the design and progression high school coaches currently employed in the greater Cleveland,
of programmes to increase activity/exercise in CFS. PARTICIPANTS: Ohio area. ANALYSIS: Descriptive statistics were used to analyze
Thirteen CFS subjects (11 females and 2 males) who attended the information obtained from the sample of coaches studied.
support groups in and around Glasgow volunteered. The control The Pearson-product moment correlation was used to describe
group were a convenience sample of 13 healthy, age and gender the relationships between gender of the coach and comfort level
matched subjects and were recruited from family and friends of the in discussing disordered eating, and menstrual irregularity with
CFS subjects and also University staff. The mean age of the CFS the female athlete, and recognition of the signs and symptoms,
group and control group was 47.2 years and 47.5 years respectively. respectively (p < 0.05). RESULTS: Sixty-three high school coaches
METHODS: To assess their level of activity each of the subjects (46% female, 54% male) in the greater Cleveland area completed
wore an activPAL device for three days. This small activity monitor the survey. Fourteen of the 63 respondents (22%) reported having
is worn on the thigh and objectively records the amount of time heard of the female athlete triad but only 8 (12.7%) could correctly
identify all three components. Fifty-two percent reported that irregular sport leading (OR 1.40; CI 1.18 to 1.66), and bouldering (OR 1.40; CI
or absent menstruation was a normal consequence of exercise in 1.17 to 1.68). Overuse injuries were more likely for climbers soloing
female athletes. There was a fair correlation between the coach’s and traditional leading (OR 1.12; CI 1.01 to 1.24), sport leading (OR
gender and comfort discussing disordered eating (r = 0.28, p = 0.014), 1.12; CI 1.023 to 1.22), and bouldering (OR 1.24; CI 1.08 to 1.43)
and comfort discussing menstrual irregularity with female athletes more frequently. Bouldering difficulty also predicted injuries incurred
(r=.39, p = 0.001). There was no relationship between gender and from strenuous moves (OR 1.24; CI 1.04 to 1.49). CONCLUSIONS:
knowledge in recognizing the signs and symptoms of the female Climbing injuries are relatively common, and medical professionals
athlete triad (r = 0.013, p = 0.46). CONCLUSIONS: This pilot study provide key sources of advice and treatment. Climbers with the most
indicates that high school coaches in the greater Cleveland area lack ability and dedication are most at risk of injury, particularly finger
knowledge and understanding of the female athlete triad. Further overuse. Fall-related injuries are comparatively infrequent, though all
study must be conducted on a national level to determine the climbers may incur them. Self-efficacy does not appear to predict
breadth in which knowledge gaps exist and to assure that prevention climbing injuries. IMPLICATIONS: Climbers should be aware of the
and intervention strategies get quickly established. IMPLICATIONS: risk factors for injury, warm up progressively, incorporate rest periods,
This study suggests that educational programs about the female and recognise injury symptoms when they occur. KEYWORDS:
athlete triad may be important to implement to high schools Exercise, Climbing, Injury. FUNDING ACKNOWLEDGEMENTS: The
coaches. Physical therapists may be facititate the intiation of such an second author was supported by The British Academy grant SG-
educational program. KEYWORDS: Female athlete, menstrual dys- 39588.
function, osteoporosis. FUNDING ACKNOWLEDGEMENTS: None. ETHICS COMMITTEE: Leeds Metropolitan University, School of
CONTACT: [email protected] Allied Health Professions, Ethics Committee
ETHICS COMMITTEE: Drexel University IRB
Research Report Poster Display 39-06 Tuesday 5 June 09:00
39-02 Tuesday 5 June 09:00 VCEC Exhibit Hall B & C
VCEC Exhibit Hall B & C STRENGTH AND BLOOD PROFILE CHANGES IN FEMALES
RISK FACTORS FOR INJURIES FROM ROCK CLIMBING WITH POLYCYSTIC OVARY SYNDROME IN RESPONSE TO
Jones G1 , Llewellyn D2 , Asghar A3 ; 1 School of Allied Health EIGHT WEEKS OF RESISTANCE EXERCISE TRAINING
Professions, Leeds Metropolitan University, Leeds, UK; 2 School Betts E1 , Brandsen K1 , Jolin K1 , Munger M1 , Nash K1 , Wilson J1 ,
of Clinical Medicine, University of Cambridge, Cambridge, UK; Betts J2 ; 1 Program in Physical Therapy, Central Michigan University,
3 School of Allied Health Professions, Leeds Metropolitan University, Mt. Pleasant, MI, USA; 2 School of Health Sciences, Central
Leeds, UK Michigan University, Mt. Pleasant, MI, USA
PURPOSE: Rock climbing is becoming increasingly popular despite PURPOSE: Polycystic Ovary Syndrome (PCOS) is a complex syn-
the risk of serious injury. Previous research has established that drome characterized by menstrual dysfunction, hyperandrogenism,
elite indoor climbers are susceptible to overuse injuries of the hand polycystic ovaries, obesity, and insulin resistance, leading to an
and fingers. However, the present study examines the prevalence increased risk for the development of cardiovascular disease and type
of climbing injuries in a more diverse group. In addition, self- 2 diabetes. Although regular physical exercise is often recommended
efficacy is investigated as a potential risk factor. RELEVANCE: to women with PCOS, there is a paucity of research documenting
Information about the aetiology of climbing injuries should form exercise effects. Evidence for the use of resistance training is
the basis of communication strategies and educational interventions particularly lacking. The purpose of this study was to examine the
designed to prevent injury, and inform rehabilitation PARTICIPANTS: effects of an eight-week resistance training program on strength
Of 205 active British rock climbers, 201 (98%) agreed to participate and select indicators of cardiovascular and diabetes disease risk
voluntarily and yielded useable results. The 163 male climbers (M in women with a clinical diagnosis of PCOS. RELEVANCE: This
age = 35.2 years, SD = 11.8) and 38 female climbers (M age = topic is relevant to physical therapy practice, as it addresses
35.1 years, SD = 10.7) did not differ significantly in age (p > 0.05). an area of growing concern (cardiovascular disease) in women’s
METHODS: Climbers approached in their naturalistic environment health. PARTICIPANTS: Following approval from the Institutional
were asked to complete items relating to their climbing behaviours, Review Board for the use of human subjects at Central Michigan
injuries, and self-efficacy. Climbing items included number of years University, 11 women volunteers, aged 18-35 years, with a clinical
experience, and the frequency and technical difficulty of routes or diagnosis of PCOS were recruited via physician office contact,
problems accomplished in different styles (soloing, traditional leading, word of mouth, and printed advertisements. METHODS: After
sport leading and bouldering) in the last 12 months. Injury items health risk stratification and exercise risk appraisal was determined,
included days unable to climb due to climbing injuries, anatomical anthropometric measurements to determine body mass index (BMI),
location of injuries incurred (related to falling, overuse, and strenuous fasting blood profiles for glucose (GLU), cholesterol (CHOL), and
moves), and sources of treatment or advice sought. Self-efficacy was triglycerides (TRIG), and muscular strength measurements were
measured using the 10-item Climbing Self-efficacy Questionnaire taken pre-training. Resistance training of the large muscle groups of
(CSQ; developed following an initial pilot study), in which climbers the upper and lower body using standard weight training apparatus
rate their confidence to accomplish domain specific tasks on a was then performed 3 days per week for 8 weeks. All pre-test
scale of 0-100. ANALYSIS: Statistical analysis included univariate measurements were repeated post-training. ANALYSIS: Paired t-
statistics, logistic regression and t-tests. RESULTS: Twenty-one tests and ANOVA were used to determine differences in test values
climbers (10%) had been injured as the result of a fall, with 4 pre- and post-training. RESULTS: Significant increases in strength
reporting upper or lower limb fractures. Sixty-seven (33%) had ( ↑ 24%) were achieved for all muscle groups tested. Improvements
incurred overuse injuries, including 35 finger injuries. Fifty-seven in TRIG ( ↓ 19%) and CHOL ( ↓ 10%) values were also realized
(28%) had suffered injuries from strenuous climbing moves, including post exercise training. Minimal improvement was noted in resting
31 finger injuries. The most common sources of advice or treatment GLU levels post-training. No significant change in BMI was seen.
were physiotherapists, other climbers, and physicians. Fall-related CONCLUSIONS: This study demonstrates that resistance training
injuries could not be predicted by any of the independent variables. in women with PCOS can produce significant strength gains and
The probability of sustaining an overuse injury was higher for climbers concomitant reduction in a number of risk factors for cardiovascular
who completed difficult climbs whilst soloing or traditional leading disease and diabetes. No dietary modifications were prescribed,
(odds ratio (OR) 1.23; 95% confidence interval (CI) 1.06 to 1.42), therefore these changes resulted in the absence of any significant
change in BMI. Future studies using larger, randomized samples people can see themselves in it. It is relevant for physiotherapists
could strengthen the support for use of this type of training for to work actively with incorporation of the prosthesis and the
women at risk of developing cardiovascular disease. The inclusion maintenance of phantom sensations. After having focused attention
of dietary modification in concert with exercise training would on feeling/sensing the body, this study points out another important
likely yield greater improvements in blood profiles due to changes aspect: leaving the bodily focus, letting the body become absent
in BMI. IMPLICATIONS: The results of this study suggest that again allowing attention to be directed elsewhere. It is relevant to plan
resistance training can positively influence the factors leading to experiences of success; immediately after the amputation to request
cardiovascular disease in a female population at risk. Physical a visit from another person who has experienced amputation; and
therapists should consider including this type of training in their later to plan group activities. KEYWORDS: Amputation, incorporation
exercise prescriptions. KEYWORDS: Resistance Exercise, Women. of prosthesis, ‘rites de passage’, phantom sensations. FUNDING
FUNDING ACKNOWLEDGEMENTS: This project was partially ACKNOWLEDGEMENTS: The work was unfunded. CONTACT:
funded by the College of Graduate Studies at Central Michigan [email protected]
University. CONTACT: [email protected] ETHICS COMMITTEE: The Regional Committee on Biomedical
ETHICS COMMITTEE: Institutional Review Board for the use of Research Ethics of Aarhus County, Lyseng Allé 1, DK-8270 Højbjerg,
human subjects at Central Michigan University Denmark, fax +4589446111, www.aaa.dk/komite

WHOLE AGAIN AND HOW TO GET THERE. AN FACTORS INFLUENCING SELF-EFFICACY FOR EXERCISE
ANTHROPOLOGICAL STUDY OF EXPERIENCE AND IDENTITY AND ACTIVITY IN HOSPITALIZED PATIENTS WITH
IN CASES OF LEG AMPUTATION CARDIOVASCULAR DISEASE
Oestergaard E; JCVU, University College Jutland, School Cleary K, Kidd J, French M, LaPier T; Eastern Washington
of Physiotherapy, Skejbyvej 15, DK-8240 Risskov, Denmark. University, Physical Therapy Department, Spokane, WA, USA
Homepages: www.jcvu.dk and www.efaa.dk
PURPOSE: The purpose of this study was to determine if a
PURPOSE: How do people who have had one leg amputated relationship exists between exercise and cardiac self-efficacy in
experience themselves and their body in the period after the relation to demographics, cognitive function, or prior physical function
amputation and in taking up everyday life again? Do they become in patients with cardiovascular disease (CVD). A secondary purpose
themselves again, whole again and do they feel integrated into of this study was to determine if self-efficacy and exercise behavior is
society again? Which factors are important for this process? different in patients who report a fearing of falling (fallers) vs. patients
RELEVANCE: Physiotherapists should pay close attention to the who do not report a fear of falling (non-fallers). RELEVANCE: To most
manner in which prostheses are incorporated; to the profound identity appropriately prescribe exercise, physical therapists must understand
issues raised by the alteration in the body; and to factors important the factors that influence patient self-efficacy. PARTICIPANTS: This
for feeling whole again. PARTICIPANTS: Fifteen informants: nine study included 50 patients who were admitted to the hospital for a
people who had one leg amputated and then had prosthesis, and CVD related diagnosis. Patients who could not understand English,
six health professionals (four physiotherapists, one doctor and one were not cognitively intact, or had undergone cardiac transplantation
physiotherapy assistant). METHODS: Fieldwork for seven weeks in or ventricular assist device placement were excluded. METHODS:
Denmark using participant observation: passive and moderate (n=6), This prospective descriptive study used a sample of convenience
active (n=countless); focus group discussion (n=1) and qualitative recruited from a regional medical center. Patient background and
interviews: semistructured (n=19), unstructured (n=countless). The medical information was obtained through chart review and interview.
fieldwork took place at different locations. ANALYSIS: My analytical Patients completed self-report assessments including the Barnason
perspective was anthropological theory about ‘rites de passage’ and Efficacy Expectation Scale and the Self Efficacy for Exercise
about the body as a subject. RESULTS: All the informants felt Behavior Scale (SEEB). In addition, the Physical Function subscale
whole and themselves again. For most of them, the prosthesis had of the RAND 36-Item Health Survey and the Telephone Interview
been incorporated (after 12 -3 years), and now felt like a part of of Cognitive Function were used to characterize physical and
the person and of the body, extending the scope and active radius cognitive function, respectively. ANALYSIS: Data analysis consisted
of touch and sensation. Most of the informants experienced that of descriptive statistics, correlations, t-tests, and chi-square analysis.
their body now could be absent, after it had demanded focus for RESULTS: Results indicate that patients with higher financial income
a period of time. Most of the informants felt integrated into society reported higher exercise self-efficacy in resisting relapse, but not
again. CONCLUSIONS: In a ritual perspective, the informants had in exercise self-efficacy making time. Patients with higher cognition
moved from separation through liminality to integration. Separated and older patients reported higher levels of cardiac self-efficacy.
from earlier life, body, work and society; through liminality, in Further, a positive correlation was found between cardiac self-
which they were no longer classified and not yet classified, not efficacy and prior level of physical function. No relationship existed
themselves, outside society and with an unknown future; finally between body mass index and exercise or cardiac self-efficacy. No
integration in themselves, their body and society – now in a new correlation existed between fear of falling and self-efficacy; however,
state. Important factors were: to use the prosthesis as much as a higher percent of fallers failed to meet minimum exercise guidelines
possible, to obtain and maintain phantom sensations, to do specific as compared to non-fallers. CONCLUSIONS: Results suggest that
physical training, to experience success, to be recognized as a patients with higher financial income potentially have greater time
person, to meet other people with amputated leg(s), to get a job, and resources available to exercise and are confident in adhering
to get a car and to have an independent everyday life. Future to an exercise program when external factors, such as household
studies to recognize important factors in the incorporation process chores and social obligations, are present. However, the same
are relevant. IMPLICATIONS: The ritual perspective can be used in individuals are less confident in exercise adherence when internal
relation to crisis, diseases and handicaps. It inspires us to consider factors are present. Study results also may suggest that patients
the individual human crisis in a society perspective, and it directs with higher cognition have a greater understanding of the importance
the attention to the characteristics of liminality and to the bodily of exercise in relation to their condition and associated disease
aspect of reintegration into society. It is a way to look at the process and that patients with lower physical function are less likely
illness/life process and the new life, which gives meaning because to independently engage in previous physical activities after a cardiac
event Results also may indicate that age brings experience and Research Report Poster Display
possibly confidence in coping with physical impairments. Fallers failed 02-20 Tuesday 5 June 10:30
to meet minimum exercise guidelines, indicating that fear of falling VCEC Exhibit Hall B & C
may contribute to self-imposed activity restriction. IMPLICATIONS: It PHYSICAL THERAPY MANAGEMENT FOLLOWING CARDIAC
is important to identify the factors that are associated with exercise SURGERY: CANADIAN BENCHMARKING SURVEY
self-efficacy. While multiple factors may alter self-efficacy within a
Overend T1,2 , Anderson C2 , Jackson J2 , Lucy S1 , Prendergast M2 ,
specific patient population, strategies to increase self-efficacy and
Sinclair S2 ; 1 School of Physical Therapy, University of Western
patients’ participation in their own care should be implemented. Such
Ontario, London, Canada; 2 London Health Sciences Centre,
strategies are not only relevant to patients with CVD, but with any
London, Canada
medical diagnosis and across all physical therapy practice settings.
KEYWORDS: cardiovascular disease, exercise, compliance, self-
PURPOSE: To determine the practice of Canadian physical
efficacy. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
therapists for patients requiring routine care following cardiac
[email protected]
surgery. RELEVANCE: The literature is conflicting with respect to
ETHICS COMMITTEE: Spokane – IRB
physiotherapy intervention for patients undergoing cardiac surgery.
There are also numerous gaps in this evidence base, necessitating
a survey to determine practice benchmarks to supplement evidence
from the literature. PARTICIPANTS: Physical therapists providing
care to patients undergoing cardiac surgery, and professional
practice leaders. METHODS: We conducted a telephone survey
THE IMMEDIATE EFFECT OF CHEST MOBILIZATION of a representative sample (n=18) of hospitals performing cardiac
TECHNIQUE IN PATIENTS WITH CHRONIC OBSTRUCTIVE surgery in Canada to determine current physical therapy practice
PULMONARY DISEASE with respect to the care of patients undergoing coronary artery
Tabira K1 , Oike T2 , Kawamata M3 , Sekikawa N4 , Sekikawa K5 ; bypass surgery and/or cardiac valve surgery. Six physiotherapists
1 Department of Physical Therapy, Faculty of Health Science,
designed the survey questions to address gaps in the literature
Kio University; 2 Department of Rehabilitation Medicine, Tsuda identified following a systematic review of physiotherapy care of
Hospital; 3 Faculty of Rehabilitation, Seijoh University; 4 Department patients undergoing cardiac surgery. Survey questions examined
of Rehabilitation Medicine, Yoshijima Hospital; 5 Division of Physical cardiorespiratory care, mobility, exercises, and education provided to
therapy and Occupational Therapy Sciences, Graduate School patients requiring routine care following cardiac surgery. The survey
of Health Sciences, Hiroshima University was pilot tested at one centre to determine clarity and ease of
PURPOSE: This study investigated the immediate effect of chest completion. A physical therapist from the cardiac surgery program
mobilization techniques in patients with chronic obstructive pul- at each site was then interviewed by one of two interviewers.
monary disease (COPD). RELEVANCE: This study identifies the Respondents received a copy of the survey in advance of the
effect of chest mobilization techniques in patients with COPD and interview. ANALYSIS: Seventeen of the 18 sites participated in the
suggests strategies for their treatment. PARTICIPANTS: Sixteen telephone interview. One site provided written responses. Data from
COPD patients (13 male and 3 female, mean+/−SD age 72.2+/− 6.2 the surveys were entered in tables and summary statistics calculated.
yrs) took part in this study. METHODS: We measured pulmonary RESULTS: An average of 21 cardiac surgeries per week (range 6-
function, chest expansion, oxygen saturation (SpO2), pulse rate and 42) was performed at the 18 sites. The mode response for length of
breathlessness before and after treatment. Chest expansion, defined stay was 6 days (range 4-10.6). The average staffing across the 18
as the difference in chest girth between maximal inspiration and sites was one physical therapist for 17.6 beds. Patients were seen
maximal expiration, was measured at three levels: the axilla, xiphoid preoperatively at 7/18 sites and on postoperative day one (POD-
and 10th rib. Breathlessness was measured with a visual analogue 1)at 16/18 sites. On POD-1, deep breathing and coughing (DB&C)
scale. Patients were treated with chest mobilization comprising rib were performed at 16 sites, upper extremity exercises at 13 sites
rotation, chest wall rotation, lateral flexion of the chest wall, chest and lower extremity exercises at 12. Eight sites reported the use of
wall extension, and pectoralis major muscle stretch by expert physical incentive spirometers. Twelve sites provided education around self-
therapists. ANALYSIS: The paired t-test was used to compare treatments (DB&C, bed exercises) and treatment progression. Nine
pulmonary function, SpO2 and pulse rate in pre- and posttreatment. sites continued to provide cardiorespiratory treatment on POD-3.
The Wilcoxon test was used to compare chest expansions and There was wide variation in mobility data due to staffing, surgeon
breathlessness in pre- and posttreatment. The same analysis per- preferences, tradition, and nursing practice. On POD-1, patients
formed in the patients who also demonstrated a restrictive ventilatory were dangled at 17 sites and mobilized out of bed at 13. By
impairment (vital capacity <80% predicted: n=11). Values of p < 0.05
POD-3, all sites reported patients ambulating 2-5 times per day,
was considered significant. RESULTS: Chest expansion at the level
with a range of 50-120 m per session. Seven sites reported doing
of 10th rib showed significant improvement and pulse rate was
stairs with all their patients prior to discharge. Sternal precautions
significantly decreased after treatment. However chest expansion
were variable but all sites reported 5-10 lbs as the upper limit
at the other levels, pulmonary function, SpO2 and breathlessness
for lifting. CONCLUSIONS: Within the limitations of survey data,
were unchanged. In the patients who also demonstrated a restrictive
ventilatory impairment, chest expansion at the level of axilla, xiphoid it appears that Canadian physical therapists may give unneces-
and 10th rib all significantly improved and pulse rate was significantly sary cardiorespiratory treatment, after POD-1, to uncomplicated
lower after treatment. CONCLUSIONS: These results suggest that patients following cardiac surgery. Early mobilization, ambulation and
flexibility of the respiratory muscles and mobility of the costovertebral education appear to be generally common approaches. There is
joints, facet joints and sternocostal joints were improved flowing little consensus around postoperative sternal precautions and some
chest mobilization. IMPLICATIONS: We recommend the use of chest sites provide cardiorespiratory techniques that are not supported
mobilization technique in COPD patients, in particular these who by the evidence. IMPLICATIONS: There is a need to determine
demonstrate a restrictive ventilatory impairment. KEYWORDS: chest best practice for physical therapists working with patients requiring
mobilization, chronic obstructive pulmonary disease, pulmonary routine care following cardiac surgery. KEYWORDS: cardiac surgery,
function. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: practice. FUNDING ACKNOWLEDGEMENTS: London Health Sci-
[email protected] ences Centre Physiotherapy Research Seed Fund. CONTACT:
ETHICS COMMITTEE: ethics committee in yoshijima hospital [email protected]
Research Report Poster Display utilization of evidence-based practice principles. PARTICIPANTS:
02-24 Tuesday 5 June 10:30 241 students, graduating from the same 30-month, entry-level,
VCEC Exhibit Hall B & C masters of physical therapy education program participated in this
EXERCISE CAPACITY AND QUALITY OF LIFE IN LUNG study. METHODS: Students in the program completed the WGCTA
TRANSPLANT RECIPIENTS within 1 month of matriculation, at the beginning of the second year,
and during the final academic quarter. Students had completed full-
Tamaki A1 , Chin K2 , Mishima M3 , Bando T4 ; 1 Department
time clinical practica immediately prior to WGCTA administration
of Physical Therapy, Faculty of Medicine, Kyoto University;
2 Department of Physical Therapeutics, Kyoto University Hospital; 2 and 3, providing opportuity to incorporate both academic and
3 Department of Respiratory Medicine, Kyoto University Graduate clinical learning experiences. ANALYSIS: The Sign test was used
to evaluate the differences between the number of students whose
School of Medicine; 4 Department of Thoracic Surgery, Kyoto
scores improved and whose scores declined in each of the 5 subtest
University Graduate School of Medicine
areas of the WGCTA. RESULTS: Statistically significant increases
PURPOSE: From August 2002, lung transplantations from brain-dead in scores on the inference and deductive reasoning subtests were
and living donors were performed in our hospital. We examined seen between the first and third WGCTA administration. On the
the change in exercise capacity, activities of daily living (ADL) inference subscale, Z = −3.393 (Asym Sig 2-tailed = 0.000)and the
and health-related quality of life (HRQL) in 4 recipients who deductive reasoning Z = −4.751 (Asym Sig. 2-tailed = 0.000). No
survived more than 1 year after the lung transplants. RELEVANCE: significant improvement was noted in the scores on the recognition
No studies have ever reported about exercise capacity, activities of assumptions subtest (Z = −1.470; Asym. Sig. 2-tailed = 1.41).
of daily living, health related quality of life in lung transplant Student scores often decreased on the recognition of assumptions
recipients in Japan. PARTICIPANTS: The patients were 2 males subtest between the administrations. Student score variations on
and 2 females. Two patients had pulmonary emphysema, one had the second administration of the WGCTA were less predictable than
primary pulmonary hypertension, and one patient had pulmonary between the first and third administration. CONCLUSIONS: This data
lymphangioleiomyomatosis. METHODS: Six minute walking distance supports the conclusion that over the course of academic and clinical
(6MD), ADL score (Senjyu et al.), leg extension power, and education experiences within a physical therapy curriculum, physical
HRQL (SF-36) of the 4 recipients were measured pre-operation, therapy students learn to question their assumptions and pursue
at discharge from hospital, a half year after discharge and at deductive and inductive reasoning in solving problems. Even though
the last examination. The examinations were performed from the the student’s critical thinking pattern appears to initially become
pre-operative period up to 14-44 months following transplantation. less predictable, the ability to examine evidence and participate in
ANALYSIS: Repeated ANOVA was used for statistical analysis. clinical reasoning does evolve. Future questions related to this study
RESULTS: 6MD values changed from 198m, to 387m, 466m and should focus on whether the documented changes in critical thinking
546m and ADL scores changed from 18, to 83, 91.3, and 97.8, at support efficient, effective evidence-based physical therapy practice.
pre-operation, discharge from hospital, half year after discharge and More indepth study of influences of curricular models and teaching
the last examination respectively. Leg extension powers improved strategies on critical thinking should also be done. IMPLICATIONS:
progressively following transplantation. SF-36 scores approached This work does have implications for physical therapy education
those of healthy subjects. CONCLUSIONS: These results indicated and curricular development. Physical therapy education programs
that the exercise capacity and ADL scores improved after lung can incorporate this type of information into program evaluation,
transplantation. IMPLICATIONS: The recipients of lung transplants curricular development and evaluation of educational methods.
in our hospital acquired improvement not only in physical ability KEYWORDS: critical thinking, PT entry-level education, teaching.
but also in HRQL. KEYWORDS: Lung Transplant Recipients, FUNDING ACKNOWLEDGEMENTS: This study was unfunded.
Exercise capacity, Quality of life, Activities of daily living. FUNDING CONTACT: [email protected]
ACKNOWLEDGEMENTS: This. CONTACT: [email protected] ETHICS COMMITTEE: Midwestern University Institutional Review
u.ac.jp Board
ETHICS COMMITTEE: Kyoto University ethics committee
Research Report Poster Display 05-16 Tuesday 5 June 10:30
04-08 Tuesday 5 June 10:30 VCEC Exhibit Hall B & C
VCEC Exhibit Hall B & C INTERNATIONAL SERVICE-LEARNING AND OTHER INTERNA-
DEVELOPMENT OF CRITICAL THINKING IN PHYSICAL TIONAL VOLUNTEER SERVICE OPPORTUNITIES IN PHYSICAL
THERAPY EDUCATION: CHALLENGING ASSUMPTIONS, WHILE THERAPY EDUCATION PROGRAMS IN THE USA AND CANADA
INCREASING INDUCTIVE AND DEDUCTIVE REASONING SKILLS
Pechak C, Thompson M; Texas Woman’s University, Dallas, USA
Cech D, Conroy C; Midwestern University, Downers Grove, IL, USA
PURPOSE: This study examined the prevalence of international
PURPOSE: A goal of physical therapy entry-level education is to service-learning (ISL) and other international volunteer service (IVS)
effectively and efficiently prepare students to utilize current best in US and Canadian physical therapy (PT) education programs,
evidence and make appropriate clinical decisions. It is important faculty’s perceptions of barriers to and benefits of ISL, and program
for the physical therapy education curriculum to assist students in differences between those with and without ISL/IVS. RELEVANCE:
developing critical thinking and clinical decision making skills. This The PT profession is at a critical point in defining and directing
study examined changes in critical thinking patterns of physical its role in the global health arena. ISL/IVS opportunities can
therapy students over the course of the entry-level physical therapy facilitate relationships between educational institutions in one country
education program, utilizing the Watson Glaser Critical Thinking with educational institutions and/or projects in other countries, and
Appraisal (WGCTA) and focusing on changes within the 5 subtests of offer PT students direct participation in examining global issues.
the instrument. Signifiant changes in critical thinking patterns were PARTICIPANTS: Questionnaires were sent to directors of all 213
considered in relation to the curricular map and as they reflected PT education programs in the USA and Canada. METHODS:
possible influences of the curriculum on development of clinical Eighty-seven questionnaires from US programs (44%) and 8 from
problem solving skills. RELEVANCE: This study provides insight Canadian (62%) were returned, resulting in an overall response rate
into the development of clinical problem solving skills for physical of 45%. Questionnaire consisted of four sections, one optional non-
therapy students; a method of curricular outcome evaluation; and a anonymous section about past and current ISL and IVS sites, and
framework for curricular development related to critical thinking and three anonymous sections that included: (a) demographics, use of
ISL/IVS (past 10 years), plans for ISL (next 2 years), and domestic to examine the effect of time delay in grading the videotaped
service-learning and volunteer service (past 10 years); (b) perceived performance comparing consistency of instructors’ video grading
barriers to ISL in the program, and benefits of ISL in general; and with live grading. RESULTS: No significant differences in midterm
(c) miscellaneous questions related to membership and international scores or final scores were noted between students using video or
health groups within the professional organizations of the USA and no video during self assessment. Both the video and the non-video
Canada. ANALYSIS: Descriptive analyses described respondents, groups improved significantly in exam scores by the final exam with
programs, and their responses. Chi Square examined differences the exception of professionalism scores, which did not significantly
between programs with and without ISL and/or IVS. RESULTS: In change. Comparing students’ self-scoring with instructors’ scoring
the past 10 years, 30% of the programs (28% US, 50% Canadian) revealed students graded their professional behaviors more critically,
had ISL, 23% (24% US, 13% Canadian) had IVS, and 43% (41% but had inflated views of their skills. When comparing agreement
US, 63% Canadian) had ISL and/or IVS. In comparison, 84% (86% between students’ self-score and instructors’ score, there were
US, 63% Canadian) utilized domestic service in the past 10 years. no significant differences between the video and non-video group.
Of those that did not utilize ISL and/or IVS in the past ten years, 17% Instructor scoring live during a practical was significantly different
planned to add ISL and 11% planned to add IVS in the next two years. from scores using the video tape when the variable of time between
No significant differences were found between the programs with ISL live and video grading was introduced. Immediate viewing of the
and/or IVS compared to those without either ISL or IVS – in structure video resulted in a slight reduction of the student’s score (3%
of university, private vs. public, entry-level degree. Lack of funding change in grade) whereas viewing 2 weeks later resulted in a score
and no faculty time were the greatest barriers, and positive effect on close to live scoring. CONCLUSIONS: Students’ self-assessment of
student personal development and facilitates students’ development practical exam performance is not enhanced by viewing videotapes
of cross cultural competency were the greatest benefits to ISL. US compared to self assessing without the visual aid. Viewing the video
programs have served in more countries, but Canadian programs did not improve final exam scores, nor did it improve agreement
have utilized countries with greater geographic variety. Most US and with the instructor’s scoring. Rescoring exams on video does not
Canadian programs have been in the Caribbean, Central America, result in substantial grade changes and thus may be an inefficient
and Mexico. CONCLUSIONS: Despite significant barriers, ISL exists use of instructor’s time. IMPLICATIONS: Use of videotaping to
in US and Canadian PT programs. Benefits are consistent with enhance skills and professionalism through self-reflection may be
core professional values and WCPT’s mission. Modest growth of more efficiently applied in a formative assessment environment rather
ISL and IVS is expected. IMPLICATIONS: Future research should than during a practical exam. Future studies should explore self-
address minimizing barriers, and include examination of successful assessment using videotapes in non-threatening practice situations
programs. KEYWORDS: service-learning, education. FUNDING and with one-on-one feedback. KEYWORDS: videotaping, self-
ACKNOWLEDGEMENTS: The Health Policy and Administration assessment, professionalism. FUNDING ACKNOWLEDGEMENTS:
section of the American Physical Therapy Association generously This research project was funded in part by the Judge Julian Beck
funded the cost of the survey. CONTACT: [email protected] Instructional Improvement Grant. The authors had no opportunity for
ETHICS COMMITTEE: IRB Committee – Texas Woman’s University, material gain from this project. CONTACT: [email protected]
Dallas, Texas ETHICS COMMITTEE: Approved by the Judge Julian Beck Grant
Committee
VIDEOTAPING PRACTICAL EXAMS FOR STUDENT VCEC Exhibit Hall B & C
SELF-ASSESSMENT: FOSTERING PERFORMANCE AND EFFECTS OF HIGH VOLTAGE PULSED CURRENT (HVPC), LOW
PROFESSIONALISM LEVEL LASER THERAPY (LLLT) ON THE HEALING PROCESS
Phillips B, Kachingwe A; California State University, Northridge, USA OF DIABETIC FOOT ULCERS
Sandoval Ortiz M, Herrera E, Camargo D; Universidad Industrial
PURPOSE: The purpose of this study was to explore the efficacy de Santander – Bucaramanga, Colombia
of videotaping practical exams as a mechanism to promote student
self-assessment of skills and professional behavior. Additionally, the PURPOSE: To establish the efficacy of HVPC, LLLT on the healing
use of video assessment for improving students’ exam scores and course of diabetic foot ulcers RELEVANCE: The experimental design
instructors’ accuracy in scoring was explored. RELEVANCE: Self- is the highest level of evidence. This research is the first in our
assessment is key to professionalism and an integral component of country that compares two modalities commonly used in physical
clinical practice and academic education of physical therapists. These therapy for healing diabetic ulcers PARTICIPANTS: Subjects with
aptitudes are emphasized in the Normative Model of Physical Ther- controlled diabetes according to WHO criteria, with foot ulcers stage
apist Professional Education and bring into question how to teach I to III (Wagner classification). Exclusion criteria were ulcer infection,
and evaluate student self-assessment abilities. PARTICIPANTS: Fifty amputation, or orthopedic or neuromuscular pathologic conditions.
students from two clinical courses were randomly assigned to assess The research protocol was approved by the Universidad Industrial
their skills and professional behavior immediately following their de Santander Health Faculty Ethics Committee METHODS: A three
practical exams using either a video tape of their performance or groups double blinded randomized trial: (CG) control group with
quiet reflection alone. METHODS: A detailed professionalism rubric standard nursing care, HVG (standard and HVPC: 100 pps, submotor
was developed and used in both classes in conjunction with the level, negative polarity during 4 days and then positive to the end of
skills portion of each exam. Students completed the same scoring treatment) and LG (standard and LLLT: punctual, 633 nm, 30 mW,
rubric as the instructor. Instructors graded students during the live continuous, 2 J/cm2 in the borders of the ulcer and 1.5 J/cm2 in the
practical exam and only this score was used in determining the bed). The patients were followed during 16 weeks. The end point was
student’s grade. The instructors repeated the entire grading process area reduction 75%. Variables related to neurological (protective
while viewing the videotaped performance at either 2 days or 2 sensation) and vascular (ABI index) status and neuroconduction
weeks post-examination to compare live versus videotape grading parameters (conduction velocity, latency, duration and amplitude)
consistency. ANALYSIS: One-way ANOVA was used to analyze were measured. Ulcer evaluation included location, area and depth
differences in final exam scores between video versus non-video ANALYSIS: CONSORT recommendations were followed. Multiple
groups and to compare the two groups on agreement of student log-binomial regression model was done [alpha=0.05] RESULTS:
self-scoring with instructor live scoring. Two-way ANOVA was used Ninety eight patients were assessed for eligibility, 65 excluded
because not meeting inclusion criteria, and 33 were allocated: 11 TCBs (5.69±0.69), and the TCBs subgroup mature D was smaller
(CG), 12 (HVG) and 10 (LG); 2, 1 and 1 were lost to follow up in each (4.51±0.6). The dimensional data showed higher differences in the
of the groups mentioned above. Twenty nine patients were analyzed; subgroup irradiated in mature group than subgroup irradiated in
mean age 59.8±11.9 years, 41.4% male, overweight 48.3% and young group. Histological analysis showed statistically significant
obesity 27.6%. Diabetes duration 11±9.9 years, and ulcers duration increase in the number of capillary vessels and fibroblast cell
16.2±34.6 months, 93.1% classified as Wagner I, initial area was proliferation after LLLT in both young and mature groups, but the
747.3±1495.8 mm2. Altered protective sensation was detected in higher stimulation was in the mature group. CONCLUSIONS: Minor
72.4% in plantar and 69% in sural. ABI index was normal in 90%. influence of laser radiation in the young group may be justified
Absent and abnormal potentials for motor tibial were 3.5% and by divergence on chemical, physical and metabolic age-related.
65.5%; plantar 48.3% and 13.8%, and sural 31.0% and 20.7% Maybe the accumulated oxidative stress resulting from a gradual
respectively. Except for area and depth of the ulcers there were shift in the redox status of tissues should be a key mechanism
not gross differences between groups. The end point was reached underlying the aging process and the higher laser effect noted
by 66.7%, 81.8% and 77.8% for CG, HVG and LG respectively. in the mature group. Age should be considerate an important
After adjusting by initial area and depth, multiple binomial regression parameter in the dosimetry of LLLT. IMPLICATIONS: The results of
model showed RR 1.07 (SE=0.0000738) and 1.32 (SE=0.000137) this work showed important parameter that it must be considered
for LG and HVG respectively compared to standard nursing care. in the LLLT of tendon healing, the age. KEYWORDS: Laser,
CONCLUSIONS: This study showed that the two modalities favor the growth plate, dosimetry, AFM. FUNDING ACKNOWLEDGEMENTS:
healing diabetic foot ulcers IMPLICATIONS: These modalities should CAPES, CNPq, FAPESP. CONTACT: [email protected]
be used as part of the treatment of diabetic ulcers KEYWORDS: ETHICS COMMITTEE: Federal University Animal Ethics Committee
Diabetic foot ulcers, low level laser therapy, high voltage pulsed approval.
current. FUNDING ACKNOWLEDGEMENTS: This research was
financed by the Instituto Colombiano para el desarrollo de la ciencia
y la tecnologı́a, Colciencias. CONTACT: [email protected] Research Report Poster Display
ETHICS COMMITTEE: The Universidad Industrial de Santander 10-04 Tuesday 5 June 10:30
Health Faculty Ethics Committee. VCEC Exhibit Hall B & C
TIME TO PEAK TORQUE OF THE MEDIAL ROTATORS OF THE
SHOULDER IN SUBJECTS WITH IMPINGEMENT SYNDROME
Mattiello-Rosa S, Camargo P, Santos A, Pádua M, Reiff R,
Salvini T; Department of Physical Therapy, Federal University of
São Carlos, São Carlos, SP, Brazil
AGE AND DOSIMETRY RELATED TENDON HEALING
RESPONSE IN THE RAT MODEL FOLLOWING LLLT: PURPOSE: The time to peak torque (TPT) and the peak torque
STRUCTURAL AND HISTOLOGICAL EVALUATION ratio of the lateral to medial rotators (LR/MR) during isokinetic
lateral and medial rotations of the shoulder were evaluated in
Parizotto N, Taciro C; Physical Therapy Department, Federal
subjects with shoulder impingement and in healthy subjects.
University of São Carlos – São Carlos (SP), Brazil
RELEVANCE: Studies about time to peak torque can provide
PURPOSE: Due to a complex interaction of medical and epidemi- information about the motor unit recruitment of the muscles involved
ological factors there has been a rapid increase in the size of the in a movement. In this case, the medial and lateral rotations of
elderly population. With this there has also been a parallel increase in the shoulder were evaluated. This information is important because
morbidity associated with age-related delayed tendinopathy healing, they could bring new information about the motor coordination and
and treatment of such acute and chronic condition costs the Health early intervention before clinical disturbance, especially in shoulder
Services over 1 billion dollars per year. Despite the obvious clinical impingement. PARTICIPANTS: Fifteen subjects (26.1±5.1 years)
impact, the basic cellular and molecular mechanisms underlying with shoulder impingement on the dominant side and 9 healthy
impaired human tendon healing are largely unknown. However, there subjects (21.5±1.3 years) were evaluated. The clinical diagnosis
are recent reports about the action mechanism of low level laser of shoulder impingement was made following the clinical criteria:
therapy (LLLT) producing accelerated tendon healing, but the real reproduction of pain by Neer, Hawkins and Jobe tests. Radiography
effects of this therapy associated with aging effects are not yet and ultrasonography for both involved and uninvolved shoulders
known. RELEVANCE: This study evaluated the effects of the LLLT were also conducted to confirm the diagnosis. METHODS: TPT and
on repair process of rat calcaneal tendon in different ages and LR/MR were measured bilaterally during isokinetic concentric lateral
purposes a relationship among age, tendon healing process and and medial rotations in the scapular plane, at 60º/s and 180º/s, using
lasertherapy. PARTICIPANTS: Eighty male Wistar rats were divided an isokinetic dynamometer. The evaluation at each speed consisted
in 2 experimental groups with 40 rats at each one: young group (4-5 of 5 repetitions of maximal effort during lateral and medial concentric
weeks old), mature adult (24-25 weeks old). METHODS: Each group rotations. ANALYSIS: Mann-Whitney and Wilcoxon tests were used
was subdivided in subgroup A (12 session, laser 685nm, 5.4W/cm2, 3 for the statistical analyses of the peak torque ratio and time to
J/cm2), subgroup B (12 session, laser 685nm, 5.4W/cm2, 10 J/cm2); peak torque. Within groups, dominant and nondominant sides were
subgroup C received placebo treatment, and subgroup D not received compared using Wilcoxon test. The dominant and nondominant sides
any treatment. Every subgroup was totally tenotomized in the medial of the impingement group were compared to their counterparts in
region of left calcaneal tendon. They were euthanasied on the the control group using Mann-Whitney test. A level of 5% was used
14th post-operative day and their tendons were surgically removed to determine significant differences. RESULTS: The impingement
for a quantitative and qualitative analysis. ANALYSIS: We used group showed a bilateral decrease (P < 0.05) in the TPT during
quantitative and qualitative analysis through atomic force microscopy medial rotation for both 60º/s and 180º/s. No differences were found
(AFM) for evaluated alignment, thickness and aggregation of collagen in the LR/MR between the groups (P > 0.05). CONCLUSIONS: It
bundles in mature irradiated groups. Light microscopy was used is proposed that decreased time to peak torque of the medial
to measure quantitative for capillary vessel and fibroblast cell rotators can be used as a tool for early detection of shoulder
proliferation. RESULTS: AFM analysis showed better organization impingement. Notably, the decreased time to peak torque of the
quality (alignment, thickness and aggregation) of collagen bundles medial rotators may occur before the alteration in the peak torque
in mature irradiated groups. However, it was found differences ratio. IMPLICATIONS: The results show the possibility of an early
(p < 0.05) in thickness of collagen bundles (TCBs) for several functional diagnosis associating time to peak torque with clinical
intersections between subgroups. The mature B subgroup had bigger tests in subjects with impingement syndrome or in subjects with
potential to develop this disturbance. This study also supports the that the expression of angiogenic factor mRNAs were decreased in
idea that shoulder impingement rehabilitation, mainly in the early unloading without exercise preconditioning than in control muscles.
stages, should focus on the bilateral training of the rotator cuff The expression levels of the angiogenic genes were higher in the
and proprioception. KEYWORDS: time to peak torque, rotator cuff, exercise preconditioning than the unloading muscles. Especially,
impingement. FUNDING ACKNOWLEDGEMENTS: Paula Camargo the expression levels of KDR/Flk-1, Flt-1 and Tie-2 genes were
and Michelle Pádua were the recipients of research fellowships from higher in the exercise preconditioning. CONCLUSIONS: Although
CAPES and CNPq (Brazilian agencies), respectively. CONTACT: hindlimb unloading conditions induced significant reduction of the
[email protected] capillary network with decreased angiogenic factors, results from
ETHICS COMMITTEE: This study was approved by the Ethical the present investigation indicate that the exercise preconditioning
committee of the university and was conducted according to the attenuated the regression of muscle capillary in hindlimb unloading
Helsinki Statement. rats. IMPLICATIONS: More mechanistic studies on the effect
of exercise preconditioning and how exercise may benefit Bed-
ridden patients with muscle atrophy are needed. KEYWORDS:
capillary network, angiogenic factors, exercise preconditioning.
10-08 Tuesday 5 June 10:30 FUNDING ACKNOWLEDGEMENTS: These findings indicate that
VCEC Exhibit Hall B & C the application of exercise preconditioning might be an effective
EXERCISE PRECONDITIONING ATTENUATES CAPILLARY countermeasure to muscle atrophy induced by hindlimb unloading.
REGRESSION IN ATROPHIED SOLEUS MUSCLE CONTACT: [email protected]
Fujino H1,2 , Kohzuki H1,2 , Takeda I2 , Kajiya F1,3 ; 1 Department ETHICS COMMITTEE: All experiments were permitted by the Animal
of Cardiovascular Physiology, Okayama University, Okayama; Experimental Committee of the Himeji Dokkyo University.
2 Department of Physical Therapy, Himeji Dokkyo University, Himeji;
3 Department of Medical Engineering, Kawasaki Medical School,
Kurashiki, Japan 10-12 Tuesday 5 June 10:30
PURPOSE: Much less is known about the coupling between VCEC Exhibit Hall B & C
capillary network and muscle disuse atrophy, although atrophy A DESCRIPTION OF LUMBO-PELVIC CONTROL: ITS ROLE IN
is characterized by a decrease in muscle volume, mass, and ECCENTRIC CONTROL OF THE HAMSTRINGS MUSCLES
strength. We have previously reported that muscle atrophy induced
Celebrini R1,2 , Allen T2 , MacIntyre D1,2 ; 1 School of Rehabilitation
structural alterations in the capillary network, an apoptosis of
Sciences, University of British Columbia, Vancouver, Canada;
endothelial cell of the muscle, and hemodynamic disturbance in 2 Rehabilitation Research Lab, GF Strong Rehab Centre, Vancouver,
capillaries (Fujino et al., J Appl Physiol, 2005). We propose here
Canada
exercise preconditioning as novel approach to retard the detrimental
effects of the atrophy process on the skeletal muscle. We have PURPOSE: The purposes of this single subject case report were
also investigated the mechanism of exercise preconditioning to 1) to determine if an instruction to voluntarily pre-contract the lumbo-
prevent structural alterations of the capillary network through the pelvic stabilizing muscles, could lead to a change in muscle activation
gene expression of angiogenesis-related factors in the rat soleus patterns and 2) to determine the effects of this pre-contraction
muscle following hindlimb unloading with exercise preconditioning. on a subject’s performance of an eccentric hamstrings exercise.
RELEVANCE: Bed-ridden patients require effective rehabilitation RELEVANCE: Despite wide spread use in injury prevention and
techniques to counteract inactivity-induced atrophy and facilitate the performance training, there are no studies indicating that active
recovery process. They require not only therapy to supplement lumbo-pelvic stabilization, i.e. voluntarily pre-contracting the core
existing physical activity but also preventive approach, which is stabilizing muscles, in healthy individuals, results in improvement of
based on their daily activity before “Bed-ridden”. PARTICIPANTS: performance outcomes. This study investigates the effect of active
Fifteen male Wistar rats were used in this study. They were lumbo-pelvic stabilization on an eccentric hamstrings exercise using
randomly divided into an age-matched control group, a hindlimb a unique test ideally suited for this purpose. PARTICIPANTS: The
unloading for 2-wk without and with exercise preconditioning. subject was a healthy, 23 year-old male, semi-professional level
The exercise preconditioning was performed treadmill running (20 soccer player. METHODS: The subject performed 17 eccentric
m/min, 20ºgrade, 25 min) before hindlimb unloading. METHODS: To hamstrings exercises, alternating between “active pre-contraction”
clarify three-dimensional architecture of capillary network, contrast (8 trials) and “no active pre-contraction” (9 trials) of the lumbo-
medium-injected sections were visualized clearly with a confocal pelvic stabilizing muscles. The eccentric hamstrings exercises were
laser scanning microscope. The mRNA for angiogenesis-related performed with the subject starting in a kneeling position with the
factors, including HIF-1 alfa, VEGF, KDR/Flk-1, Flt-1, angiopoietin- ankles stabilized, and gradually lowering his trunk and upper body
1 and Tie-2, was analyzed using a real time quantitative reverse to a horizontal position in a controlled motion. Active pre-contraction
transcriptase-polymerase chain reaction (real time PCR). In addition, involved a voluntary, submaximal contraction of the pelvic floor and
the myofibrillar protein content and myosin heavy chain isoforms were transversus abdominus muscles at the start of the test. Surface EMG
measured. ANALYSIS: Statistical significance was determined by the signals of 5 muscle groups were compared for onset and activity. The
nonparametric Kruskal-Wallis ANOVA test. If significant differences angle at which controlled movement was lost was measured using
were observed, then post hoc pairwise comparisons between all an Optotrack movement analysis system. ANALYSIS: EMG data
groups were made by Dunn’s method. In all cases, P < 0.05 were rectified, filtered and analyzed using custom software designed
was considered statistically significant. RESULTS: After hindlimb within Igor Pro (Wavemetrics). Muscle onset was defined as the time
unloading, the cross-sectional area of muscle fiber and muscle mass (seconds) or angle (degrees) at which EMG amplitude exceeded 3
were significantly decreased in with and without exercise. However, standard deviations above the resting EMG for a period of 400msec.
the exercise preconditioning showed significantly higher myofibrillar The “threshold angle” was defined as the knee angle at which joint
protein content and slow type of myosin heavy chain compared acceleration exceeded 120 º/sec2 . This threshold for acceleration was
with hindlimb unloading. The mean capillary density, the number the point in the exercise when the lowering movement could no longer
of anastomotic capillaries, the tortuosity of capillaries and capillary be controlled during the exercise as determined by the sharp increase
luminal diameter were significantly smaller in hindlimb unloading in acceleration at this point. Trials were averaged for each condition
than in control. However, in hindlimb unloading with exercise and means and standard deviations calculated. T-tests were used to
preconditioning, these were significantly higher compared with evaluate statistical differences (p < 0.05). RESULTS: Instructions to
hindlimb unloading without exercise. Real time PCR analysis showed “pre-contract” resulted in earlier EMG onset in the proximal muscles
(p < 0.05) and increased EMG signals in all muscles evaluated subjects who would quit smoking was lowest for subjects in their
(p < 0.05). The “pre-contract” trials showed a significantly greater twenties up to the price range of 700 yen. The results of Logistic
threshold angle (p < 0.001), a decrease in peak velocity (p = 0.002), Regression Analysis showed that prices necessary to achieve 25%
and a decrease in acceleration (p = 0.008) when compared to the and 50% cessation for subjects in their twenties were 430 yen and
“no pre-contraction” trials. CONCLUSIONS: These results indicate 550 yen, respectively. CONCLUSIONS: As cigarette prices in Japan
that 1) an instruction to “pre-contract” of the lumbo-pelvic stabilizing are significantly lower than those in other industrialized nations, it
muscles can lead to different muscle activation patterns and 2) the would be appropriate to set cigarette price to 430 yen to achieve a
“pre-contraction” resulted in improved performance of an eccentric 25% reduction in the smoking population and to set cigarette price
hamstrings exercise. IMPLICATIONS: This pilot study may lead to a to 550 yen to achieve a 50% reduction in the smoking population.
prospective experimental design to investigate further the relationship IMPLICATIONS: For an appropriate tobacco pricing policy and for
of voluntarily pre-contracting the lumbo-pelvic stabilizing muscles the prevention of smoking-related diseases in Japan. KEYWORDS:
and performance parameters. It is reasonable to hypothesize that smoking-related diseases, cigarette prices, public health. FUNDING
improved dynamic control of the lumbo-pelvic region should result in ACKNOWLEDGEMENTS: Funded by Department of Rehabilitation,
improvements in such areas as strength and balance performance. Seijoh University. CONTACT: [email protected]
However, at present there is no scientific basis for including this ETHICS COMMITTEE: The ethics committee of Seijoh University
component into injury prevention and performance training pro-
grams for healthy individuals. KEYWORDS: neuromuscular control,
core, hamstrings. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: Clinical Research Ethics Committee, Univer- Research Report Poster Display
sity of British Columbia, Vancouver, Canada 11-20 Tuesday 5 June 10:30
Research Report Poster Display PHYSICAL ACTIVITY BY PRESCRIPTION
11-16 Tuesday 5 June 10:30 Varning Poulsen D, Lund B; University College South
WHAT CIGARETTE PRICES WOULD BE REQUIRED TO REDUCE PURPOSE: To increase physical activity among citizens in the
THE SMOKING POPULATION IN JAPAN BY 25 TO 50 PERCENT? primary sector and to develope a trainingskonsortium (network)
between the PT school, private fitness studios and sports clubs in the
Kawamata M1 , Tsuda T2 , Senju H3 ; 1 Department of Rehabilitation,
community. RELEVANCE: In all civilized societies the consequences
Seijoh University, Aichi, Japan; 2 Department of Respiratory
for a physical inactive lifestyles is decreased health, with high
Medicine, Kirigaoka Tsuda Hospital, Fukuoka, Japan; 3 Course
health economical expences for the society and decrease quality
of Health Sciences, Graduate School of Biomedical Sciences
Nagasaki University, Nagasaki, Japan of life for the individual. The usual traditional approach to dealing
with this issue shows low compliance and marginal effekt on
PURPOSE: It had been reported that smoking was the leading peoples health. Previous experiences are that the participants stop
cause of death for 114,000 people in Japan. The rate of smoking exercising when the courses stops. Another kind of therapeutic
is higher in Japan than that of other industrialized nations. Lower approach seems to be required. Summarizing this means health
cigarette prices in Japan would be responsible for this situation. educationaly moving fra a “moralistic” approach to a “democratic”
Increases in cigarette prices have had an appreciable impact on approach with increase of peoples action competence as a mean!
smoking prevalence in several countries. However, cigarette prices DESCRIPTION: The physiotherapy department at the University
that could effectively accomplish a reduction in the size of the College South is the project manager and collaborates with general
smoking population are not clearly known. The present study aimed practitioners, sportsclubs in the community and private fitness
to determine appropriate hypothetical cigarette prices necessary institutions. The target group is people with: Diabetes Mellitus,
to achieve 25% and 50% smoking cessation for current smokers Metabolic Syndroms and Coronar Diseases. The age span is from
in Japan. RELEVANCE: This study may be able to assist in the 24 to 75. Course design: 12 participants pr. training group and each
formulation of an appropriate tobacco pricing policy and to prevent
person participates in an individual motivational dialog and test of
smoking-related diseases in Japan. PARTICIPANTS: 1,671 smokers
condition. These are repeated after 3 months, 6 months and 12
were chosen from 450,000 survey monitors. A stratified random
months. The course has a duration of 6 months, and the training
sampling method according to sex and prevalence of smokers in
intensity is 3 times pr. week one hour. 48 citizens have participated
their age group was utilized. A written consent was obtained for each
at the moment. The training is organised in such a way that it
subject. METHODS: A questionnaire survey regarding a hypothetical
motivates the participants to engage in new physical activity settings.
increase in cigarette prices and smoking behavior was conducted on
The physiotherapeutic approach is to be recognized as the health
them. A questionnaire survey was performed in September 2005 by
using the internet. Main question on the questionnaire survey was educational democratic approach which works with self-efficacy and
as follows: “If the price of cigarettes is increased to the following developement of action competence in mind. EVALUATION: The
prices, what would you do? Please choose one of the following 4 project is still running, and evaluation is therefor not completed at
choices. 1. I would keep smoking the same brand. 2. I would switch this moment. The evaluation will be based on: individual dialogs,
to a cheaper brand and keep smoking. 3. I would quit smoking. tests of condition, focusgroup interviews and evaluation of the
4. Other.” The hypothetical price increases ranged from 300 yen to course design and the collaboration and collaborating parts of
1,400 yen. ANALYSIS: Logistic Regression Analysis was applied to the network. CONCLUSIONS: The preliminary conclusion is that
analyze the relationship between the hypothetic increase in the price course has a positive impact on the participants and their lifestyle
of cigarettes and the smoking cessation rate. A value of p < 0.05 also after ending the course. IMPLICATIONS: We believe that
was considered significant. RESULTS: The subjects had an average outcome of physical activity by prescription could increase more from
age of 42 years (range: 20 to 69 years). The percentages of total focusing on 2 dimensions: • a physiotherapeutic health educational
subjects who would quit smoking given a cigarette price increase approach that has an awareness of more than the physiological
were 4.9% with a hypothetical price of 300 yen; 23.1% with a impact but also includes the human dimension and quality of life;
hypothetical price of 400 yen; 43.7% with a hypothetical price of 500 • a network orientation between collaborating partners who can con-
yen; and 77.4% with a hypothetical price of 1,000 yen (1USD=113 tribute with different offers located in the community. KEYWORDS:
YEN, September 2005). The study revealed that the percentage of Physical Activity; Health Education; Action Competence; Net-
work. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: Research Report Poster Display

[email protected], [email protected] 13-08 Tuesday 5 June 10:30
ETHICS COMMITTEE: Presented at the conference with the VCEC Exhibit Hall B & C
topic: “Enhancing physiotherapy competences in innovative learning ANALYZING ATTENTION POINTS TO DEVELOP TEACHING
environments” PROCEDURES FOR OBSERVATIONAL GAIT ANALYSIS
Watarai M1 , Kaneko S2 , Naka T3 ; 1 Department of Rehabilitation,
Research Report Poster Display St. Luke’s International Hospital, Tokyo, Japan; 2 Tokyo Metropolitan
13-04 Tuesday 5 June 10:30 University of Health Science; 3 Tokyo Metropolitan Institute of
VCEC Exhibit Hall B & C Gerontology
RELATIONSHIP BETWEEN GAIT SPEED AND ACTIVITY AT PRE- PURPOSE: This research aims to develop the teaching procedure in
FERRED GAIT SPEEDS ON FLAT GROUND AND TREDMILLS gait analysis for physical therapy students or inexperienced physical
Saito N; Department Of Physical Therapy,Health Science therapists by analyzing attention points. RELEVANCE: The teaching
University,Yamanashi,Japan procedure can help the learning process of students and physical
PURPOSE: It has been reported that the preferred gait speed on therapists. PARTICIPANTS: 10 physical therapy students took part
treadmills is much slower than that on flat ground, and the gait in this study. They were already lectured about gait kinematics and
speed on treadmills is felt faster. In this study, we compared speeds kinetics. The purpose and method of this study was informed and the
and mechanical activities at the preferred gait speeds between gait consents were acquired. In addition, the Research Ethics Committee
on flat ground and gait on treadmill. RELEVANCE: Abbreviation at St. Luke’s international hospital approved this study. METHODS:
PARTICIPANTS: Abbreviation METHODS: The subjects were 15 10 subjects saw a video of a person’s walking on the treadmill,
healthy young people (12 men and 3 women) aged 21-22 (mean: and an eye-mark recorder (EMR-8, NAC Inc.) was used to measure
21.1±0.4). The preferred gait speed on flat ground was determined their eye movements. Three trials were performed on each subject.
from the measured time of a 10m gait. Two preferred gait speeds on ANALYSIS: From these data (eye movements), the attention points
the treadmill (SPR-7050, Sakai Medical) were determined. One was were determined. Lengths of attention point trace and stationary
determined by increasing the speed up to the preferred gait speed, points were calculated. RESULTS: 1, At the beginning of the first
and the other was determined by decreasing the speed down to the trial, attention points’ traces of all subjects were moving without
preferred gait speed. ANALYSIS: In each measurement, data were stopping. So the lengths of attention point trace were longest of all
transmitted from small-sized, tri-axial acceleration transducers (AS- trials for all the subjects. 2, As the trials were repeated, the attention
TG, KYOWA) attached to the back of the subjects and connected to a points started to focus on particular areas. The more the trials were
PC via a dynamic strain measurement device (DPM-700B, KYOWA) repeated, the shorter the lengths of attention point trace were and
and an AD converter. The 3 dimensional change of acceleration rate the more the stationary points appeared. CONCLUSIONS: When we
during the preferred gait was then analyzed using the PC software see subjects, especially moving subjects, we try to find the attention
(PowerLab System 8, ADInstruments). An integral (total impulse) point that represents the feature of the subject. Then we focus on
of the averaged acceleration rates was determined, and used as the feature and analyze the point in detail. Through the process we
the index of activity. The gait speeds and mechanical activities can recognize the character of the moving subjects. This process is
wer compared by using one-way analysis of variance (repeated called as attention point analysis. This research proved that we use
measures) to find a significant difference. RESULTS: The mean this process in gait analysis. The knowledge from this study can help
preferred gait speed on flat ground was 4.98±0.70 [km/h]. The mean to develop the teaching procedure for observational gait analysis as
preferred gait speeds on the treadmill with increasing speed and we can teach students how to focus earlier on the relevant points of
decreasing speed were 3.85±0.79 [km/h] and 4.00±0.56 [km/h], detail. IMPLICATIONS: For physical therapy education KEYWORDS:
respectively. These results indicate the preferred gait speed on flat Observational Gait Analysis, Attention Points, Teaching Procedure.
ground was significantly faster than that on the treadmill (p < 0.05). FUNDING ACKNOWLEDGEMENTS: This work was unfunded.
The mean preferred gait activity on flat ground was 379.9±49.2 CONTACT: [email protected]
[N-min/kg]. The mean preferred gait activities on the treadmill with ETHICS COMMITTEE: Research Ethics Committee at St. Luke’s
increasing speed and decreasing speed were 292.1±56.3 [N-min/kg] International Hospital
and 311.5±61.6 [N-min/kg], respectively. These results indicate that
the activity of the preferred gait on flat ground was significantly higher
than that on the treadmill (p < 0.05). CONCLUSIONS: The preferred Research Report Poster Display
gait speed on the treadmill was slower than that on flat ground. These 13-12 Tuesday 5 June 10:30
results are identical to those reported previously, and are thought to VCEC Exhibit Hall B & C
be due to the difference in subjective speeds. It has been reported
AGE-RELATED DIFFERENCES IN SPATIOTEMPORAL MARKERS
that energy consumption is greater in a treadmill gait than in a flat-
OF GAIT STABILITY DURING DUAL TASK WALKING
ground gait at constant speeds. In this study, we compared energy
consumption at the subjective preferred gait speeds, and the results Hollman J, Kovash F, Kubik J, Linbo R; Program in Physical
suggest that the treadmill gait might consume less energy because Therapy, Mayo Clinic College of Medicine, Rochester, MN, USA
it is slower. We measured the changes of gait speed and activity of PURPOSE: Increased stride-to-stride variability during walking
young healthy subjects on flat ground and treadmills at their preferred characterizes gait instability and predicts falls in older adults.
gait speeds. The results suggest that the values of speed and activity
Walking while performing cognitive tasks (dual tasking) is also
at preferred gait speed may be higher in flat-ground gait than in the
associated with increased risk of falling. This study examined
treadmill gait. IMPLICATIONS: Abbreviation KEYWORDS: Activity,
whether variability in gait velocity differs in older adults compared
Preferred gait, Acceleration. FUNDING ACKNOWLEDGEMENTS:
with middle-aged and younger adults during dual task walking.
N.A.
RELEVANCE: Understanding the influence of dual tasking on
ETHICS COMMITTEE: Ethics committee on Health Science
gait may influence practices designed to minimize fall risk while
University was approved.
walking. PARTICIPANTS: Twenty older (mean age = 81 years),
20 middle-aged (mean age = 48 years), and 20 young adults
(mean age = 25 years) participated in the study. All participants
were classified as healthy non-fallers with normal cognitive abilities.
METHODS: Subjects walked across an instrumented walkway under
each of two conditions. In normal walking, subjects walked at self- in each testing condition. Test results were recorded using a hand-
selected speeds. In dual task walking, subjects walked while verbally held dynamometer. Hip abduction was tested with the subject in
spelling 5-letter words backward. Gait velocity was measured and side-lying with the upper thigh positioned at approximately 30º of
variability in gait velocity was quantified with the coefficient of abduction. Stabilization at the pelvis was provided by the examiner.
variation (%CV). Errors in the cognitive task were quantified in the Tests were performed with the dynamometer placed at both short
dual task condition. ANALYSIS: Analyses of variance (ANOVAs) and long lever positions. Hip adduction with manual stabilization
with post hoc t-tests were conducted to examine differences in was tested with the subject in side-lying and the examiner cradling
gait velocity and variability in gait velocity between groups and the non-test extremity. Tests were performed with long and short
between walking conditions. Cognitive performance during dual task lever arms. Hip adduction with fixed stabilization incorporated a 36
walking was compared between groups with the Kruskal-Wallis cm high padded bench for support of the non-test extremity. The
ANOVA by ranks. Relationships between cognitive performance adduction tests were repeated with the same HHD placements as
and walking performance were analyzed with Pearson product- with the manual stabilization tests. ANALYSIS: Intratester reliability
moment and Spearman rank correlation coefficients. An a value of was assessed using intraclass correlation coefficient model 3 form 1
0.05 was used for all tests. RESULTS: Older participants walked (ICC3,1). Intertester reliability was assessed using ICC(2,1). A
more slowly than did middle-aged and younger participants during t-test was used to assess torque differences between the hip
normal (122±23, 148±15 and 146±18 cm/s, respectively) and dual abductor tests. A two-way repeated measures ANOVA, with lever
task walking (97±22, 136±16 and 135±22 cm/s, respectively). arm (short and long) and bench (with and without) as independent
Similarly, gait velocity was more variable in older participants than variables, was conducted to examine differences in torque production
middle-aged and younger participants in normal (6.1±2.0, 3.6±1.5 (a=.05). Post hoc comparisons were analyzed using paired t-tests
and 3.9±2.3%CV, respectively) and dual task walking (9.0±6.5, with the Bonferroni-corrected a. RESULTS: Reliability of abduction
5.1±1.6 and 5.2±3.0%CV, respectively). Across groups, gait velocity testing was greatest in the long lever condition (0.93). Adduction
decreased and variability in stride velocity increased in dual task test reliability was greatest in the long lever condition with bench
walking. In older subjects only, increased errors in the cognitive stabilization (0.89). Maximal hip abduction torque tested in the long
task were correlated with reduced gait velocity (r=-.487) and lever position was significantly greater (t = 9.21, P < 0.001) than in
increased variability in gait velocity (r=.534). CONCLUSIONS: The the short lever position. Maximal hip adduction torque occurred using
gait changes observed in dual task walking characterize decreased a long lever for application of resistance and a bench to stabilize
gait stability and indicate that attention-demanding tasks during the non-test leg (F = 15.64, P = 0.001). CONCLUSIONS: Muscle
walking have a destabilizing effect on gait that is most apparent in performance testing of hip abductors and adductors using a hand
older people. Performing cognitively demanding tasks during walking held dynamometer can be performed with good to excellent intra
may place older people at greater risk of falling. IMPLICATIONS: and inter-tester reliability. Hip abduction is best performed using
Recognizing the potential role of attention-demanding tasks on a long lever. Hip adduction is best performed using a long lever
fall risk, one might instruct older individuals at risk of falling to and a bench to stabilize the non-test extremity. IMPLICATIONS:
avoid performing cognitive tasks while walking. In contrast, one This study provides evidence for preferred techniques to test hip
may also recognize the utility of dual tasking and choose to muscle performance in the clinical setting. KEYWORDS: Evaluation,
engage the individual in cognitive activities while walking in an measurement. FUNDING ACKNOWLEDGEMENTS: None.
effort to improve the person’s ability to perform dual tasks in a ETHICS COMMITTEE: Mayo Foundation IRB
safe and functional manner. KEYWORDS: Gait instability; Aging;
Dual task. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: Research Report Poster Display
[email protected]
ETHICS COMMITTEE: Mayo Foundation Institutional Review Board
THE SLOUCHED POSTURE EFFECT ON EMG OF SHOULDER
GIRDLE MUSCLES DURING ELEVATION ON THE SCAPULAR
PLANE
VCEC Exhibit Hall B & C Sagano J1 , Shirogane S2 , Yoshida N2 , Yamanaka M3 ; 1 Dept of
Rehabilitation Medicine, Fujisawa Shounandai Hospital; 2 Institute of
INFLUENCE OF LEVER ARM AND STABILIZATION ON
Rehabilitation Science, Tokuyukai Medical Corporation; 3 Department
MEASURES OF HIP ABDUCTION AND ADDUCTION TORQUE
of Health Sciences, Hokkaido University School of Medicine
OBTAINED BY HAND-HELD DYNAMOMETRY
Krause D, Schlagel S, Stember B, Zoetewey J, Hollman J; Program in PURPOSE: To investigate the effect of trunk posture (erect or
Physical Therapy, Mayo Clinic College of Medicine, Rochester, USA slouched posture) on the EMG activity of shoulder girdle muscles
(upper trapezius, middle trapezius, lower trapezius, serratus anterior,
PURPOSE: (1) To assess the intra and inter rater reliability of hip and latissmus dorsi) during elevation on the scapular plane.
abduction and adduction strength testing (2) To evaluate torque RELEVANCE: The slouched posture is thought to be one of the
values using long and short lever arms, and (3) To evaluate manual causes of shoulder joint dysfunction. To prevent the trouble of the
and fixed stabilization on hip adductor strength testing. RELEVANCE: shoulder and to develop specific exercises in physical therapy, it
Given manual muscle testing problems reported because of the force is important to reveal the effect of trunk posture on activation
producing capacity of hip muscle groups as compared to examiner patterns of shoulder girdle muscles. PARTICIPANTS: A sample
strength, we propose reliable testing techniques for use by clinicians of 9 healthy young subjects with full, pain-free shoulder range of
and a novel technique for testing hip adductors. PARTICIPANTS: motion, and no history of shoulder pathology. METHODS: Each
Twenty-one healthy subjects (12 men and 9 women) were recruited subject was positioned and stabilized while sitting in both erect
from the authors’ institution. The age range was 22 to 31 years. and slouched posture. In each sitting posture a three dimensional
Exclusionary criteria were a history of hip or knee injuries/pathology electromechanical digitizer was utilized to measure the trunk posture
on the tested lower extremity. METHODS: Six different testing and humeral position. Trunk angle was defined between a line
positions were performed. Each test was administered three times passing C6 and Th1 and a line passing th12 and L3. Then
on each subject. Examiner A tested each position twice to examine subjects elevated the arm on the scapular plane. The superficial
intra-rater reliability. Examiner B tested each position once in order EMG recorded the output from the target muscles during elevation
to examine intertester reliability compared to examiner A. Examiners on the scapular plane. ANALYSIS: EMG activities were analyzed
applied force that was sufficient to overcome subject generated force while each subject performed humeral elevation in two different
seated positions. The data were normalized by maximum voluntary segments to be included in this new clinical postural assessment
contraction. And the results were analyzed statistically using a paired tool (cervical, thoracic and lumbar curves, head, shoulders, pelvic
T test. RESULTS: The mean trunk angle of each posture was 10.6 and lower limb alignment in three planes). Digital photographs will
degrees in the erect posture, and 37.7 degrees in the slouched be taken and calculation of these angles will be software-based.
posture. The slouched posture showed less muscles activity than Postural asymmetries are associated to corresponding muscular
erect trunk posture in all muscles. In upward phase, statistically chain (anterior or posterior) implication. CONCLUSIONS: A postural
significant muscle activity differences were seen in upper trapezius, assessment tool must contain postural indices that are useful to
middle trapezius, lower trapezius, and serratus anterior muscle. characterize the specific pathology. It should be easy and fast to
The latissmus dorsi muscle showed no significant difference. In use, reproducible and sensitive to short-term change, inexpensive,
downward phase, there were significant differences in all muscles accessible for use in clinical settings, and should guide clinicians to
except middle trapezius muscle. CONCLUSIONS: The results in understand muscle involvement in those with postural abnormalities.
this study showed trunk posture affects the muscle activity around Measurement of body angles taken from photographs may be the
shoulder girdles. The slouched posture significantly decreases the most comprehensive, accurate and rapid way to assess posture in
periscapular muscle activity. IMPLICATIONS: The results in this a clinical setting. The planned development of a software program
study suggest that the trunk posture affects the activation patterns of to measure the indices on a digital photograph will simplify the
shoulder girdle muscles. This knowledge may contribute to physical process and make it more uniform. Based on our literature review and
therapy for shoulder joint. KEYWORDS: The results in this study analysis, we have developed a new clinical postural tool. This new
suggest that the thoracic posture affects the activation patterns of tool will require a rigorous validation process before its utilization.
shoulder girdle muscles. This knowledge may contribute to physical IMPLICATIONS: This new tool will improve physical therapy practice
therapy for shoulder joint. FUNDING ACKNOWLEDGEMENTS: This by facilitating the analysis and diagnosis of underlying mechanical
study was unfounded. CONTACT: [email protected] causes of postural abnormalities. KEYWORDS: Posture assessment,
ETHICS COMMITTEE: Ethics committee of faculty of Health Science, reliability, validity. FUNDING ACKNOWLEDGEMENTS: This project
Hokkaido University is supported by the Discovery Advancement Program of the
Canadian Arthritis Network. C.Fortin is supported by a Ph.D.
scholarship from the FRSQ, MENTOR (CIHR) and research centre
of CHU Sainte-Justine.
DEVELOPMENT OF A NEW GLOBAL QUANTITATIVE CLINICAL
POSTURAL ASSESSMENT TOOL 16-04 Tuesday 5 June 10:30
FortinC1,2 , Feldman D3,5 , CherietF1,4 , Labelle H1,2 ; 1 Centre de
recherche CHU Sainte-Justine; 2 Faculté de médecine, Université de OUTCOME MEASURES OF FUNCTIONAL PERFORMANCE
Montréal; 3 École de réadaptation, Université de Montréal; 4 École IN PERSONS WITH ANKLE FRACTURES. A ONE YEAR
polytechnique, Université de Montréal; 5 Groupe de Recherche FOLLOW-UP
Interdisciplinaire en Santé Hugo B1 , Borjesson M1,3 , Karlsson Thur C2,4 , Wretenberg P2,4 ;
1 Section of physiotherapy, Karolinska University Hospital, Stockholm,
PURPOSE: Physiotherapists commonly assess posture and tend
Sweden; 2 Section of orthopaedics, Karolinska University Hospital,
to do so qualitatively. Evidence-based practice calls for objective
Stockholm, Sweden; 3 Department of neurobiology, care sciences and
tools to monitor treatment effectiveness. The purpose of this project
society, division of physiotherapy, Karolinska Institutet, Stockholm,
is to identify valid and reliable postural indices (from the current
Sweden; 4 Department of molecular medicine and surgery, section
literature) and construct a quantitative clinical postural assessment
of orthopaedics, Karolinska Institutet, Stockholm, Sweden
tool that relates posture to muscle involvement that will be useful for
clinicians assessing and treating postural problems. RELEVANCE: PURPOSE: Ankle fractures are one of the most common injuries
Postural asymmetries may be the cause or consequence of pain, in the lower extremities, but few studies have been published
bony deformity or muscle imbalance. Radiological images verify the evaluating functional performance after ankle fractures with objective
bony structures, however, postural problems are not necessarily activity tests. Self-selected walking speed is an objective, valid
reflected by bony structural problems. Developing a quantitative tool and reliable test of functional performance and has been used in
to assess posture will describe posture in an objective fashion and many populations, both healthy persons and persons with different
will enable monitoring of change over time. This will be useful for impairments. The aim of this study was to evaluate some commonly
clinicians to describe disease progression, or to demonstrate effec- used outcome measures and self-selected walking speed in persons
tiveness of therapeutic approaches. DESCRIPTION: We conducted with ankle fractures. This study was part of a larger study with
a comprehensive literature search in order to retrieve articles that the purpose of measuring functional performance in persons with
describe psychometric properties of postural indices and evaluations ankle fractures. RELEVANCE: It is important to find objective activity
that have been used previously in clinical settings. We used the tests that are easily performed in a clinical setting. Measurements
following keywords to search for articles on posture from 1980- of gait speed are easily performed, a stopwatch and a measured
2006 in CINAHL, Embase and Medline: posture and assessment, distance is all that is needed. PARTICIPANTS: This prospective study
posture and scoliosis, posture and reliability and posture and low included 35 patients, aged 17-88 years, with ankle fractures, who
back pain. EVALUATION: We identified 32 different articles that were operated between February and June 2005 at the Karolinska
responded to our search criteria. Results revealed that none of the University Hospital in Stockholm, Sweden. The persons were tested
measurement tools based on visual observations (direct or from 6 months and 1 year after the operation. Two persons were unable
photographs) met the criteria of reliability and accuracy to assess to attend one of the follow-up meetings and were therefore excluded
effectiveness of physiotherapy interventions in patients with stroke from this study. METHODS: Outcome measures were loaded dorsal
or low back pain. Reliability of quantitative clinical methods using and plantar flexion, number of toe rises, ankle circumference
photographs or instruments such as goniometer, inclinometer, tape (swelling) and normal and fast self-selected walking speed, combined
measurement, flexi-rule, etc. has been demonstrated. Reliability of with an estimation of pain during walking according to Borg CR 10
postural body angles was higher in studies using biologically relevant scale. The study was approved by the institutional ethics committee.
measurement (relative measurements between body segments) than ANALYSIS: Mean and standard deviation were calculated and
those using an external vertical reference line for postural angle median and range (Borg CR 10 scale). Student’s t-test was used
calculation. We identified 14 relevant items representing all body to calculate differences between the 6 month and 1 year follow-up.
RESULTS: Loaded dorsal flexion improved from 29 to 30 degrees visits to the orthopaedic surgeon, injections and surgeries. Most
(p < 0.05), loaded plantar flexion improved from 39.5 to 42 degrees of those services addressed peripheral joint impairments related to
(p < 0.01), number of toe rises improved from 19 to 21 (p < 0.05) and osteoarthritis. Subjects in the IFR had two times more diagnostic
swelling decreased from 28.1 to 27.9 centimetres (p < 0. 05). Normal radiology procedures during the second year (p = 0.03). However,
walking speed increased from 1.28 m/s to 1.39 m/s (p < 0.001). Fast only three patients in each group (8.6%) received X-Rays of the knee.
walking speed increased from 1.83 m/s to 1.97 m/s (p < 0.001). Pain During the third year after TKA, no significant difference was found
during walking according to Borg was stated 0 (=no pain) in both between groups for health care services utilization. CONCLUSIONS:
walking speeds at both test occasions. CONCLUSIONS: The tests During the second year after TKA, participants in the control
of loaded dorsal/plantar flexion, number of toe rises and swelling were group required more medication and more medical services than
not considered clinically relevant. The tests of self-selected walking participants in the IFR group. However, this finding is unlikely due to
speed were considered clinically relevant. Measurement of self- IFR only given the short duration of the IFR. Many other factors could
selected walking speed is a relevant and objective method to evaluate have impacted on the measured outcomes such as physical activity
functional performance after ankle fractures. IMPLICATIONS: Tests level, general health and joint condition and ageing. IMPLICATIONS:
of walking speed, positive aspect: It is easily performed in a clinical No long term benefits of the IFR program were observed in this
setting. Limitations: Assumes no other new conditions affecting gait study. To maintain the benefits of IFR on functional ability and
during the follow-up period. KEYWORDS: ankle fracture, outcome QOL after the first year post surgery, the practice of exercises and
measures, walking speed. FUNDING ACKNOWLEDGEMENTS: -. physical activities should, most likely, be continued on a regular basis.
CONTACT: [email protected] KEYWORDS: Health services utilization; Rehabilitation intervention;
ETHICS COMMITTEE: Karolinska University Hospital, Stockholm, Knee surgery. FUNDING ACKNOWLEDGEMENTS: This project was
Sweden 03-764 funded by the Canadian Institutes of Health Research. CONTACT:
[email protected]
ETHICS COMMITTEE: Ethics Committee from Quebec Rehabilita-
tion Institute, Quebec City, Canada
INTENSIVE FUNCTIONAL REHABILITATION AFTER PRIMARY
TOTAL KNEE ARTHROPLASTY: LONG TERM FOLLOW-UP IN 17-16 Tuesday 5 June 10:30
PARTICIPANTS OF A PREVIOUS RANDOMIZED CLINICAL TRIAL VCEC Exhibit Hall B & C
Moffet H1,2 , Denis M2,3 , Collet J4 , Shapiro S4 ; 1 Department of AQUATIC EXERCISE COMPARED WITH LAND-BASED
Rehabilitation, Faculty of Medicine, Laval University, Quebec City, EXERCISE IN PATIENTS WITH KNEE OSTEOARTHRITIS. A
Canada; 2 CIRRIS Research Center, Quebec Rehabilitation Institute, RANDOMIZED CONTROLLED TRIAL
Quebec City, Canada; 3 CHUQ (Hôtel-Dieu Hospital), Quebec City, Weile U; Parker Institute, Copenhagen, Denmark
Canada; 4 Department of Epidemiology and Biostatistics, McGill
University, Montreal, Canada PURPOSE: To compare in the treatment of knee osteoarthritis (OA)
an aquatic with a land-based exercise program focusing on balance,
PURPOSE: To compare functional ability and quality of life (QOL) strength, and function applying similar exercises considering the
3 years after a primary total knee arthroplasty (TKA) and utilization different media. RELEVANCE: Physiotherapeutic treatment is a part
of health care services during the 2nd and 3rd year after TKA, in of the management of knee OA and is second most frequently
persons who participated in a previous randomized controlled trial. prescribed treatment after medication. PARTICIPANTS: 79 patients
RELEVANCE: In a previous study, the effectiveness of an intensive (17 male and 62 female, mean age 68 years old) with knee OA
functional rehabilitation (IFR) program to improve functional ability were randomized into one of three groups: aquatic exercise (n=27),
and QOL during the first year after TKA has been demonstrated. In land-based exercise (n=25), or control (n=27). METHODS: The
that study, 77 persons with knee osteoarthritis who had undergone intervention groups had two exercise sessions pr week for eight
primary TKA were randomized into two groups. Two months after weeks with a follow-up after 3 months. The outcome measures
TKA, half of them received the IFR program consisting of 12 were static balance measured on a force plate, isokinetic muscle
supervised rehabilitation sessions combined with home exercises. strength, KOOS questionnaire, and pain measured on a VAS scale.
The other participants received the usual care (control group: The measurements were performed by independent observers.
CTL). Long term impacts of the IFR program are, however, ANALYSIS: The primary analysis is based on a mixed procedure
unknown. PARTICIPANTS: Sixty-two persons from the previous via General Linear Model, with the outcome measures as dependent
cohort participated in a functional ability and QOL evaluation 3 years variables. Subject was applied as random factor, treatment group as
after TKA (IFR: n=33 CTL: n=29) and we obtained information from fixed-factor, and for each analysis the individual base-line level was
government statistics data banks for the 2nd and 3rd year after TKA used as covariate in the 1-way analysis of covariance. In addition,
for 70 persons (IFR: n=35 CTL: n=35). METHODS: Functional ability an intention to treat analysis was included using the last observation
was evaluated with the 6-minute walk test (6MWT) and the Western carried forward methodology. RESULTS: Attendance was 92% in the
Ontario and McMaster Universities Osteoarthritis Index (WOMAC). aquatic group and 85% in the land group. Balance expressed as the
QOL was evaluated with the Medical Outcomes Study 36-item Short- sway velocity, was significantly lower in the aquatic group compared
Form Health Survey (SF-36). Healthcare services utilization and to the land-based group (0.7032 s vs. 0.8561 s,p = 0.034). Balance
medication costs were collected from the Quebec Government Health expressed as a percent of maximal stability showed a significantly
Care and Social Services Ministry. ANALYSIS: T-tests for indepen- better stability in the aquatic exercise group compared to the
dent samples and 95% Confidential Intervals of mean differences control group (79.6% vs. 76.6%, p = 0.030). No significant differences
were used to compare groups. RESULTS: Three years after surgery, between groups were observed for muscle strengh, self-reported
no significant difference between groups was demonstrated for the daily symptoms, pain, daily function, sport activities, or quality of life
6MWT. Total and subscale scores from the WOMAC questionnaire (measured as KOOS). At follow-up, a significant reduction in pain at
and from the SF-36 were similar in both groups. Two years after rest was observed in the land-based exercise group compared to the
surgery, non-steroid anti-inflammatory medication cost was higher control group (11.2mm vs. −8.3 mm,p = 0.039). A highly significant
in the control group (p = 0.01); otherwise, the medication costs difference in adverse effects was observed between the aquatic and
were similar three years after TKA in both groups. Subjects in land-based exercise, i.e. 14 participants reported adverse effect in
the control group required more orthopaedic services during the land-based exercise while only 3 reported adverse effect in aquatic
second year after surgery (p = 0.02). Those services included medical exercise group (p = 0.0002). CONCLUSIONS: Exercising in water
is superior to a land-based program concerning balance. Adverse CONCLUSIONS: Effects of OAFantasyTM brace on joint kinematics
events are significantly more frequent with the land-based program was identified and determined. An estimated 0.56 mm decrease of
compared to the aquatic exercises. However, no effect on daily joint compression was smaller than 5 unloading braces that applied
function or pain was observed in either the groups. IMPLICATIONS: direct valgus force on the knee (Dennis, 2006). Considering excellent
For physical therapy practice. KEYWORDS: Knee osteoarthritis; clinical results of this brace, joint unloading of 0.5 mm may be
Aquatic therapy; Balance. FUNDING ACKNOWLEDGEMENTS: The sufficient for successful bracing for knee OA. The unique hinge
study was supported by The Oak foundation, The Research mechanism that does not require uncomfortable valgus force may
Foundation of the Danish Physiotherapy Association, The Danish be the key to the success of this brace. IMPLICATIONS: Patients’
Rheumatism Association, the Spies foundation, and H:S Central compliance for knee brace is a significant clinical challenge and
Research Fund Denmark. Skilful and much- appreciated assistance efforts of reducing weight of the brace and direct force on the joint
was given by supervisor PT,PhD Hans Lund,the Parker Institute, have been required. The result of this pilot study provides support
Copenhagen, Denmark. CONTACT: [email protected] for the efficacy of an advanced hinge mechanism for OA braces.
ETHICS COMMITTEE: The Scientific-Etical Committee for Copen- KEYWORDS: knee osteoarthritis, unloading brace, joint separation.
hagen and Frederiksberg, Denmark. FUNDING ACKNOWLEDGEMENTS: Funding for the direct costs
of this study was provided by Keiai Orthopedic Appliance Co., Ltd.
None of the authors received any salary by participating in this study.
17-20 Tuesday 5 June 10:30 ETHICS COMMITTEE: Approved by the Ethics Committe at Faculty
VCEC Exhibit Hall B & C of Health Sciences, Nagasaki University
RADIOGRAPHIC EVALUATION OF AN OFF-LOADING KNEE
BRACE APPYLYING NO DIRECT FORCE ON THE JOINT MEA-
SURED BY A SINGLE-PLANE SHAPE-MATCHING TECHNIQUE
Sadakiyo M1 ,Sugino S1 ,Gamada K2 ,
Yokoyama S3 ,
Banks S4 ; VCEC Exhibit Hall B & C
1 Department of Rehabilitation, Sadamatsu Hospital, Omura, Japan;
2 Department of Physical Therapy, Hiroshima International University, MEASUREMENT OF PAIN RELATED FEAR IN PATIENTS WITH
Higashi-Hiroshima Japan; 3 Department of Physical Therapy, Seirei LOW BACK PAIN: CAN IT BE DONE SIMPLY?
Christopher College, Shizuoka, Japan; 4 Department of Mechanical Oostendorp R1−3 , Demolon N2,4 , Van der Zanden O2,4 , Duquet W2 ;
1 Radboud University Nijmegen Medical Centre, Nijmegen, The
and Aerospace Engineering, University of Florida, Gainesville, USA
Netherlands; 2 Free University of Brussels, Faculty of Medicine
PURPOSE: OAFantasy™ (Keiai Orthopedic Appliance, Japan) is
and Pharmacology, Brussels, Belgium; 3 Dutch Institute of Allied
a unique unloading brace for knee osteoarthritis (OA) providing
Health Care, Amersfoort, The Netherlands; 4 Private Practice for
excellent clinical results and high compliance. It applies no direct
Physiotherapy, Belgium and The Netherlands
force on the joint, but separates the medial compartment by utilizing
specially designed hinges, in which the medial hinge extends and PURPOSE: The study had three objectives: (1) to determine the
the lateral hinge shrinks as the knee extends, so that the medial prevalence of pain-related fear in patients with chronic low back pain
compartment is unloaded requiring less bulky structure. The goal (CLBP) in a physical therapy private practice setting; (2) to determine
of this study was to determine if OAFantasy™ has any kinematic the differences in characteristics of subjects with a high versus low
effects on the knees with varus deformity. We hypothesized that it score on the Tampa Kinesiophobia Scale (TKS); (3) to determine
decreases adduction angle of the knee during open and closed chain which question(s) have prognostic value for classifying patients with
activities. RELEVANCE: This study will provide evidence of the effect CLBP in a high versus low TKS score category. RELEVANCE: CLBP
of an unloading knee brace on the joint kinematics. PARTICIPANTS: is one of the most common health problems in primary care. Many pa-
Twenty knees of 10 consenting patients with bilateral, primary knee tients are referred to physiotherapy. Since pain-related fear is a very
OA were enrolled in this IRB-approved, prospective study. Knees with strong prognostic factor in LBP its recognition is important to make an
history of traumatic events, ligament injuries, fractures, rheumatoid adequate choice with regard to physiotherapeutic treatment strategy.
arthritis or surgeries were excluded. METHODS: A shape-matching PARTICIPANTS: Patients with LBP (>6 weeks) were recruited from 6
technique (Banks, 1996) using single-plane frontal fluoroscopy and private practices for physiotherapy in The Netherlands and Belgium.
CT-based patient-specific knee models were used for kinematic METHODS: Questionnaires were used to collect data on patients’
analyses. Participants underwent CT scan at 1.0 mm slice width characteristics (e.g., age, gender, education, duration of LBP, medica-
to create geometric bone models of the femur and tibia. Patients tion), pain intensity (Visual Analogue Scale [VAS score range 0-100]),
first performed 3 cycles of weightbearing and non-weightbearing pain-related fear with regard to injury and movement (Tampa Kinesio-
knee extension activities without the brace for each knee, followed phobia Scale [TKS score range 17-68]), depression (Beck Depres-
by the same activities with the brace. The range of knee motion sion Inventory [BDI score range 0-63]), pain coping behaviour (Pain
was set between 30 degrees and maximal voluntary extension. Coping Inventory list [PCI]; six subscales), and activities of daily living
ANALYSIS: A custom program (KneeTrack) produced by a co- (Oswestry Low Back Pain Disability Questionnaire [OLBPDQ score
author (SB) were used for the shape-matching procedure to obtain range 0-100%]). ANALYSIS: The data were analyzed with descrip-
6 degrees-of-freedom knee kinematics (Fregly, 2005). Cardan/Euler tive (frequency distribution, central tendency) and (non)parametric
angle convention (Tupling and Pierrynowski, 1987) was used for inferential statistics (alpha set at 0.05). Forward stepwise logistic
quantitative analyses. Paired t-test and Bonferroni correction were regression was used to determine which question(s) had the highest
used for comparisons of flexion and abduction angles (4 tests) and prognostic value to classify patients in a high versus a low TSK
p < 0.05 were used for the level of significance. RESULTS: None of score category. RESULTS: Fifty patients with CLBP participated.
the patients experienced increased pain during the experimental ac- The TKS total score varied between 23 and 57. The median score
tivities and all performed the requested motions without restrictions. (38.5) was chosen as cut-off point for a high (>38.5; n=24) versus a
Two patients (4 knees) were excluded from the analysis due to the low (<38.5; n=26) score on the TKS. Use of medication, stopping of
image blur of the video fluoroscopy. Bracing increased the abduction activities/hobbies due to LBP, worrying/catastrophizing, use of rest,
angle during weightbearing extension by an average 0.64 degree and passive coping strategies were significantly higher (p0.05) in
(p = 0.006) which was significant after Bonferronni correction, while subjects with a high TKS score. The “agree” option for the statement
there were no differences in knee extension nor external rotation “the safest way to prevent an increase in pain is prevention of unnec-
angles. Trigonometric calculation revealed an abduction angle of 0.64 essary movements” (TKS statement 10) had the greatest predictive
degree was equivalent to 0.56 mm less medial joint compression. value (92%) for identifying subjects with a high TKS score (22 out
of 24 patients). CONCLUSIONS: Pain-related fear of injury and where differences in stiffness curves of PAs of the cervical spine
movement is common in patients with LBP. Patients with a high or a in painful and less painful locations were suggestive of both of the
low TKS score have significantly different characteristics. The “agree” patterns described from the non-linear simulations. Further studies
option for TKS statement 10 is a good prognostic indicator of a TKS are underway to clarify the relationship between symptoms and
score higher than the median (high score category). IMPLICATIONS: PA mobility. Recognising the non-linear behaviour of intervertebral
It is possible to measure pain-related fear in a simple manner in stiffness and the complex relationship between intervertebral mobility
daily practice. It is important to recognize pain-related fear in patients and PA stiffness may result in greater accuracy in the assessment
with LBP because the best available evidence for physiotherapeutic and interpretation of both manual and instrumented assessment of
treatment for these patients is exercise therapy combined with passive movements. KEYWORDS: simulations passive movements.
cognitive behavioural principles exposing patients to pain-related FUNDING ACKNOWLEDGEMENTS: NT is supported by an Aus-
activities. KEYWORDS: Low back pain, pain-related fear, physiother- tralian Postgraduate Award. CONTACT: n.tuttle@griffith.edu.au
apy, exposure. FUNDING ACKNOWLEDGEMENTS: No funding was
received for this study. CONTACT: [email protected]
ETHICS COMMITTEE: Commissie Mensgebonden Onderzoek, Vrije
Universiteit Brussel, Belgium. Research Report Poster Display
THE COMPARISON OF STRETCHING AND PASSIVE CLOSE
LENGTHENING FOR INCREASING AROM – WHAT IS PASSIVE
CLOSE LENGTHENING?
THE EFFECTS OF ALTERING INTERVERTEBRAL STIFFNESS
Ikebuchi N1 , Utsunomiya H2 ; 1 Japanese Physical Therapy
ON PASSIVE MOVEMENT TESTING OF THE CERVICAL SPINE:
Association,a health care center for the elderly (MIZUHO club,
A COMPUTER-BASED SIMULATION
Japan); 2 JM institute
Tuttle N, Laakso L, Barrett R; School of Physiotherapy and Exercise
Scicnce, Griffith University, Gold Coast, Australia PURPOSE: In comparison with active range of motion (AROM) of
shoulder joint flexation, this study was undertaken to introduce a
PURPOSE: To determine how increasing segmental intervertebral
new technique called passive close lengthening (CLOSE) that was
stiffness affects simulated passive posteroanterior movements (PAs)
found to be more effective than conventional methods of stretching.
to the cervical spine. RELEVANCE: PAs are common techniques
The aim of CLOSE is to bring joint surfaces closer to each other
intended to assess stiffness of individual intervertebral motion
when bone movement is stopped, after it was moving more – a
segments. PAs were originally considered to produce isolated
technique pioneered by Hatsuo Utsunomiya from Japan. As a result,
accessory glides between vertebrae and were described as though
this technique made joint movement easier. Based on the results of
the PA movement occurred entirely at the target location. It is
research completed, I will present a comparison of the conventional
now known that PAs affect both local and regional structures, but
method with this new technique. RELEVANCE: This study applies
it is not known how altered mobility at specific locations affect
to the Exercise in Track3. PARTICIPANTS: A total of 41 subjects
PAs. PARTICIPANTS: Computer based simulation. METHODS: A
whose shoulder joints have neither disease nor pain. The subjects
simplified two-dimensional computer-based model of the cervical
spine was constructed consisting of eight bodies corresponding to the who agreed to participate in this study comprised 31 women and
head and cervical vertebrae linked by seven uniaxial joints. One set 10 men with a mean age of 82.5±6.7 years (ranging from 66–95
of simulations of PA movements at C4/5 (target level)was performed years of age). METHODS: A measured AROM of flexation shoulder
with the joints modelled as linear springs with constant stiffness. joints while in a sitting position was compared with three patterns:
Simulations were performed using: 1) normal stiffness values, 2) the control, stretch and CLOSE groups. Within each group, 30
increased intervertebral stiffness at the target level and 3) increased shoulders from among the 41 subjects were randomly selected.
stiffness at C3/4 (adjacent level). Two additional sets of simulations When a subject was chosen more than once, there was at least a
were then performed with the joints modelled as non-linear springs one week gap between testing. The control group was examined to
with minimal stiffness in the neutral zone and linear interpolations see whether a change occurred by performing flexure twice. After the
of stiffness between known data points. Sets of simulations were first measurements were taken with the stretch and CLOSE groups, I
performed with the intervertebral stiffness increased in two ways; the used each technique and attempted to move their joints as much as
size of the neutral zone decreased and the stiffness within the neutral possible. The second measurements were taken with the subject’s
zone increased. ANALYSIS: SD curves of PAs were plotted for each joints returned to the starting position. The improvement rate was
simulation. RESULTS: For the linear model where the stiffness of calculated as follows: Improvement rate (%) = (2nd angle result after
each joint was a constant, the stiffness of all PA movements were technique applied − the first angle)/(180 − the first angle) × 100.
also constants. Stiffening the target level resulted in greater effect on ANALYSIS: A Wilcoxon signed rank test was used to generate
the PA stiffness than increasing the adjacent level. The SD curves statistics for the 3 groups. The effects of each technique were
of PAs from the non-linear model consisted of a series of ‘steps’ of compared using a Mann-Whitney test. RESULTS: The control group
increasing stiffness. Decreasing the size of the neutral zone resulted was not a significant difference which indicates that repeating the
in SD curves of similar shape, but shifted horizontally such that procedure twice had no real effect. In the stretch group, the average
increases in stiffness occurred earlier in the PAs. Increasing the pre-angle was137.6±3º, and after stretching it was 141.5±2.7º.
stiffness within the neutral zone also resulted in a similar shaped In the CLOSE group, the average pre-angle was136.2±3.3º, and
SD curve, but the curve was distorted vertically. The effects on PA after CLOSE it was 145.7±3.2º. The significant difference left the
stiffness from increasing stiffness of the target level occurred earlier stretch and CLOSE group (p < 0.01). The improvement rate of
in the movement and were greater in magnitude than effects from the stretch group was 13.6±14.7%, while the CLOSE group was
increasing stiffness of the adjacent level. CONCLUSIONS: When 26.3±20.4%. The result of a Mann-Whitney test showed more
intervertebral stiffness was modelled as non-linear, the location and significant improvements in the CLOSE group than in the stretch
type of altered intervertebral mobility were reflected in characteristic group (p < 0.05). CONCLUSIONS: The use of the CLOSE technique
changes in the pattern of PA stiffness suggesting ways clinicians can result in an improvement in AROM. It depends on a lubrication
using PAs may be able to localize the location and type of increased theory. Although this approach goes against conventional theories
intervertebral stiffness in the cervical spine. IMPLICATIONS: The in AROM improvement, we have observed that movement becomes
results of this study are consistent with pilot data we have collected easier by bringing joint surfaces closer. IMPLICATIONS: For physical
therapy practice. KEYWORDS: ROM, CLOSE, lubrication theory. Research Report Poster Display
FUNDING ACKNOWLEDGEMENTS: This research is not funded. 20-24 Tuesday 5 June 10:30
ETHICS COMMITTEE: Based on the Declaration of Helsinki,I got VCEC Exhibit Hall B & C
approval of Mayor of institution and consent of participants. LIVING WITH RHEUMATIC DISEASE: PATIENTS’ EXPERIENCES
OF THEIR INNER STRENGTHS, CAPACITIES AND HEALTH
RESOURCES
19-16 Tuesday 5 June 10:30 Biguet G1 , H. Opava C1,2 ; 1 Karolinska Institutet, Department of
VCEC Exhibit Hall B & C Neurobiology Care Sciences and Society, Division of Physiotherapy;
2 Karolinska University Hospital, Department of Rheumatology
CERVICAL MUSCULOSKELETAL IMPAIRMENTS IN
CERVICOGENIC HEADACHE – A META-ANALYSIS PURPOSE: Many patients suffering from a chronic disease, such as
Gadotti I, Armijo-Olivo S, Magee D; University of Alberta, inflammatory rheumatic disease, have experienced personal health
Edmonton, Canada resources at their disposal that will allow them to live a good life
in spite of symptoms and functional impediments. Health resources
PURPOSE: The differential diagnosis of cervicogenic headache in this context refer to patients’ inner strengths and capacities
(CEH) requires the presence of a pattern of symptoms and that have to do with their experience of well-being and mastery.
cervical musculoskeletal signs that distinguish it from other types of The purpose of the study was to explore and describe health
headaches. The objective of this meta-analysis was to evaluate the resources based on patients’ experiences of living with inflammatory
available literature regarding cervical musculoskeletal impairments rheumatic disease. RELEVANCE: This study is part of a larger
(CMI) in patients with CEH when compared with control subjects. project aimed at elucidating the phenomenon of patients’ personal
RELEVANCE: The evaluation of musculoskeletal impairments of health resources in physical therapy in order to form a knowledge
the cervical spine can help in the diagnosis of CEH as well in basis for identifying and supporting this resources and thereby
its overall treatment. PARTICIPANTS: Not Applicable METHODS: improving well-being and quality of life. PARTICIPANTS: Twelve
Studies were searched from 1965 up to and including May 2006 patients (nine women, three men) who had lived for several years
and were obtained through a search of bibliographic databases with some form of inflammatory rheumatic disease were purposefully
including Medline-Pubmed, Embase, Cochrane Library and Best selected for participation. METHODS: Conversational interviews with
Evidence, ISI Web of Sciences, and CINAHL. Key words used were: open-ended questions were conducted. ANALYSIS: The interviews
cervicogenic headache, cervical headache, headache, cephalalgia, were transcribed verbatim for qualitative analysis in accordance with
cervical vertebrae, neck, neck muscles, neck pain, neck injuries, a phenomenological approach. RESULTS: The essential meaning of
and physical/musculoskeletal impairment. The outcomes of interest health resources is to become a self-agency in order to not letting
were any musculoskeletal impairment in the cervical spine (i.e. the disease get the upper hand over life, particularly by becoming
altered range of motion, muscular activity, cervical or head posture, pro-active and preventing situations in which one no longer has
and muscular function). ANALYSIS: Two trained physical therapists “anything left to fight back with” . This requires an ability to plan, adjust
analyzed all papers for the inclusion/exclusion selection criteria. The and prioritize that presupposes an ongoing assessment of resources
methodological quality of the final selected studies was analyzed based on available capacities. It is also a question of being able
with a methodological scale. This scale considered nine important to provide a buffer, a reservoir of strength, e.g. by regular exercise,
methodological issues. Revman 4.2 Software was used to summarize in preparation for variations in the condition. Prevention does not
the effects (standardized mean differences) and odds ratio from the exclude negotiation and trading off and paying later strategies, i.e.
variables for each CMI. RESULTS: The database search resulted patients decide to pay the price for valued activities in the form of
in a total of 1769 articles. Of these 1769 articles, 21 were selected increased discomfort. Nevertheless, the acceptance of temporary
as potential studies based on their abstracts. However, only 10 met exacerbation does require confidence in the capacity to recover and
the relevance criteria. Three articles were of strong methodological once more build up a protective buffer. Central to this assessment
quality, 4 moderate, and 3 of weak methodological quality. Seven process is the ability to re-evaluate what is worthwhile in life, to project
articles were considered for the meta-analysis. The following oneself into the future, to engage in reflective inner dialogues, and
standardized mean differences between patients with CEH and a to know and listen to the directions from the body. CONCLUSIONS:
control group were found for craniocervical angle: −0.22; complete Patients interviewed possessed – some not all of the time – access to
cervical rotation: −0.54; cervical flexion-extension: −0.78; cervical inner strengths and confidence in their health resources, even though
range of motion of rotation with cervical flexion: −2.23; flexor strength: they were intimately aware of difficulties and challenges. Acceptance,
−0.56; neck flexors endurance: −1.56; flexor muscle performance: more exactly reconciliation with the condition, confidence in the ability
−1.08; proprioception of the neck: −0.07. Odds ratio of having the to actively deal with difficulties, a monitoring and reflective self (self-
flexion rotation test positive for patients with CEH were 107.54 and knowledge), body awareness and regular physical exercise, seem
manual segmental examination positive at the level Co-C1: 7.89 to be interesting approaches that affect many of the dimensions
when compared with control subjects. CONCLUSIONS: Patients with of life and should be taken into account by health professionals.
CEH have altered range of motion in rotation, flexion-extension, IMPLICATIONS: Health professionals, including physical therapists,
cervical rotation with cervical flexion, altered cervical flexor strength, who traditionally focus on identification and alleviation of impairments
and altered cervical flexor endurance when compared with normal and disabilities, need to learn how to be perceptive to patients’
subjects. IMPLICATIONS: Musculoskeletal impairments must be self-assessed health resources. They should also be aware of the
evaluated in patients suffering from CEH in order to guide diagnosis risk for suppressing the patients from showing responsibility and
and treatment. The cervical flexion-rotation test and cervical manual initiative in the process of deepening self-knowledge. Finally, more
segmental motion can assist in the differential diagnosis of CEH and effort should be put into supporting patients’ confidence in their
in the identification of movement impairment at the C1/2 segment. personal health resources for promoting well-being and quality of
However, there is a clear need for well-designed controlled trials with life. KEYWORDS: coping, health perspective, mastery. FUNDING
greater sample size using valid and reliable methods to investigate ACKNOWLEDGEMENTS: The work was funded by the Swedish
CMI in CEH. KEYWORDS: cervicogenic headache, musculoskeletal Rheumatism Association, the Center for Health Care Sciences at
impairments, meta-analysis. FUNDING ACKNOWLEDGEMENTS: Karolinska Institutet and the Swedish Research Council. CONTACT:
This study was supported by Alberta Provincial CIHR Strategic [email protected]
Training Program in Bone and Joint Health, Izaak Walton Killan ETHICS COMMITTEE: The design of the study was approved by the
scholarship from the University of Alberta, and Physiotherapy Ethics Committee, Karolinska Institutet, Stockholm (02/407). Date:
Foundation of Canada. CONTACT: [email protected] 2002-11-04
THE EFFECTS OF YOGA ON PEOPLE WITH ARTHRITIS: A COMPARISON OF MOBILIZATION AND MOBILIZATION-WITH-
SYSTEMATIC REVIEW MOVEMENT TO THERAPEUTIC EXERCISE IN THE TREATMENT
Macri E1 , Newman G1 , Giesbrecht A1 , Werner L1 , Westby M2,3 ; OF PRIMARY SHOULDER IMPINGEMENT: A PILOT CLINICAL
1 University of British Columbia MPT Program; 2 University of British TRIAL
Columbia Clinical Faculty; 3 Mary Pack Arthritis Centre Kachingwe A, Phillips B, Sletten E, Plunkett S; California State
University, Northridge, Northridge, CA, USA
PURPOSE: The purpose of this systematic review was to examine
the chronic effects and safety of a yoga intervention on people PURPOSE: To investigate the effectiveness of joint mobilization
with osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing and a mobilization-with-movement technique compared to a su-
spondylitis (AS). RELEVANCE: Arthritis affects 1 in 6 adult pervised exercise program in the treatment of primary shoulder
Canadians and carries with it significant economic and social impingement syndrome. RELEVANCE: Therapeutic exercise has
consequences. There is an obvious need for treatment approaches been shown to be effective in treating primary shoulder impinge-
that will help people to manage their condition and improve their ment, however very few studies have evaluated the outcomes
quality of life. Many people living with arthritis are choosing less of therapeutic exercise combined with joint mobilizations and no
conventional forms of exercise such as yoga to meet their exercise randomized controlled trials have utilized the mobilization-with-
and therapeutic needs. In addition, yoga is being promoted by movement approach. PARTICIPANTS: 33 subjects, 17 males, 16
health care professionals, yoga instructors and lay people alike as a females (mean age 46.4 years; range, 18-74 years) diagnosed with
beneficial adjunct to the management of arthritis. Despite the growing primary shoulder impingement syndrome participated in this study.
use of this form of exercise by people living with arthritis, there METHODS: Subjects were randomly assigned to 1 of 4 groups:
appears to be a paucity of research on yoga’s effects on the disease. supervised exercise only, supervised exercise with glenohumeral
PARTICIPANTS: Studies accepted for review investigated adult mobilizations, supervised exercise with glenohumeral mobilization-
populations with OA, RA or AS. METHODS: Studies were accepted with-movement (MWM), and a control group. The three intervention
for review if they investigated any form of yoga done independently groups received physical therapy once a week for 6 weeks.
or under supervision. Outcome measures were considered within the Outcome measures were assessed by a blinded evaluator at
context of the International Classification of Function, Disability and the beginning of the study and after 6 weeks and included
Health (ICF). Peer-reviewed and non-peer-reviewed original English 24-hour pain, pain with the Neer and Hawkins-Kennedy (HK)
language studies of any design were accepted. Seventeen databases impingement tests, shoulder AROM, and shoulder function assessed
and the internet were searched, references hand-searched, and with the SPADI. ANALYSIS: Repeated measures ANOVAs with
experts contacted. ANALYSIS: Due to study heterogeneity, a meta-
Tukeys post hoc were conducted for each of the dependent
analysis of the studies was not possible. Therefore, a rigourous
variables with the pretreatment and posttreatment scores as the
qualitative analysis of the research was completed. Methodological
within subjects variable and the four groups as the between
quality of each study was determined using a composite of standard
subjects variable. Due to the wide variability between subjects
quality assessment tools. RESULTS: Seven studies (N=152) were
on pretreatment scores, a percentage of change score from
reviewed, three investigating OA and four RA. Methodological quality
pretreatment to posttreatment was calculated for each dependent
was relatively weak across all studies, with scores ranging between
variable. The difference scores and percentage of change scores
3-14 out of 18. Only one study used appropriate randomization. Two
were analyzed using univariate analyses with Tukey’s post hoc.
studies blinded the outcome assessor. Intention to treat analysis
RESULTS: The MWM group had the highest percentage of
was not completed in any studies. CONCLUSIONS: This review
change (improvement) from pre- to post-treatment on all three
provides Grade B evidence that yoga may improve pain, hand
ROM, joint tenderness, grip strength, function, and quality of life in pain measures (mean VAS 55.2%; Neer 66.5%; HK 60.2%),
people with OA and RA. Yoga appears to be safe for this population followed by the mobilization group (VAS 44.2%; Neer 57.6%;
when done under appropriate guidance. In the future, research of HK 52.1%), the exercise only group (VAS 20.8%; Neer 44.0%;
higher methodological quality is needed, where interventions are HK 39.5%), and the control group (VAS 14.4%; Neer 46.4%;
described in sufficient detail to replicate and are designed to isolate HK 11.2%). All three intervention groups had a higher percentage
the independent variable. Studies should monitor for adverse events of change than the control on the SPADI (exercise only, 61.6%;
and should include long-term follow-up. Yoga’s effect on people with mobilization, 56.7%; MWM, 55.5%; control, 34.2%). In regards
AS requires investigation. IMPLICATIONS: Specific details regarding to flexion and scaption AROM, the MWM group had a higher
type of yoga, dosage, poses, props, or modifications cannot be made percentage of change (46.7% and 66.5%) than the exercise only
at this time due to study heterogeneity, study quality and the generally group (27.6% and 19.8%) and the control group (42.6% and 29.8%),
poor descriptions of the interventions. Since aerobic capacity has and the mobilization group had the lowest percentage of change
not yet been investigated for yoga with this population, the authors (−15.9% and 2.5%). A univariate analyses on the percentage of
suggest yoga be used to complement rather than replace aerobic change from pre to post-treatment for each dependent variable
exercise for patients with OA or RA who are interested in pursuing found no statistically significant differences (p < 0.05) between the
this form of exercise. KEYWORDS: Yoga, Complementary Therapy, four groups. CONCLUSIONS: The physical therapy interventions
Alternative Therapy, Arthritis, Rheumatic, Ankylosing Spondylitis, of glenohumeral mobilizations and mobilization-with-movement in
Osteoarthritis. FUNDING ACKNOWLEDGEMENTS: None. combination with a supervised exercise program resulted in a
greater decrease in pain and improved function compared to the
supervised exercise only and control groups. The lack of statistically
significant differences in outcome measures between groups may
be attributed to the low power of this study. IMPLICATIONS:
Although the results of this study are clinically relevant, they should
not be generalized. Future research with a larger sample size
is warranted. KEYWORDS: glenohumeral mobilization, mobilization
with movement, primary shoulder impingement syndrome. FUNDING
ACKNOWLEDGEMENTS: This study was funded in part by the
University Research, Scholarship and Creative Activity Award. No
authors have any potential for material gain as a result of this Research Report Poster Display
study. 22-16 Tuesday 5 June 10:30
ETHICS COMMITTEE: The committee for the Protection of Human VCEC Exhibit Hall B & C
Subjects, California State University at Northridge, Northridge, CA, HAND TRAINING WITH FINALIST AND NON-FINALIST
USA EXERCISE IN SUBJECTS WITH MULTIPLE SCEROSIS
Gatti R, Cervi P, Viganò L, Prati C, Panzeri C, Sirtori V;
Research Report Poster Display Rehabilitation Department, San Raffaele Hospital – Milan, Italy
22-12 Tuesday 5 June 10:30 PURPOSE: Hand mobility impairment produces functional limitations
VCEC Exhibit Hall B & C in subjects with multiple sclerosis. One of the goals of the rehabil-
RELATIONSHIPS BETWEEN PARTICIPATION AND AUTONOMY itation treatment is to improve the manual functional activities. The
ASSESSMENT AND NEUROLOGICAL ASSESSMENT IN objective of this work is to compare a training using finalist exercises
PEOPLE WITH MULTIPLE SCLEROSIS with another one using non-finalist exercises for studying which
one is more effective. RELEVANCE: The use of the most effective
Pedro LCHL/FPCE−P , Pais Ribeiro JFPCE−P ; 1 Centro Hospitalar
training for hands rehabilitation is important for the decrease of the
Lisboa/Faculdade Psicologia Ciencias da Educação – U. Porto;
2 Faculdade Psicologia Ciencias Educação – U. Porto functional limitations in multiple sclerosis subjects. PARTICIPANTS:
The study included 20 subjects with multiple sclerosis, admitted
PURPOSE: Multiple sclerosis is a chronic inflammatory disease of in the Neurorehabilitation Department of San Raffaele Hospital in
the central nervous system. The prognosis in terms of development Milan (Italy) and presenting mild and moderate disability. METHODS:
of disability is unpredictable in the early stages of the disease, Subjects have been divided in two groups for the training of the right
but the risk of developing significant functional deficits is high. hand. One group (NFG) executed strength and dexterity training of
Rehabilitation treatment often represents the only treatment available the fingers. The other group (FG) executed functional activities and
to improve some functional symptoms. Recent evidence increasingly strength training using a biofeedback device. Each subject made 15
suggests that rehabilitation improves activities, participation in social daily rehabilitation sessions. At the be beginning of the first session
activities as well as the quality of life in patients with multiple and the day after the last session, the Nine Hope Peg Test (NHPT)
sclerosis. RELEVANCE: The aim of the present study is to examine and the Jamar dynamometer test were administered to assess
the relationship between disability and participation / autonomy in respectively dexterity and strength of the hand. All the subjects
patients with multiple sclerosis. PARTICIPANTS:: 280 patients with signed an informed consent form and the study was approved
multiple sclerosis were recruited via their physician at a neurology by the Ethical Committee of San Raffaele Hospital. ANALYSIS:
department of a central hospital in Lisbon. They were eligible for Samples homogeneity has been analysed comparing the two groups
inclusion in the study if they met the following criteria: diagnosis characteristics with the Mann-Whitney test. Efficacy of the treatments
according to relevant medical criteria, between 18 and 65 years, has been analysed with the Wilcoxon test. It has been used the
being diagnosed at least 1 year ago, EDSS score under 7. The Mann-Whitney test to compare the improvements of the two groups.
mean age was 40 years (range 18- 65), 71.3% were women, 61.1% The improvements have been expressed as percentage of the initial
were currently married, 63% active workers, mean school level of values. RESULTS: The two samples were homogeneous for the
12 years, and the mean score of EDSS is 2.8. METHODS: the considered variables. The comparison between the values obtained
study was explorative and descritive the patients diagnosed with before and after the period of treatment did not report significant
definite MS in contact with Centro Hospitalar Lisboa Ward or a results. The mean increase of the treated hand was: 11.5+/−23.4%
consultant in neurology, betwwen 16 April 2005 and 30 Marc 2006. Jamar, 12.4+/−23.1% NHPT in FG group and 8.3+/−15.2% Jamar
ANALYSIS: Expanded Disability Status Scale (EDSS) is a method of and 2.4+/−16.8% NHPT in NFG group. The mean increase of the
quantifying disability in multiple sclerosis. EDSS is an ordinal clinical non-treated hand was 8.7+/−19.7% Jamar and 7.2+/−8.2% NHPT
rating scale ranging from 0 (normal neurological examination) to 10 in FG group and 6.3+/−9.5% Jamar and −0.7+/−13.2% NHPT in
(death due to MS) in half-point increments. The questionnaire IPA NFG group. CONCLUSIONS: Both finalist and non-finalist exercises
(Impact on Participation and Autonomy) measures several aspects can be use to train right hand of subjects with multiple sclerosis.
of participation and autonomy. The IPA can make a unique and Only finalist exercises improve dexterity in the non trained hand.
fundamental contribution since it examines autonomy as opposed IMPLICATIONS: The sample size studied and, as a consequence,
to dependency. The IPA addresses autonomy and participation in 5 the power of the statistical tests are small. Should this data be
domains: autonomy indoors, family role, autonomy outdoors, social confirmed, other studies could analyse the efficacy of controlateral
relations, and work and educational opportunities. The IPA is a hand training, using finalist exercises, for example in hemiplegic
generic outcome measure and can be used in populations or with patients. KEYWORDS: multiple sclerosis, hand, exercise. FUNDING
individuals with a range of diagnoses. They are complementary ACKNOWLEDGEMENTS: N.A.
assessment tools: RESULTS: The mean score for the variables ETHICS COMMITTEE: Ethical Committee San Raffaele Hospital
are the following: EDSS (M=2.55; SD=1.75), five domains of IPA:
Autonomy Indoors (M=11.60; SD=5.58) Family Role (M=18.05:
SD=7.67) Autonomy Outdoors (M=12.53; SD=5.68), Social Relations Research Report Poster Display
(M=10.86; SD=4.26), Work and Educational Opportunities (M=15.56; 22-20 Tuesday 5 June 10:30
SD=6.74). The correlations between EDSS and IPA dimensions are VCEC Exhibit Hall B & C
all statistically significant but moderate: Between EDSS and Auton- PARKINSON’S DISEASE: THE USE OF VISUAL CUES AND
omy Indoors (r = 0.54), between EDSS and Family Role (r = 0.59), IMAGING TO OVERCOME FREEZING AND IMPROVE GAIT
between EDSS and autonomy outdoors (r = 0.56), between EDSS
Mitchell J1 , Marple-Horvat D2 ; 1 School of Biological Sciences,
and social relations (r = 0.38), EDSS and Work and Educational
University of Wyoming, Laramie, USA and School of Allied Health
Opportunities (r = 0.52). CONCLUSIONS: In the present study we
Professions (Physiotherapy), University of the West of England,
inspected the correlation between EDSS and the five IPA domains.
Bristol, UK; 2 Department of Physiology, University of Bristol, UK
Moderate correlations between the two instruments suggest that
and Institute for Biophysical and Clinical Research into Human
they measure different and complementary aspects. IMPLICATIONS:
Movement, Manchester Metropolitan University, UK
Information from the two instruments can give important information
for the rehabilitation programs KEYWORDS: participation/autonomy, PURPOSE: Freezing severely disturbs mobility in people with
assessment,multiple sclerosis. FUNDING ACKNOWLEDGEMENTS: Parkinson’s Disease (PD). Various cues have been used to improve
None. function, with limited success, few valid and reliable research reports
being published currently. This study was designed to demonstrate few studies have measured brain activation during lower limb
the value of actual visual cues and imaging of environmental features movement. The purpose of this study was therefore to localize
in overcoming freezing and improving gait in PD. RELEVANCE: brain activation during a weight-bearing task of a lower limb using
There are few treatment interventions to overcome freezing in near infrared spectroscopy (NIRS). RELEVANCE: Aim of this study
patients with PD. Specific visual cues and imaging may be of use found available evidence on effectiveness of exercise therapy for a
as additional tools to increase patients’ function, independence and weight-bearing task of a lower limb. PARTICIPANTS: The subjects
quality-of-life. PARTICIPANTS: Seven volunteers (3 males and 4 included 7 young individuals (4 females and 3 males, 25.7±6.0
females, age range: 53-70, mean age: 63 years) with PD, controlled years old) who were assigned to a weight-bearing task of a lower
by bilateral subthalamic nucleus simulation (STN), were recruited. limb. All the subjects gave informed consent to participate in this
None suffered from cardiovascular or musculoskeletal diseases, and study. METHODS: All the subjects were instructed to take a sitting
each subject reported freezing. Informed consent was given by each position in a chair and to press a lower limb against the floor for
subject and the study was approved by North Bristol NHS Trust, 8 seconds. A cycle of 25 s rest – 8 s task of a lower limb –
Frenchay Research Ethics Committee, UK. METHODS: A repeated 25 s rest – 8 s task of the other lower limb was repeated for 6
measures experimental design was used, each subject acting as times. The brain activation during the task was measured using NIRS
his/her own control. A Charnwood Dynamics mpx30 (CODA) system (Hitachi ETG-4000) placing the probes on the scalp overlying both
with infrared markers, placed on the shoe heels and toes, left lateral the frontal and parietal cortices. ANALYSIS: Local brain activation
maleolus, inferior femoral condyle, anterior superior iliac spine, and during the task was considered significant when the elevation
head (anteriorly and posteriorly), was used to capture kinematic of oxy-hemoglobin was above 2SDs of the baseline. RESULTS:
data during locomotion in each subject. Two wooden doorframes, We observed significant activation of bilateral frontal and parietal
each illuminated by LEDs at 10cm intervals, were positioned on a cortices during the task of either lower limb in all the subjects.
walkway, 3m from the starting position and 1.5m apart. The ambient CONCLUSIONS: This study showed that the unilateral weight-
lighting could be blocked with blinds. Subjects were required to bearing task of a lower limb induced bilateral activation of motor-
walk along the walkway, passing through both doorframes, stopping related cortical areas in healthy young subjects. The finding suggests
and turning after the second doorway. Two trials of the following that lower limb movement requires bilateral brain activity in contrast
conditions, in random order, with the STN on, then off, were to unilateral upper limb movement which induces predominantly
carried out: • fully-lit room, both doorways illuminated (baseline contralateral brain activation. IMPLICATIONS: The findings of this
condition) (LP). • darkened room, first doorway only illuminated (DA). study is of considerable importance with regard to physical therapy for
• darkened room, both doorways illuminated (visual cues) (DP). stroke patients, and further studies should be performed on increased
• darkened room, first doorway illuminated, subjects asked to imagine numbers of subjects and patients, focusing on the long-term effects
the second doorway before proceeding (imaging) (DI). ANALYSIS: of therapy. KEYWORDS: brain activation, near infrared spectroscopy,
Captured kinematic data were computed and represented graphically. lower limb movement. FUNDING ACKNOWLEDGEMENTS: This
Individual measurements for gait parameters (stride time, length, research was partially supported by CREST,JST,and the Ministry
velocity, cadence) were calculated for each subject. Data were of Education, Science, Sports and Culture, Grant-in-Aid for Young
statistically analysed and compared (unpaired t-test). RESULTS: Scientists (B),18700466,2006. CONTACT: [email protected]
There was no difference between STN-on and STN-off in time taken ETHICS COMMITTEE: All subjects gave informed to participation in
to initiate walking. On walking, no subject froze in the LP or DP consent for before experiment
trials, with STN-on or STN-off. On approaching the second, unlit
doorway in the DA and DI trials, all subjects showed freezing, six
just beyond the first and one before the first doorway, with STN-on
and STN-off. A concomitant decrease in stride length and velocity 24-04 Tuesday 5 June 10:30
and increase in cadence were demonstrated. The DA trials showed VCEC Exhibit Hall B & C
the greatest deterioration in function, and imaging did not improve THE IMMEDIATE EXERCISE EFFECT OF VOLUNTARY
gait. CONCLUSIONS: 1. STN did not ameliorate freezing in the FACILITATION AT LOWER LIMB BY MIRROR THERAPY
absence of visual cues. 2. Functional mobility improved with the Saito K1 , Sugawara K2 , Fukui Y3 , Yamamoto M3 , Abiko T3 ,
use of actual visual cues but not with imaging of environmental Fukumura K4 , Tomita Y4 , Maruyama H5 ; 1 Department of Physical
features. IMPLICATIONS: The use of relevant, strategically placed Therapy, Waseda College of Medical Arts and Sciences, 354-3,
visual cues before negotiating obstacles may be of value in Sinsyoujikuruwa, Ootaaza, Iwatuki-ku, Saitama, Saitama, 339-8555,
helping patients with PD overcome freezing and improve functional Japan; 2 Division of Physical Therapy, School of Rehabilitation,
mobility. This study serves to inform evidence-based professional Faculty of Health and Social Work, Kanagawa University of Human
practice. KEYWORDS: Parkinsons Disease, freezing, visual cues Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa, 238-8522, Japan;
and imaging. FUNDING ACKNOWLEDGEMENTS: Action Medical 3 Department of Physical Therapy, Tokyo Metoropolitan Rehabilitation
Research, UK. CONTACT: [email protected] Hospital, 2-14-4, Tsutsumi dori, Sumida, Tokyo, 131-0034, Japan;
ETHICS COMMITTEE: North Bristol NHS Trust, Frenchay Research 4 Department of Biosciences and Informatics, Faculty of Science and
Ethics Committee, UK Technology, Keio University, 3-14-1, Hiyoshi, Kohoku-ku, Yokohama,
Kanagawa, 223-8522, Japan; 5 Department of Physical Therapy,
Research Report Poster Display Faculty of Health Science, International University of Health and
23-24 Tuesday 5 June 10:30 Welfare, 2600-1, Kitakanemaru, Ootawara, Tochigi, 324-8501, Japan
VCEC Exhibit Hall B & C PURPOSE: In mirror therapy, the patient recalls movement of the
MEASUREMENT OF CEREBRAL ACTIVATION DURING A paralyzed side by visual illusion using a mirror, and actively or
WEIGHT-BEARING TASK OF A LOWER LIMB USING NEAR passively moves the paralyzed side. Its effectiveness in treatment
INFRARED SPECTROSCOPY of phantom pain of an amputee and upper limb motor paralysis
after cerebral stroke has been reported. Although the therapy
Kaneko J1,2 , Takeda K1,2 , Shiomi T1,2 , Shimoda N1,2 ,
has been applied to clinical cases, there has been no report
Maruyama H1 , Kato H1,2 ; 1 International University of Health and
concerning the lower limbs. Further improvement of lower limb
Welfare,Japan; 2 CREST,Japan Science and Technology
function increases gait ability, and leads to improvement of ADL
PURPOSE: Recent studies using functional MRI have shown that and QOL. RELEVANCE: In this study, we performed mirror therapy
cerebral activation during voluntary upper limb movement is seen using a mirror in patients with cerebral stroke-associated hemiplegia
predominantly on the contralateral hemisphere of the brain. However, with difficulty in voluntary plantar dorsiflexion of the ankle joint, and
investigated its effect on the improvement of voluntary facilitation side parameters (latency and amplitude) and the clinical parameters
of the lower limb on the paralyzed side by measuring the time (kinetic sense of the great toe, sensory discrimination of the planta
required for plantar dorsiflexion and dorsal angle of the ankle joint. pedis, Brunnstrom stage motor function test, and Barthel Index
PARTICIPANTS: The subjects were 6 patients with cerebral stroke- activities of daily living test). RELEVANCE: If a relationship exists
associated hemiplegia(the mean time after onset: 130.6±90.5 days, between the SEPs sound side parameters and clinical parameters,
mean age: 54.3±3.8 years). The study was adequately explained the improvement of ability on the sound side may be related
to all subjects, and performed after obtaining informed consent. to the recovery of the sensory and motor impairment in stroke
METHODS: In the mirror therapy, a mirror was placed so as to patients. PARTICIPANTS: Fourteen patients (6 women, 8 men) with
reflect the leg on the non-paralyzed side when the patient looked hemiplegia (mean age: 73.9±10.4; range 28-57 years) participated.
at the paralyzed leg in the mirror. The patient voluntarily performed Four cases had right hemisphere damage, and ten cases had left
plantar dorsiflexion (foot tap) of the bilateral ankles for 20 minutes hemisphere damage. METHODS: The study was approved by the
while looking at the non-paralyzed leg in the mirror. The patient ethics review board of Hiroshima University, and all subjects were
also tapped the feet, wearing a foot switch on the sole, 20 times given a written informed consent. Tibial nerve SEPs were recorded
as fast as he/she could without looking at the mirror before and after stimulation at the ankle, using a frequency of 2Hz, a pulse
after foot tap with looking at the mirror. The mean and standard duration of 0.2 ms, and enough current to produce minimal twitches
deviation of the intervals of 20 foot taps at the maximum speed were of the thenar muscles. A total of 500 responses were averaged twice
calculated using MATLAB (Math Work), and this mean value was for the sound sides. The following parameters were determined for
regarded as the maximum foot tap. An electric angle system was both sides: P40 latency, N50 latency, P60 latency, N75 latency, P40-
attached to the paralyzed ankle joint, and the dorsiflexion angle was N50 peak-to-peak amplitude, N50-P60 peak-to-peak amplitude, and
measured. ANALYSIS: For statistical analysis, t-test was used, and P60-N75 peak-to-peak amplitude. After measuring the SEPs, each
the significance level was set to lower than 5%. RESULTS: Regarding subject was evaluated for the clinical parameters. ANALYSIS: To
the time required for plantar dorsiflexion, the maximum foot tap was assess the correlation between the SEPs and clinical parameters,
503.9±90.0 ms before mirror therapy and 477.9±92.2 ms after mirror we used a regression analysis (Pearson’s correlation coefficients).
therapy, showing a significant difference The dorsiflexion angle of the RESULTS: The P60 latency of the sound side had a moderate
ankle joint was 15.8±0.2 degrees before and after mirror therapy. The negative correlation with the Brunnstrom stage (−0.60; P = 0.03). The
mean tap interval was shortened after mirror therapy, suggesting that P40-N50 amplitude of the sound side had a moderate correlation
the repulsive muscular coordination involved in plantar dorsiflexion of with the discrimination sense of the affected side (0.68; P = 0.007).
the ankle joint was improved. The dorsiflexion angle of the ankle joint CONCLUSIONS: The integrity of sensory and motor pathways and
did not change after mirror therapy. CONCLUSIONS: The patients areas of the central nervous system may improve through latency
may have concentrated on rapid switching of the plantar dorsiflexion, shunting and amplitude enhancement. IMPLICATIONS: Exercise
and may have not paid attention to the angle. Input of visual illusion of the involved side may promote the general recovery of the
by mirror therapy may have affected the motor image formation sensory and motor impairment in stroke patients. KEYWORDS:
on the paralyzed side. IMPLICATIONS: Physical Therapy can help SEPs, CVA, compensation. FUNDING ACKNOWLEDGEMENTS:
hemiplegia people by clarify the effect voluntary facilitation of lower Unfunded. CONTACT: [email protected]
limbs with hemiplegia. KEYWORDS: Mirror Therapy, Hemiplegia, ETHICS COMMITTEE: The study was approved by the ethics review
Voluntary facilitation. FUNDING ACKNOWLEDGEMENTS: unfound. board of Hiroshima University.
ETHICS COMMITTEE: Tokyo Metoropolitan Rehabilitation Hospital
ethics committee
ORTHOPEDIC INJURIES AND TREATMENT FOR MUSICIANS
VCEC Exhibit Hall B & C Saito N1 , Akiyama S2 ; 1 International University of Health and
Welfare; 2 International University of Health and Welfare
VALIDATING THE RELATIONSHIP BETWEEN THE
SOMATOSENSORY EVOKED POTENTIALS AND RECOVERY OF PURPOSE: The purpose of this research is to investigate musician-
SENSATION AND MOTOR ABILITY IN STROKE PATIENTS related injuries,treatments,and these therapeutic responses for
musicians in Japan. RELEVANCE: A lot of injuries suffered by
Shiratani T1 , Murakami T2 , Arai M3 , Shimizu M4 , Shimizu H2 ,
instrumental musicians are musculoskeletal disorders on their upper
Yanagisawa K5 ; 1 Graduate student, Institute of Health Sciences,
extremities due to overuse or misuse. Therefore,they would receive
Faculty of Medicine, Hiroshima University; 2 Division of Occupational
advices from experts like physical therapists to get rid of the
Therapy, Institute of Health Sciences, Faculty of Medicine,
orthopedic problems.In Japan, however, there are few physical
Hiroshima University; 3 PNF Society of Japan; 4 Department
therapists who have a chance to treat musician’s disorders at medical
of Physical Therapy, Faculty of Health and Welfare, Prefectural
institutions. Moreover, knowledge on some of the characteristics of
University of Hiroshima; 5 Department of Physical Therapy, Tokyo
orthopedic abnormalities are not sufficiently spread among medical
Metropolitan University of Health Sciences
staffs. PARTICIPANTS: Eighty-one professional musicians who had
PURPOSE: Clinically, we have experienced how exercising the agreed to the investigation participated in the research. METHODS:
involved extremity improves the compensation of sensory and motor Anonymous questionnaire were distributed to instrumental musicians
impairment by the sound side in stroke patients. Iwamura et al by mail. The survey content consisted of five items and fifteen in total
(1994) indicated that the interhemispheric transfer of information covering symptoms, treatments, and self managements. ANALYSIS:
occurs at higher levels of hierarchical processing in each hemisphere. Data were analyzed with descriptive statistics and displayed using
If ipsilateral responses are transmitted through the contralateral tables and graphs. RESULTS: Sixty-nine(85%) people had any
hemisphere, compensation by the sound side may be related to kinds of body disorder, and forty(58%) people had received
the recovery of sensory and motor impairment in stroke patients. treatment until now. Among those 42 people, 83% of them were a
The measurement of compensation by the sound side may be practitioner clinic. The most common method of treatment was quasi-
measured by tibial somatosensory evoked potentials (SEPs), which is medical practice, such as massage, manipulative, acupuncture, and
an objective method of assessing the integrity of sensory and motor chiropractic. Eighty percents of them improved after the massage,
pathways and areas of the central nervous system. The purpose of the manipulative, and acupuncture. However, it was only 4% that
this study was to find the relationships between the SEPs sound have recovered completely. Among such body parts as lips and
teeth, the mandible, the cervix, the shoulder, the arm, the wrist, the = 0.54, and walk ratio r = 0.52). Remarkable longitudinal changes
finger, and the low back, most commonly affected parts were found were found in maximum walking speed (male −14.11%, female
out to be shoulders, a cervix, and low back. Increased frequency −15.08%) and step length (male −9.46%, female −10.16%) but not
of occurrence of symptoms and long-lasting conditions were main in cadence. ANOVA revealed that the relative longitudinal change
reasons to start seeing a doctor. Word-of-mouth information was in step length at both the preferred and maximum walking speeds
the most reliable source to select a place to receive treatment. increased significantly with increasing age group. CONCLUSIONS:
CONCLUSIONS: It was shown that many of musicians in Japan also Even after 8 years, subjects tended to maintain the individuality
have occupational chronic injuries. They often received quasi-medical of their walking traits, and this was particularly true for maximum
practices that would bring a prompt relief. When they took medical walking speed. There were remarkable relative longitudinal changes
treatment, their personal doctors prescribed more medications and in maximum walking speed and step length. In particular, step length
physical medicines, but much less rehabilitations. A lot of musicians became shorter with advancing age. IMPLICATIONS: Step length
start treatment after the symptoms became worse, but few reached measurement is a good indicator of longitudinal changes in the
a complete cure. IMPLICATIONS: Physical therapists in Japan walking ability of the aging. KEYWORDS: logitudinal study, aging,
would be soon working to treat musician’s injuries. I think that walking ability. FUNDING ACKNOWLEDGEMENTS: This study was
physical therapists will have becomes a chance to intervene for part of a research project,Tokyo Metropolitan Institute of Gerontology
them by advising the posture while playing, and methods to build up Longitudinal Interdisciplinary Study on Aging(TMIG-LISA), and was
muscles to treat the cause fundamentally. KEYWORDS: musician, partially supported by the Ministry of Education, Culture, Sports,
occupational injury, treatment. FUNDING ACKNOWLEDGEMENTS: Science and Technology Grant-in-Aid for Exploratory Research.
This research is not funded. CONTACT: [email protected] CONTACT: [email protected]
ETHICS COMMITTEE: This wor approved by the ethics committee
of Tokyo Metropolitan Institute of Gerontology
WALKING ABILITY OF OLDER ADULTS IN THE COMMUNITY: 27-04 Tuesday 5 June 10:30
AN 8-YEAR FOLLOW-UP STUDY VCEC Exhibit Hall B & C
Ito H1 , Sugiura M2 , Nishizawa S2 , Furuna T3 , Kinugasa T4 , AGE-RELATED EFFECTS OF A COGNITIVE TASK ON VELOCITY
Nagasaki H5 ; 1 Ibaraki Prefectural University of Health Sciences, AND FRONTAL PLANE STABILITY DURING NARROW-BASE
Ibaraki, Japan; 2 Tokyo Metropolitan Institute of Gerontology, Tokyo, WALKING
Japan; 3 Sapporo Medical University, Hokkaido, Japan; 4 University Kelly V1 , Schrager M2 , Price R1 , Ferrucci L2 , Shumway-Cook A1 ;
of Tsukuba, Ibaraki, Japan; 5 Tohoku Bunka Gakuen University, 1 Department of Rehabilitation Medicine, University of Washington,
Miyagi, Japan Seattle, Washington, USA; 2 Clinical Research Branch, National

Institute on Aging, Baltimore, Maryland, USA
age-related, and particularly longitudinal, changes that occurred PURPOSE: The purpose of this study was to examine age-related
in walking ability in older adults in a rural Japanese community. effects of a cognitive task on velocity and frontal plane stability
RELEVANCE: Assessment of age-related changes in walking ability during narrow-base walking. RELEVANCE: Age-related changes in
is a prerequisite for physical therapy for the elderly, because our frontal plane stability during walking are associated with impaired
previous studies have demonstrated that the baseline walking ability balance and increased fall risk in older adults. Clinically, tandem
can predict future functional status and the likelihood of falls, and narrow-base walking are used to assess gait stability. Adding
institutionalization, and mortality. PARTICIPANTS: The cohort was a cognitive task to narrow-base walking (i.e. dual tasking) may
part of a group of 734 residents aged 65 and over from a rural further challenge stability, allowing identification of early balance
area of Akita Prefecture, Japan, who participated in the Medical deficits not detected under single task conditions. Assessment of
Science Research Activity of the Tokyo Metropolitan Institute of dual task walking performance may also reflect age-related changes
Gerontology–Longitudinal Interdisciplinary Study on Aging (TMIG- in functional mobility, because mobility during daily life often requires
LISA). In our study, 380 elderly subjects (146 male, 234 female) the performance of concurrent cognitive or motor tasks (e.g. talking or
received walking ability measures in both the baseline research and carrying objects). PARTICIPANTS: Thirty healthy adults participated,
the follow-up research 8 years later. From the baseline data, the categorized by age: <65, 65-74, 75 years, with 10 individuals per
subjects were divided into four groups: 65–69 years (211 subjects, 88 group. METHODS: Participants were asked to walk at a comfortable
male, 123 female); 70–74 years (105 subjects, 37 male, 68 female); pace within a narrow path under both single and dual task conditions.
75–79 years (49 subjects, 17 male, 32 female), and over 80 years In the dual task condition, participants were asked to say the days
(15 subjects, 4 male, 11 female). METHODS: In the walking test, of the week backwards while walking within the narrow path. We
participants walked a straight and level walkway 11 meters long examined spatiotemporal characteristics of gait and center of mass
at their preferred speed, and then at maximum speed. Toward the (CoM) parameters using a 3-dimensional VICON motion analysis
middle of the walkway (about 3 to 8 meters from the start), the system (Lake Forest, CA). ANALYSIS: Visual 3D (Gaithersburg, MD)
number of steps, along with the total distance and time taken, were was used to calculate the whole body CoM from a 13-segment
measured manually. Velocity, step length, cadence, and walk ratio model with head, trunk, pelvis, and bilateral foot, shank, thigh,
(step length/ cadence) were calculated. ANALYSIS: We calculated upper arm, and forearm segments. Custom software was used to
the 8-year relative changes in the gait parameters measured at calculate gait velocity, step length, step width, mediolateral (M-L) CoM
baseline and at follow-up, where: relative longitudinal change rate = displacement, and M-L CoM peak velocity. Statistical comparisons
(8-year follow-up measurement – baseline measurement) / baseline were performed using analysis of variance with 2 task conditions
measurement x 100. To detect longitudinal changes in walking ability, (single v. dual) and 3 age groups. Post hoc analyses were conducted
ANOVA with age-group and gender serving as factors was applied for significant (p < 0.05) main effects. RESULTS: The percent of
to the relative longitudinal change rate for each walking variable. accurate steps did not differ significantly between groups and was not
RESULTS: When we controlled for gender, significant (P < 0.001) affected by performance of a secondary task. Both age (p = 0.001)
correlations were observed between the baseline and the 8-year and the performance of a secondary task (p = 0.000) decreased gait
follow-up study (at preferred walking speed, for velocity r = 0.47, step velocity, with no interaction effect. Similarly, both age (p = 0.000) and a
length r= 0.53, cadence r = 0.38, and walk ratio r = 0.52; at maximum secondary task (p = 0.011) decreased step length, with no interaction
walking speed, for velocity r = 0.65, step length r = 0.62, cadence r effect. There was no effect of age or a secondary task on step
width. Participants 75 years had greater M-L CoM displacement for LOS and mean number of days before transfer to specialist
than those <65 years (p = 0.03), but dual task performance had no elderly care unit(ECU). We excluded patients with LOS>50 days
effect on this variable. Participants 75 years also had greater M-L for analysis. RESULTS: Mean ages of the groups (before-OPAL
CoM peak velocity than those <65 years (p = 0.001), but a secondary 80.4±6.6 years, after-OPAL 83.4±8.0 years) were comparable. A
task did not effect M-L CoM peak velocity. CONCLUSIONS: Age- significant difference was found in the mean LOS (before-OPAL
related changes in both velocity and frontal plane stability are 13.1±11.7 days, after-OPAL 9.0±7.7 days p < 0.018). Mean delay
evident during narrow-base walking. Performance of a secondary for transfer to the ECU before-OPAL was 9.0(±8.2)days compared to
task resulted in decreased gait velocity and step length for all age 2.4(±1.8)days after-OPAL(p < 0.0001). Differences in the prevalence
groups. Contrary to our hypothesis, the addition of a secondary of problems identified and addressed by OPAL were evident in most
task did not affect M-L CoM control in these healthy older adults. domains including falls(before 0/27, after 21/23), functional depen-
IMPLICATIONS: Screening tools that are sensitive to fall risk are dency (before 12/39, after 22/25)and sensory impairments(before
important to identify older adults who may benefit from balance and 2/30, after 32/33). CONCLUSIONS: CGA screening and specialist
gait rehabilitation. Further research is needed to determine if narrow- intervention including ward-based case-management and rapid care
base walking with and without a secondary task can be used to pathways implementation, improve quality of patient care and
identify older adults with pre-clinical instability or an increased risk general hospital performance. IMPLICATIONS: This innovative case-
for falls. KEYWORDS: Gait, Center of Mass, Dual Task. FUNDING screening service demonstrates physiotherapists’ ability to pro-
ACKNOWLEDGEMENTS: This research was funded by the National actively manage older peoples care. Screening systems enabling
Institute on Aging. CONTACT: [email protected] faster access for older people to specialist interventions including
ETHICS COMMITTEE: An independent institutional review board physiotherapy should be a priority for older people’s research.
approved the protocol for the Baltimore Longitudinal Study on Aging. KEYWORDS: older persons, screening, emerging roles. FUNDING
ACKNOWLEDGEMENTS: No funding was received. CONTACT:
[email protected]
EXTENDING PHYSIOTHERAPY ROLES IN CASE-FINDING AND 28-16 Tuesday 5 June 10:30
SPECIALIST INTERVENTION IN OLDER PEOPLE’S INPATIENT VCEC Exhibit Hall B & C
SERVICES: EVALUATION OF AN INNOVATIVE MODEL THE CONSIDERATION OF FALLING FACTOR FOR THE
Buttery A, Langley J, Hopper A, Harari D; Guy’s and St Thomas’ ELDERLY -AN ELECTROMYOGRAPHIC STUDY-
NHS Foundation Trust London, UK Furukawa K1 , Shimino T2 , Yaguchi J3 ; 1 Seijoh Rehabilitation
Academy; 2 Seijoh University; 3 SAKAI Medical Co., Ltd
PURPOSE: We evaluated a novel service for older people admitted
to a large teaching hospital in London, UK. The Older Persons PURPOSE: The clarification for mechanism of elderly physical
Assessment and Liaison Team(OPAL), consisting of a specialist functional erosion has been addressed in various disciplines. The
physiotherapist, nurse, and half-time geriatrician, screen all general factors that lead to this erosion were muscle fiber atrophy and
medical patients aged 70+ within 24 hours of admission using a loss. These alterations may result in sluggish movement and muscle
Comprehensive Geriatric Assessment(CGA) tool to identify patient’s weakness, thus will be forecast to cause elderly falling. The aim of
with moderate-to-high clinical risk. Depending on clinical need, this study is to manifest the physiological changes for capital lower
actions include: rapid transfer to older persons specialist unit, case extremity muscles with advancing age. RELEVANCE: If current study
management on general medicine wards and referral to specialist will be able to suggest these typical changes with aging, it may
clinics (e.g. falls, continence, day hospital). The service aims to assist to prescribe training program for the elderly. PARTICIPANTS:
improve patient pathways and reduce length of stay(LOS) for older Sixty-eight healthy women aged 20-80 were participated. They had
medical inpatients through early, targeted intervention. RELEVANCE: no history of any trauma and disorder of bilateral legs. They were
Older people, often with chronic conditions and disabilities, have given written informed consent prior to participation to this study.
high levels of use of Emergency Departments(EDs) and subsequent METHODS: They resisted against maximum manual resistance to
hospital admission. With admission figures predicted to rise, national their knee extension – flexion and ankle dorsi – plantar flexion for 5
initiatives to decrease hospital admissions and LOS for older seconds. Surface EMG signal from vastus lateralis, semitendinosus,
people are at the forefront of government policy. One possible tibialis anterior and medial gastrocnemius of each task were
method of achieving this is case screening. Models of care for recorded. All experimental procedures was approved by research
screening older persons presenting to EDs and those admitted to ethics committee of author’s academy. ANALYSIS: For 5 seconds
hospital, have shown benefits in some countries. We recognised detected signal, median frequency values (MDF) of each subjective
that physiotherapists, with effective case-management skills, could muscle were calculated by Fast Fourier Transform algorithm using
provide leadership in such integrated models of inter-professional intermediate 3 seconds signal, and analyzed correlationship between
working. PARTICIPANTS: Women and men 70 years admitted to MDF and age. Significant level was set at p < 0.05. RESULTS: The
general medical wards at St Thomas Hospital, London. METHODS: MDF of two thigh muscles showed no significant difference with
We carried out a prospective ‘before-OPAL’ (August 2004) and advancing age. MDF of tibiaris anterior decreased significantly with
‘after-OPAL’ (August 2005) evaluation on 50 consecutively admitted aging (p < 0.01), whereas that of medial gastrocnemius increased
patients. Participants were categorised as medium-to-high risk using (p < 0.05). CONCLUSIONS: The results in current study showed
the CGA tool performed by OPAL staff. A blinded independent that these two leg muscles had different alteration of fiber type
evaluator retrieved and compared data from hospital notes and composition with advancing age. Generally, tibiaris anterior is
service data. No ethical approval was required for this service activated through gait cycle, and enhanced activations are observed
evaluation. ANALYSIS: Baseline characteristics of the 2 groups were at heel strike in initial stance phase and at initial swing phase.
compared. Proportions of prevalence of problems (ADL dependency, On the other hand, gastrocnemius is activated from midstance to
falls history, mobility impairment, delirium and other domains of the the end of stance phase, and show highly activations at push off
CGA tool) were compared. We compared the proportions of problems for acceleration. Hence, these muscles are required quick reaction
identified and addressed by OPAL intervention, to ‘before-OPAL’. The to change gait cycle, and this conflicting fiber type alterations
proportion of patients referred to inpatient specialist rehabilitation may be affected the timing of toe clearance. It is known that the
units and outpatient clinics were compared. A ‘before’ and ‘after’ falling of elderly was often due to “stumble”, not for “knee break”.
bivariate analysis was undertaken using a Mann-Whitney U test In addition to this phenomenon, elderly ankle flexibility diminish
progressively with aging. Therefore, if executing training program or Rehabilitation services for additional testing and provision of fall
for the elderly, we should give much thought to these important prevention strategies is warranted. KEYWORDS: older adults, fall
considerations. IMPLICATIONS: If this conflicting alterlation will be risk screen, falls. FUNDING ACKNOWLEDGEMENTS: College of
improved, it will reduce elderly falling. KEYWORDS: elderly, fall, Health Professions, Temple Unviersity, Philadelphia PA. CONTACT:
sEMG. FUNDING ACKNOWLEDGEMENTS: The author wishes to [email protected]
thank all participants and my colleagues. ETHICS COMMITTEE: Temple University Institutional Review Board
ETHICS COMMITTEE: Research ethics committee of Seijoh
Rehabilitation Academy
28-20 Tuesday 5 June 10:30 VALIDITY OF A MODIFIED WALK TEST FOR CHILDREN WITH
VCEC Exhibit Hall B & C DISABILITIES
DEVELOPMENT OF AN EMERGENCY DEPARTMENT SCREEN Goin J, Kerr E, Wedgworth P, Effgen S; Department of
TO IDENTIFY OLDER ADULTS AT RISK FOR FALLS Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA
Newton R1 , Gentile N2 , Klima D3 , Lidicker J4 ; 1 Department PURPOSE: The purpose of this study was to determine if a more
of Physical Therapy, Temple University, Philadelphia, PA, USA; convenient, 3 minute walk test (3MWT) would yield similar results
2 Department of Medicine, Temple University, Philadelphia, PA, USA;
to the commonly used 6 minute walk test (6MWT) in children
3 Department of Physical Therapy, University of Maryland-Eastern
with disabilities. RELEVANCE: Physical therapists require accurate,
Shore, MD,; 4 Center for Statistical and Information Science, College timely measures of physical performance. Determining if the 3MWT
of Health Professions, Temple University, Philadelphia PA, USA yields similar results to the longer 6MWT would allow therapists to
PURPOSE: To develop and validate an ED fall risk screen to use a test requiring less testing time; less exertion and sustained
predict future falls. RELEVANCE: A growing segment of the global participation from the child; and increased examination efficiency.
population is over 60 years. A major health concern is falling. PARTICIPANTS: Twenty-two children (11 males, 11 females) with
Elders entering the Emergency Department (ED) for a myriad of varied disabilities (e.g. cerebral palsy, Down syndrome, mental
reasons often return home to potential declines in health. The ED retardation), ages 6 to 20 years (X= 12.39 years, SD= 4), volunteered
is an opportune time to determine their risk for falls and provide for this study. Each child had to meet established inclusion/exclusion
referral to physiotherapy. PARTICIPANTS: Adults over 60 years criteria to participate. METHODS: The 6MWT protocol of the
were recruited from: ED (n=51), university faculty, senior housing American Thoracic Society was followed for data collection. The
and assisted living facilities (n=123). METHODS: Based on our distance the child walked in the first 3 minutes of the 6MWT was
research and evidenced-based studies, a Fall Risk Screen was also recorded. ANALYSIS: Data was analyzed using the paired
developed that consisted of 9 questions addressing major fall risk sample t-test comparing the distance walked the first 3 minutes to
factors and a Six-Item Mental Status Screen. Fifty-one ED clients the distance walked the last 3 minutes of the 6MWT. The Pearson
received the screen and a 6-week follow-up survey. Based on their correlation was used to determine the correlation between age of
results, the Fall Risk Screen was modified to include: Activities the child and distance walked. RESULTS: The paired sample t-test
Specific Balance Confidence Scale (ABC); Multi-Directional Reach indicated there was no significant difference between the distance
Test (MDRT), Timed Up and Go (TUG), Stance Tests (ST), 20 walked in the first 3 minutes compared to the distance walked
foot walk test and Gait Stability Ratio (GSR). The modified version the last 3 minutes of the 6MWT (t= 1.241). The mean difference
was tested on 123 community-based independent walkers, including between the distance walked the first 3 minutes (654 ft./ 196.2m)
those using a cane or walker (AD), and who were not terminally and the last 3 minutes (628 ft./188.4m) was only 27 ft. (7.8m).
ill. Of those, 107 received a score >3 on the Six Item Mental Status Eleven of the participants decreased their distance walked during
Screen and subsequently received a 3-month follow-up questionnaire the last 3 minutes. The Pearson correlation coefficient was used to
assessing falls and fear of falling (n=102, mean age = 79.8+10.8 determine differences in distances walked based on the age of the
yrs). The study was approved by the University’s Institutional Review child. There was a significant difference for both the first 3 minutes
Board. ANALYSIS: Data were entered into SPSS 14.0 Statistical (r = 0.623, p = 0.01) and last three minutes walked (r = 0.594, p = 0.01)
Package. Descriptive statistics were used to characterize the sample, compared with the age of the child. CONCLUSIONS: Based on our
and logistic Regression to determine which variables predicted falls data, the 3MWT is a valid substitution for the 6MWT for children
at 3 months. RESULTS: At baseline, the majority of subjects self- with disabilities. There was a correlation between the age of the
reported no problems with balance or walking, and 56% used child and distance walked, with older children walking further in
an AD. Most common co-morbidities were poor vision (93%) and both the first and last 3 minutes. Future tests with more subjects
arthritis (66%). Scores on assessments were: MDRT-Forward 7.8+3 would increase the validity of the findings where the analyses
in; MDRT-Backward 3.8+2.6in; MDRT-Right 5.4+2.8in; MDRT-Left can be broken down by age and diagnosis of the participants.
5.3+2.6 in; TUG 16.4 +8.3 sec; SLS-left leg (SLS-L) 7.1 +9.5 sec; IMPLICATIONS: Based on the statistical analysis of the data, a
GSR 2.2+0.8 m/sec. Mean ABC score was 67+24. Twenty-three 3MWT would be an appropriate modification of the 6MWT for some
falls were reported one month prior to baseline assessment and children with disabilities. A shorter test accommodates those who
21 falls were reported at 3-month follow-up. Logistic regression fatigue easily, have low endurance, and have low tolerance for walking
analysis revealed a significant interaction between AD and past 6 minutes consistently. KEYWORDS: Pediatrics, Gait, Measurement.
history of falls (p = 0.021) where those elders reporting a past history FUNDING ACKNOWLEDGEMENTS: This study was not funded.
of falls and also used an assistive device had a 60% likelihood ETHICS COMMITTEE: Medical Institutional Review Board, Office of
of falling at 3 months (other combinations were all less than 22% Research Integrity, University of Kentucky
likely to fall). Although not statistically significant, clinically significant
factors included MDRT-forward; MDRT-backward; Timed Up and
Go; SLS-L, ABC and poor vision. CONCLUSIONS: A combination
of self-report measures, fear of falling and practical balance and
gait measures are necessary inclusions in a fall risk screen to
predict future falls. IMPLICATIONS: The ED Fall Risk Screen is an
easy, quick tool and, upon validation, will be incorporated into the
standard ED intake process. Appropriate referral to Physical Therapy
ENERGY EXPENDITURE INDEX AND HEART RATE DURING RELATIONSHIP BETWEEN MUSCLE THICKNESS AND MOTOR
AMBULATION OF CHILDREN WITH CEREBRAL PALSY, ACTIVE FUNCTION IN CHILDREN WITH MODERATE TO SEVERE
AND SEDENTARY PEERS CEREBRAL PALSY
Fleming Walsh S1,2 , Karapondo D1 , Bryanna L1 , Brittany P1 ; Ohata K1 , Tsuboyama T1 , Haruta T2 , Ichihashi N1 , Nakamura T3 ;
1 The University of Findlay; 2 Rocky Mountain University of Health 1 School of Health Sciences, Kyoto University; 2 Mukougaoka
Professions yougogakkou, school for physically handicapped children;

3 Graduate school of medicine, Kyoto University
PURPOSE: This study examines the differences in the Energy
Expenditure Index (EEI) and heart rate in children who are active PURPOSE: The muscle weakness of people with cerebral palsy
or sedentary as well as in children with cerebral palsy (CP). (CP) affects their motor function. However, it is not clear whether
RELEVANCE: All children, with and without disabilities, are at an muscle volume is associated with the motor function or activities
increased risk for inactivity and decreased fitness. Many health evaluated by validated assessment tools such as the Gross Motor
care professionals, including physical therapists are needed to lead Function Measurement (GMFM) or the Pediatric Evaluation of
and develop health promotion plans for children. PARTICIPANTS: Disability Inventory (PEDI) in children with CP. The purpose of
Ten children diagnosed with varying degrees of CP and scored on this investigation was to examine whether muscle thickness (MTH)
the Gross Motor Function Classification System I-III, (GMFCS), ten has a relationship with GMFM and PEDI scores. RELEVANCE:
children defined as physically active, and ten children defined as This study may clarify the value of MTH as a quantitative muscle
sedentary, between the age of 4-10 years, participated in this study. evaluation for children with cerebral palsy. PARTICIPANTS: Thirty
Active and sedentary groups were defined using the Modifiable Activ- six children with moderate to severe CP (16 females and 20
ity Questionnaire for Adolescents and their participation in athletics. males; mean age 11.9y; range 6y to 18y, the Gross Motor Function
METHODS: The walking protocol consisted of 3 bouts of walking Classification System level II to V) participated in this study.
for 3 minutes. Data gathered during the walking protocol included: METHODS: MTH was measured by B-mode ultrasound images of
resting heart rate, (HRrest) heart rate maximum during ambulation the quadriceps muscle on both thighs. The muscle thicknesses were
(HRmax), time for heart rate to recover to resting(HRrecover), and normalized according to their body weights. The motor function and
distance walked (D). EEI was calculated using the equation EEI = the function of activity of daily life were evaluated by GMFM-66
HRmax – HRrest/(D/3.0 minutes). ANALYSIS: MANOVA testing was and PEDI mobility scores, respectively. ANALYSIS: The correlation
used to analyze the differences between groups and post-hoc tests between the weight-normalized MTH and GMFM-66 or PEDI mobility
were performed using Games-Howell analysis. RESULTS: MANOVA scores was examined by Pearson correlation coefficient. Significant
demonstrated significant between group differences with respect to levels were set at P < 0.05. RESULTS: The results showed that
HRmax, D, EEI and HRrecover. No between group difference was the weight-normalized MTH is significantly related to the GMFM-
found for HRrest. Post-hoc testing revealed children with CP had 66 (r=.60, p < 0.001) and PEDI mobility scores (r=.59, p < 0.001).
higher HRmax and EEI and decreased D versus active children CONCLUSIONS: The weight-normalized MTH reflects the motor
(p = 0.048, p = 0.019, and p = 0.001, respectively). Children with CP function in children with CP. It seems a useful method of quantitative
also displayed increased EEI (p = 0.039) and D (p = 0.007)when muscle evaluation. IMPLICATIONS: The results of this study provide
compared to children who were sedentary. In addition, children a basis for the study of relationship muscle atrophy and motor
who were sedentary had significantly higher EEI compared to function in children with CP. KEYWORDS: Muscle thickness, Motor
children who were active (p = 0.002). Post-hoc testing was unable function, ADL status. FUNDING ACKNOWLEDGEMENTS: this study
to determine the nature of the omnibus difference for HRrecover. was unfunded. CONTACT: [email protected]
CONCLUSIONS: This study demonstrates children participating in ETHICS COMMITTEE: Kyoto University Graduate School and
significant amounts of physical activity expend less energy during Faculty of Medicine Ethics Committee.
ambulation compared to children with sedentary behaviors. This
study also demonstrates that children with CP expend more energy
in a 3-minute ambulation activity than active and sedentary peers Research Report Poster Display
even though their resting heart rate did not show a significant 31-12 Tuesday 5 June 10:30
difference. This increased EEI was due to an increased HRmax VCEC Exhibit Hall B & C
and decreased D ambulated. Limitations of this study include: OBSERVATIONAL LEARNING OF A NOVEL MOTOR SKILL IN
limited sample size, lack of randomization, environmental conditions, CHILDREN WITH COGNITIVE DELAYS: A SINGLE-SUBJECT
anxiety of participants, and possible unreliability of the heart rate DESIGN
monitors. Suggestions for future study include:increasing the sample
Benner S1 , Long T2 , Moerchen V3 ; 1 Department of Physical
size; attempting to quantify how much physical activity a child
Therapy and Rehabilitation Science, University of Maryland
without disabilities needs to engage in for optimum health benefits;
School of Medicine, Baltimore, MD, USA; 2 Center for Child and
quantifying energy expended during other typical play activities
Human Develoment, Georgetown University, Washington, DC, USA;
for children with cerebral palsy; and quantifying how this energy 3 Human Movement Science, University of Wisconsin-Milwaukee,
expenditure changes as the level of disability varies in children with
Milwaukee, WI, USA
cerebral palsy. IMPLICATIONS: There appear to be many possible
causes for increased energy expenditure among children with CP PURPOSE: The use of peers as models for teaching new skills to
during ambulation. Physical therapists should consider this increased children is a common practice for physical therapists and educators.
energy demand on children with CP when utilizing ambulatory The effectiveness of using peer models for teaching new gross motor
activities and other activities of daily living during treatment, such tasks to children who have cognitive impairments has not been
that attention is given to allow for adequate rest and recovery. previously examined. The purpose of this study was to assess the
KEYWORDS: Energy expenditure; Cerebral palsy; Health promotion. effect of peer modeling on motor skill acquisition of a novel task
FUNDING ACKNOWLEDGEMENTS: This work was funded in part in two children with cognitive impairments, as well as in a child
by a grant from Special Olympics and the generosity of The University who is developing typically. RELEVANCE: Families, educators, and
of Findlay. CONTACT: walsh@findlay.edu therapists often expect children with cognitive impairments to benefit
ETHICS COMMITTEE: The University of Findlay IRB; Rocky from peer modeling when included in the general education setting.
Mountain University of Health Professions IRB This study provides preliminary evidence on the effectiveness of peer
modeling in an inclusive educational setting for learning and retaining interval of 2Hz at rest, awake with eyes closed, and in a sitting
a novel motor skill. PARTICIPANTS: Three children between the position. The MEG recordings were performed using a 204-channel
ages of 5-7 years were chosen to be subjects. Two of the three wholehead magnetometer. The MEG was recorded 100 times for 50
subjects had cognitive impairments that placed them in the range of seconds each and then averaged. The moment (Q) of the equivalent
mild mental retardation. One of the three subjects was developing current dipoles (ECDs), peak latency, and the estimated sites of
typically. A 5-year-old peer model was selected to demonstrate the ECDs of the right cerebral hemisphere were estimated by using
the novel motor task. METHODS: A modified ABA single-subject MEG. ANALYSIS: The MEG was measured a total of three times,
design was used to track the acquisition and retention of the skill once prior to and two times after an application of 1% capsaicin
in two children with cognitive impairment and one child with typical cream to the dorsal side of the left forearm. The quantity of pain
development. Self-propulsion of a novel riding toy was selected incurred by the capsaicin cream application was recorded with the
as a novel motor task. ANALYSIS: Graphical analysis of baseline, Visual Analogue Scale (VAS). We chose to measure the MEG when
intervention, and retention phases was used to evaluate the rate of the VAS was reported to be 2 and 4. The sites of the ECDs were
change in each subject’s performance. RESULTS: After observing identified through overlays of the axes that fit between the axes of
the peer model, all subjects acquired and retained the ability to propel the coordinate system derived from MEG and magnetic resonance
the novel riding toy. The subject with mild cognitive impairment had imaging recordings. RESULTS: The Q tended to increase linearly for
the most variability of performance during the intervention phase, but 2 and 4 on the VAS scale after the capsaicin cream was applied. The
also had inconsistent attention to the modeled task. The subject with Q of 4 on the VAS scale especially increased significantly. There were
moderate cognitive impairment, in contrast, had the highest rate of two types of changes in the estimated sites of ECDs coinciding with
skill acquisition during peer modeling. CONCLUSIONS: The findings the changes from prior to 2 and 4 on the VAS. One was the changing
support the efficacy of peer modeling as a method of teaching from the primary somatosensory cortex in prior to the supplementary
motor skills to children with cognitive impairments. IQ alone did not motor area (SMA) in 2 and 4 on the VAS. The other was the SMA
affect the rate of acquisition and retention of the motor skill in this estimated sites of ECDs coinciding with the changes from prior to
learning context. Maintaining attention to the model may be critical 2 and 4 on the VAS. CONCLUSIONS: The Q tended to increase
to learning in a peer-instructed environment. Adult support during linearly for 2 and 4 on the VAS scale after the capsaicin cream was
peer modeling may be required for children with attentional deficits applied. There were two types of changes in the estimated sites of
to benefit from observational learning. IMPLICATIONS: This study ECDs coinciding with changes from prior to 2 and 4 on the VAS.
provides preliminary evidence that children with cognitive delays can The changes of brain responses for the distal electric stimulation
learn and retain a new motor task by observing the performance of a were identified as the estimated changes of Q and ECDs sites. The
peer model in a structured, adult directed environment. This approach MEG data from the distal constant electric current stimulation to the
may prove to be an effective practice model that provides motivation forearm was mostly likely detected in the brain through the influence
and socialization in learning. Use of observational learning may allow of sensitization of the dorsal horn of the spinal cord. IMPLICATIONS:
more efficient use of therapist time and is and is more consistant We believe that quantities of pain can be evaluated objectively on the
with the goals for educational inclusion. Further study, including basis of the Q and ECDs sites for evaluation of pain in physical ther-
a larger group of subjects and comparison to alternative methods apy. KEYWORDS: magnetoencephalography (MEG), hyperalgesia,
of instruction, will add to the evidence pertaining to the ability of capsaicin. FUNDING ACKNOWLEDGEMENTS: Unfunded.
children with cognitive impairments to learn from peer modeling. ETHICS COMMITTEE: The Hiroshima University Ethics Committee
The role of attention in motor learning through peer modeling
also warrants further examination. KEYWORDS: Observational
learning, Cognition, Pediatrics. FUNDING ACKNOWLEDGEMENTS: Research Report Poster Display
Unfunded. CONTACT: [email protected] 31-20 Tuesday 5 June 10:30
ETHICS COMMITTEE: Internal Review Board of the Human VCEC Exhibit Hall B & C
Research Protection Office at University of Maryland Baltimore EFFECTS OF MECHANICAL NOCICEPTION ON HEART RATE
School of Medicine. VARIABILITY AND SKIN CONDUCTANCE IN HEALTHY HUMAN
PARTICIPANTS
Research Report Poster Display Shay B, Morrison G; Dept. of Physical Therapy, University of
31-16 Tuesday 5 June 10:30 Manitoba, Winnipeg, Canada
VCEC Exhibit Hall B & C PURPOSE: Objective measurement of pain has been part of
MAGNETOENCEPHALOGRAPHIC STUDY OF HYPERALGESIA the focus of pain research. It has been suggested that the
INDUCED BY CAPSAICIN autonomic nervous system (ANS) may play a significant role in
pain physiology. There is little clinical research with respect to
Kawamura H1 , Ushida T2 , Tani T2 , Tsurumi T1 , Shimizu M3 ;
1 Division of Physical Therapy, School of Rehabilitation, Faculty interventions for pain and their effect on the ANS. Skin conductance
(SC) and heart rate variability (HRV) have been proposed as
of Health and Social Work, Kanagawa University of Human
accurate measures of autonomic activity. HRV as the summation
Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa 238-8522,
of sympathetic/parasympathetic effects at the sinus node provides
Japan; 2 Department of Orthopaedics, Kochi Medical School,
information towards dominant autonomic tones within the individual.
Kohasu, Nankoku, Kochi 783-8505, Japan; 3 Department of Physical
This study uses SC and HRV to measure ANS responses to
Therapy, Faculty of Health and Welfare, Prefectural University of
mechanical nociception and, provides further understanding in the
Hiroshima, 1-1 Gakuen-cho, Mihara, Hiroshima 723-0053, Japan
relationship between nociception and the ANS. RELEVANCE: Skin
PURPOSE: The purpose of this study was to investigate brain conductance (sudomotor activation) has been used to indicate SNS
responses to the application of capsaicin cream and slight electrical activity in pain/stress states. Using HRV as a quantitative indicator
stimulation on the dorsal side of a hyperalgesic forearm with the for pain is a unique approach that can further our understanding
use of magnetoencephalography (MEG). RELEVANCE: We hope to of pain and the autonomic nervous system. PARTICIPANTS: Ten
improve the evaluation of pain in physical therapy. PARTICIPANTS: healthy males aged 21-36 years were recruited from the University
Eight normal adult volunteers, who ranged in age from 25 to 45 years of Manitoba staff and students. Participants were excluded if they
(31.4±6.6), were our subjects. All the subjects gave their informed reported any painful conditions, tobacco, alcohol, drug or medication
consent. The Hiroshima University Ethics Committee approved the use. METHODS: The Polar S810i heart rate monitor was used to
study. METHODS: The electric stimulation was given at the site collect HRV data. SC was monitored via skin electrodes on the 2nd
of the capsaicin application using a stimulus pulse delivered at an and 5th phalanges bilaterally. Mechanical nociception (assessed by
verbal pain rating scales) was created by pinching the skin of the of a variety of research approaches produces richer information,
lateral forearm with a small battery clip. Participants were positioned and more effective marketing strategies. Quantitative information is
supine in a temperature controlled, soundproof cubicle. After heart available about what the general public in Australia know about
rates (HR) reached a steady baseline, control HR were collected, physiotherapy, and qualitative studies have examined how clients
followed by clip application for 5 minutes and then continuous perceive physiotherapy services in a variety of settings. However,
monitoring for an additional 40 minutes recovery time. ANALYSIS: the perceptions of people who do not go to physiotherapy has
R-R intervals (ms) were downloaded via infrared interface to a not been investigated. This study involved inspection of publicly
PC into Polar Precision software where data was divided into available promotional material from the Australian Physiotherapy
five minute bins for comparison. Standard deviation values were Association (APA) and competitor professions. Interviews were
computed for each bin to represent the R-R interval variability. conducted, which are reported elsewhere (report in progress). This
HRV was normalized to percent control at baseline. SC values abstract reports on the findings of an aspect of these interviews that
were exported to SigmaPlot software and divided into five minute involved participant description of images depicting a physiotherapist
bins consistent with HRV data. Mean values were computed for providing treatment, published by the APA. ANALYSIS: Analyses for
each bin. Kruskal-Wallis tests for repeated measures were used the whole study involved first and second order coding of interview
to determine differences between control, nociceptive and recov- data and thematic analysis of promotional and website material
ery conditions. Differences (p > 0.05) were considered significant. about physiotherapy and its competitors. For this presentation, data
RESULTS: Skin conductance measured ipsilateral to the noxious relevant to the image of physiotherapy have been extracted from
stimulus was significantly increased during the clip application the overall analyses. RESULTS: The major themes with respect
and for 30 minutes after the clip was removed. Contralateral SC to the image of the profession were a strong association with
was increased significantly during the clip application but was not sport and a traditional, medical model of health care, and difficulty
different within 5 minutes of clip removal. HRV either increased or distinguishing physiotherapy from alternative services. Participants
decreased between the conditions. CONCLUSIONS: Increased skin recognised a typical physiotherapist image: relatively young, often
conductance indicating activation of the SNS appears related to female, fit and ‘sporty’. In addition, participants identified issues
mechanical nociception. R-R interval variability increased/decreased, of physical and emotional disempowerment accompanying the role
suggesting that the ANS is perturbed in response to mechanical of ‘patient’. CONCLUSIONS: There is a mismatch between what
nociception. Further studies need to be done to determine the the Physiotherapy profession aims to be, and how it is perceived,
specific variables related to these responses. IMPLICATIONS: which limits access to potential clients and restricts performance in
To date, there are no documented studies using HRV as an the health marketplace. IMPLICATIONS: From this study will come
objective indication of pain. This experiment provides important a better understanding of the professional image of Physiotherapy
information on autonomic pertubations in response to nociception. in Australia and how to develop marketing strategies that consider
The results may provide clinicians with objective means to evaluate consumer preferences, our competition and how to reach different
pain and the response to treatment intervention. KEYWORDS: target populations. Further research is needed into how services
heart rate variability, sympathetic nervous system, pain. FUNDING may be improved to better meet consumer needs. KEYWORDS: Pro-
ACKNOWLEDGEMENTS: Manitoba Medical Services Foundation, fessional image, Marketing of physiotherapy, Consumer perceptions.
MMSF:2005. CONTACT: [email protected] FUNDING ACKNOWLEDGEMENTS: This project was unfunded.
ETHICS COMMITTEE: University of Manitoba, Faculty of Medicine, ETHICS COMMITTEE: School of Community Health Ethics Commit-
Bannatyne Research Board tee, Charles Sturt University

THE PUBLIC IMAGE OF PHYSIOTHERAPY IN AUSTRALIA: A PATIENT EDUCATION IN PHYSICAL THERAPY PRACTICE: A
QUALITATIVE INQUIRY GROUNDED THEORY INVESTIGATION
Chapman L1 , Ruston S1 , Beecham R1 , Spry S; 1 School of Rindflesch A; Mayo Clinic College of Medicine, Rochester, MN
Community Health, Charles Sturt University, Albury, Australia
PURPOSE: Patient education is a critical component of the practice
PURPOSE: This project was undertaken as an Honours project of physical therapy. It has been shown to be used extensively
for a Bachelor of Physiotherapy degree at Charles Sturt University in practice. Research of patient education in physical therapy is
in Australia. The research question addressed why people do not scarce and terms used for patient education differ from other
seek physiotherapy when experiencing common musculoskeletal professions. Much of the research that has been done has focused
conditions, such as back pain. This presentation focuses on on frequency of use or in measuring effectiveness in persons with
an aspect of this investigation: how consumers perceive the specific pathologies. Never has a study proposed a theory supporting
Physiotherapy profession in Australia. RELEVANCE: The importance patient education derived directly from observations of physical
of this project relates to international findings that Physiotherapy therapists practicing patient education. This study examines the
is not clearly differentiated from its competitors and that this is practice of patient education in physical therapy using a grounded-
detrimental to its market performance and professional standing. theory qualitative approach. The primary purposes of this study
In Australia, as in other western countries, physiotherapists deliver are to establish a theory for the practice of patient education
services in competition with a variety of alternative health providers,in in physical therapy and to outline the process by which physical
a marketplace that is changing to reflect the health characteristics therapists educate patients. Because physical therapy and patient
of the local population, and where there is increasing consumer education are practiced across diverse settings, three of the most
demand for choice and client-focused care. The relevance of this common areas of practice were chosen to collect data: acute
presentation, therefore, concerns the need for the Physiotherapy care, outpatient, and inpatient rehabilitation. RELEVANCE: This
profession to understand its image in order to promote its services. study contributes to the evidence base supporting the practice of
PARTICIPANTS: Six participants were recruited who had never patient education in physical therapy. Currently there is no published
been to physiotherapy, in order to access general perceptions about research proposing a theory supporting patient education that is
physiotherapy. Participants were recruited using a ‘snowball’ strategy, derived directly from observations of physical therapists practicing
by using a personal contact to gain access to an appropriate patient education. This study is relevant because patient education
sample. METHODS: In researching consumer behaviour, the use is such a large part of practice. PARTICIPANTS: Nine physical
therapists were chosen for this study, three from each of the questionnaire. Mean age 43 years (SD 8.1). Mean number of years
following areas of practice: acute care, inpatient rehabilitation, and of practice 16 years (SD 8.8). 100% of the respondents reported
outpatient orthopedics. All therapists practice within a mid-western that all relevant aspects of physical functioning were represented
academic medical center. Therapists were nominated by their peers in the ASK-NL. 92% distinguished the capability and performance
as outstanding patient educators before being asked to participate. version as distinct constructs. 85% reported that the length of the
METHODS: First, therapists were interviewed as a group during a ASK-NL was average compared to instruments they used. 77%
one-hour session, answering questions about the practice of patient of the respondents wanted to add more items to the 38 items
education in physical therapy. Second, each therapist was observed and 53.8% wanted to remove one to three items. Ninetyseven
in practice working with at least three patients. Sessions were children completed the ASK-NL their total scores ranged from
audiotaped, transcribed, and themes emerged resulting in model 22.1–100 ASKc and 12.5–100 ASKp. No floor effects were found
formation and theory identification. Finally, all therapists were asked for both the ASKc and the ASKp. Ceiling effects were aware in
to verify the results. ANALYSIS: Qualitative thematic analysis using 13.3% ASKc and 8.4% ASKp. CONCLUSIONS: Content validity
the constant comparative coding method. RESULTS: Results show of the ASK-NL was rated as good by experienced healthcare
the inseparability of patient education from the practice of physical professionals. ASK scores among children with musculoskeletal,
therapy. Each are intertwined. Physical therapists seek to empower neuromuscular and miscellaneous conditions show very limited c
patients through patient education. Empowerment is the purpose IMPLICATIONS: The ASK-NL provides rehabilitation specialists of
of patient education. Physical therapists use informal methods to a well designed and well perceived generic functional outcome
evaluate readiness to learn, to deliver patient education, and to instrument. KEYWORDS: Functional Outcome; Physical Activity;
evaluate its effectiveness. Examples of methods will be shared. Childhood. FUNDING ACKNOWLEDGEMENTS: not applicable.
CONCLUSIONS: Physical therapists perform patient education ex- CONTACT: [email protected]
tensively in practice. The practice of patient education is inseparable
from other primary interventions in physical therapy. Therapists
attempt to empower patients. Therapists use informal methods to
evaluate readiness to learn and outcomes. IMPLICATIONS: Now 36-08 Tuesday 5 June 10:30
that a theory supporting the practice of patient education has been VCEC Exhibit Hall B & C
identified, the theory brought forward here can and should be THE VALIDITY OF THE RT3 ACCELEROMETER TO MEASURE
further tested in other physical therapy settings. KEYWORDS: Patient PHYSICAL ACTIVITY IN PATIENTS WITH COPD
education. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: Mc Groarty M1 , O’ Dwyer J1 , Shanahan C1 , Hussey J1 , O’
rindfl[email protected] Connell F2 , Kealy S2 ; 1 Discipline of Physiotherapy, School of
ETHICS COMMITTEE: Mayo Institutional Review Board Medicine, Trinity Centre for Health Sciences, Dublin, Ireland; 2 St.
James Hospital, Dublin, Ireland
PURPOSE: To investigate the validity of the RT3 accelerometer
35-24 Tuesday 5 June 10:30 in the measurement of physical activity and inactivity in subjects
VCEC Exhibit Hall B & C with COPD. RELEVANCE: An objective and valid outcome measure
CONTENT VALIDITY OF THE DUTCH VERSION OF THE of physical activity is needed in the characteristically sedentary
ACTIVITIES SCALE FOR KIDS (ASK-NL) COPD population. Rehabilitation aims to improve exercise tolerance
and functional activity in this population. The RT3 (a triaxial
van der Net J1 , Stukstette M1 , Takken T1 , Engelbert R1 , Young N2 ,
accelerometer) is a battery-powered device that measures physical
Helders P1 ; 1 University Children’s Hospital UMC at Utrecht, The
activity in three planes of movement and could potentially be used
Netherlands; 2 Laurentian University, Sudbury, ON, Canada
as an outcome measure in the rehabilitation setting. PARTICIPANTS:
PURPOSE: To determine content validity of the Dutch translation of A sample of fifteen patients (nine male & six female) was recruited
the ASK (ASK-NL). RELEVANCE: Insight in children’s capabilities from St. James’ Hospital pulmonary rehabilitation programme, Dublin,
and level of performance are important for healthcare professionals Ireland. To be eligible for inclusion the participants had to be able
for their clinical reasoning process by formulating and evaluating to walk on a treadmill continuously for five minutes without the
treatment goals. The ASK is a generic self report measure to assistance of oxygen therapy. Patients with unstable or severe
describe and evaluate change in the level of daily life capabilities cardiovascular disease, a neuromuscular or disabling cognitive
and performance in children 5-15 years (Young, 2000). As part of a disorder were excluded from the study. METHODS: Accelerometers
translation and cross cultural validation process the content validity of were worn at the waist on the right hand side. The subjects were
the ASK-NL was established. PARTICIPANTS: In order to investigate required to sit quietly for 5 minutes, walk at 1.5km/hr on a treadmill
the content validity of the ASK-NL, 13 healthcare professionals and sit for a further 5 minutes. Estimated energy expenditure from
(teachers, pediatric physiotherapists, occupational therapists, and the RT3 (kcal/min/kg) was compared to EE measured by a portable
physiatrists) were recruited at a school for special education, a centre indirect calorimeter (kcal/min/kg). ANALYSIS: ANOVA was employed
for pediatric rehabilitation and a primary care facility for children. to compare the mean of each activity mode. Correlations were
In order to investigate the difficulty of the 38- items of both the analysed with the Pearson correlation coefficient to identify any
ASKc-NL and ASKp-NL floor and ceiling effects were calculated in a relationship between VM counts and measures related to EE. The
sample of 97 children (14 healthy and 83 a various musculoskeletal, level of agreement between the measures was analysed using a
neuromuscular and miscellaneous conditions). Informed consent graphical technique by plotting the difference against the mean of
of all children was obtained. The local board of ethics approved the measures. RESULTS: The results indicate that the RT3 has the
this study. METHODS: Feasibility and quality of evaluative and ability to distinguish between inactivity and activity (P < 0.0001). The
discriminative characteristics were determined with a questionnaire. RT3 was found to consistently underestimate EE in all cases when
Demographics, level of experience and years of practice were compared to indirect calorimetry (bias 0.004, 0.02, 0.006 kcal/min/kg
gathered from the healthcare professionals. Floor and ceiling effects during baseline, treadmill walking and recovery respectively). When
were examined by exploring the range of scores among the sample both activity modes were combined, analysis of the data returned a
of selected children and their primary care takers. ANALYSIS: significant correlation between VM counts measured by the RT3 and
Qualitative analysis of the questionnaire was performed using SPSS EE measured by indirect calorimetry (r =0.89 P < 0.001). There was
11.5 and Kwalitan-students version. Descriptive statistics were used also a significant correlation between the RT3 VM counts and the
to describe floor and ceiling effects in the total scores. RESULTS: VO2 uptake calculated by indirect calorimetry (r = 0.87, P < 0.001).
Thirteen healthcare professionals completed the content validity CONCLUSIONS: The RT3 was found to be sensitive to changes
in physical activity in a laboratory-based protocol using rest and motor development, physiotherapy, posture, re-train/re-gain function,
treadmill walking. While EE as measured by the RT3 has limitations, scoliosis. FUNDING ACKNOWLEDGEMENTS: We are grateful for
the RT3 can be used in the classification of physical activity. This the support from the Medical Research Foundations of the Northern
device could be used clinically to determine habitual physical activity University Region, from Östersund Hospital and from the Marcus and
in this group of patients. Future research could focus on advances Amalia Wallenberg Foundation. CONTACT: [email protected]
in technology such as mobile phones, Blackberry® technology, ETHICS COMMITTEE: This study was approved by the ethical
and global position systems (GPS) in conjunction with the RT3. committee at the University of Umeå (§15/97, dnr 97-1)
IMPLICATIONS: The RT3 may have a role as an outcome measure
for pulmonary rehabilitation or any intervention where the aim is
to enhance physical activity. KEYWORDS: accelerometer, COPD,
physical activity. FUNDING ACKNOWLEDGEMENTS: This study 37-16 Tuesday 5 June 10:30
was partly funded by the Chartered Physiotherapists in Respiratory VCEC Exhibit Hall B & C
Care, Ireland. CONTACT: [email protected] A REVIEW OF GRADED EXERCISE TRAINING FOR CHRONIC
ETHICS COMMITTEE: The study was approved by St. James FATIGUE SYNDROME/ MYALIGIC ENCEPHALOPATHY (CFS/ME)
Hospital and Federated Dublin Voluntary Hospitals Joint Research
Larun L1 , Festvåg L2 ; 1 Norwegian Knowledge Centre for the Health
Ethics Committee.
Services; 2 Physiotherapy Consultant, Oslo
PURPOSE: To assess and synthesize the evidence base for
treatment of Chronic Fatigue Syndrome/ Myalgic Encephalopathy
37-12 Tuesday 5 June 10:30 (CFS/ME), with special emphasis on Graded Exercise Therapy
VCEC Exhibit Hall B & C RELEVANCE: CFS/ME is characterized by persistent and unex-
GENERAL DEVELOPMENT IN FEMALES WITH RETT plained fatigue and low tolerance for physical and mental exercise,
SYNDROME, FOCUSING ON ABILITIES, DEFORMITIES AND resulting in severe impairment in daily functioning. These patients
MANAGEMENT: THE SWEDISH RETT CENTER SURVEY are often referred to physiotherapists. PARTICIPANTS: The review
Larsson G1 , Lindström B2 , Witt Engerström I3 ; 1 Swedish Rett included five studies concerning GET, with a total of 336 patients, of
Center, Frösö Strand, Box 601, S-832 23 Frösön, Sweden; which most were women. Mean illness duration was two years. The
2 Dept of Community Medicine and rehabilitation, Building15, Umeå participants were included if they satisfied either the Oxford or the
University, Sweden; 3 Swedish Rett Center, Frösö Strand, Box 601, CDC 1994 criteria. METHODS: The literature search was performed
S-832 23 Frösön, Sweden in the databases Cochrane Database of Systematic Reviews (CDSR)
and Database of Abstracts of Reviews of Effects (DARE) in The
PURPOSE: The aim of this study was to describe the early Cochrane Library, as well as in MEDLINE, EMBASE, PsycINFO and
development in individuals with the diagnosis Rett syndrome (RTT) AMED. Home pages from relevant organisations (e.g. AHRQ) were
using parents’ information. RELEVANCE: This research provides hand searched and articles from experts or patients considered. The
physical therapists with information important to clinical work. About search for systematic reviews was done in November 2005 and the
the development of RTT and about the possibility for some to keep, one for recently published RCTs and CCTs in April 2006. Patients
re-gain, learn new abilities after the regression that is part of the syn- with Chronic Fatigue Syndrome (CFS), Myalgic Encephalopa-
drome. PARTICIPANTS: 125 out of all 178 families in Sweden with thy/myelitis (ME), postviral fatigue syndrome (PVFS) and Chronic
a girl/woman diagnosed with Rett syndrome in 1997. METHODS: In Fatigue and- immunodysfunctionsyndrom /CFIDS) were included.
1997 a questionnaire was sent to all 178 families in Sweden with Interventions could be any kind of physical activity for CFS/ME. All
a girl/woman diagnosed with RTT. Information received from 125 outcomes were considered, fatigue, physical and mental health and
cases provided us with families’ description of early development in quality of life are reported. ANALYSIS: The review team, consisting
gross motor function, fine motor function and communication/social of experts from different disciplines and methodological expertise,
interplay. ANALYSIS: Descriptive analysis was made of the closed has performed a health technology assessment according to inter-
questions and a qualitative analysis of the open-ended questions. nationally approved principles. Two patient organisations gave input
RESULTS: Best abilities of the persons with RTT before regression during the process. The level of documentation was done according
were presented, 62% lost their best abilities, 22% kept them and 5% to GRADE. RESULTS: Graded exercise therapy (GET)usually aims
kept them with deterioration. Seventy-three per cent learnt to walk, to improve aerob capacity, but our studies describe different forms
20% stopped walking and 2% retrained walking. Concerning feeding, of exercise varying from what would be called pacing (40% VO2
69% learnt to feed themselves, 57% lost this ability, 7% re-trained the max) to exercise intending to increase aerob capacity (75% VO2
ability and 5% learnt to feed after regression. Sixty-four per cent were max. If exercise exceeds 70% of VO2 max drop out was high (RR
one year or younger when a deviation in development was noted. 1.73 (95% CI 0.92 to 3.24). The intervention period was 12 weeks,
Sixty answers reported the girl was late in developing functions while 3-5 times per week with a minimum of 30 minutes duration. At 12
35 reported sudden loss of reached abilities. Seventy-four per cent weeks individually adapted GET were more effective on fatigue than
developed a scoliosis and 83% reported other deformities of which treatment as usual(SMD −0.77, 95% CI: −1.6 to −0.28). This was not
deformities in feet were the most common. Postural control was poor significant after 24 weeks. There was no significant effect on depres-
since all but 15 girls/women leant in various directions when sitting, sion and QoL. The documentation is low. CONCLUSIONS: Graded
i.e. they did not keep an upright position when sitting. Transitional Exercise Therapy for CFS patients suggests a reduction of fatigue,
movements were difficult to perform, which also may indicate poor but did not document effect on depression or quality of life. Drop-out
postural control. In 80% of cases the families were those who first was high, especially with high intensity exercise. IMPLICATIONS:
suspected that something was wrong in the child’s development. There are insufficient studies as to the better treatment for severely
CONCLUSIONS: There is loss of function in this group but the pos- ill or disabled sufferers. The evidence base for children and young
sibility for some to keep abilities, re-train/re-gain abilities and achieve people is scarce. For the remaining patienst with CFS/ME the level
abilities after regression is most important to keep in mind when plan- of documentation is low or very low. There is a need for research
ning for intervention. IMPLICATIONS: It is essential that medical staff related to all aspects of exercise and physical activity for the CFS/ME
are aware of the different ways RTT develops in order to give families group. KEYWORDS: Chronic Fatigue Syndrome,CFS,Myalgic En-
early appropriate support and a plan for intervention. More research cephalopathy,ME, Graded Exercise Therapy,GET, Physical activ-
has to be focused on management and treatment to help persons ity, Exercise. FUNDING ACKNOWLEDGEMENTS: The Norwegian
with Rett syndrome keep and develop abilities according to their Knowledge Centre for the Health Services. CONTACT: lille-
individual resources. KEYWORDS: Foot deformities, loss of function, [email protected]
PREVALENCE OF FIBROMYALGIA AND ASSESSMENT OF THE RELATIONSHIP BETWEEN DECLINE ANGLE WITH
ASSOCIATED SYMPTOMS, FUNCTIONAL DISABILITY AND RUSSIAN HAMSTRING AND HAMSTRING STRENGTH AND ITS
QUALITY OF LIFE, IN EMBU, SAO PAULO, BRAZIL EFFECT AFTER EXERCISE
Assumpção A, Cavalcante A, Sauer J, Chalot S, Capela C, Matsui H, Urabe Y, Tanaka K, Tanaka T, Sasaki R, Miyagawa K;
Marques A; Physiocaltherpy, Speech an Ocupational Therapy Department of Sport Rehabilitation, Graduate School of Health
Department of Medicine School of University of Sao Paulo Science, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima
734-8551, Japan
PURPOSE: Fibromyalgia is a rheumatic syndrome characterized
by chronic widespread pain, tender points, fatigue, sleep disorders PURPOSE: Anterior Cruciate Ligament (ACL) injuries often occur
and morning stiffness. Functional Disability and negative impact in during sports activities. We need to act immediately for establishing
the quality of life are also frequent. Studies show a fibromyalgia its prevention strategy. Proper neuromuscular control of joint
prevalence around 2% and 3%. The aim of this study was movement is necessary for ACL injury prevention. The jump landing
to assess the prevalence of fibromyalgia, associated symptoms, motion is one of the most typical mechanisms of ACL rupture.
functional disability and quality of life in residents of Embu, SP, Female athletes showed relatively low muscle activation of hamstring
Brazil. RELEVANCE: Physiotherapy and exercise in general have muscles compared to the male at landing. Hamstring muscles
being described as an important form of treatment to fibromyalgia have synergy function with ACL. If contraction force of hamstring
patients, improving pain, functional disability and quality of life of muscles is increased, it may help to prevent ACL injuries. Russian
fibromyalgia patients. With the fibromylagia prevalence, the health (Nordic) Hamstring (Myklebust et al. 1998) is a kind of exercise
care system could prepare the physioterapists to treat this kind for the strengthening hamstring. The purpose of this study was
of patients properly. PARTICIPANTS: The sample was selected in to demonstrate the relationship between the decline angle during
individuals of the primary health care, aged by 35 and 60 years the Russian Hamstring and hamstring strength, and investigate
old. Of all 2269 subjects with phone number, we interviewed 768 the effect of the Russian Hamstring exercise. RELEVANCE: If
with questions about presence of pain, pain location and time of Russian Hamstring is effective for strengthening hamstring, Russian
pain. Of these subjects, 304 were personally evaluated. METHODS: Hmastring is the necessary exercise for prevention of ACL injury.
The subjects were interviewd by phone with questions about pain PARTICIPANTS: One hundred twenty seven female volunteered this
and pernosinally evaluated about tender points examination and study. All of them were belong to local high school basketball team.
assessment of pain by the Visual Analogue Scale (VAS), sleep The mean (±SD) age was 16.1±0.8 years, height was 160.7±5.9
disorders by the Post Sleep Inventory (PSI), fatigue by the Chalder cm, and body weight was 53.5±5.7 kg. METHODS: The maximum
Fatigue Scale, functional disability by Stanford Health Assessment trunk decline angle during the Russian Hamstring was measured
Questionnaire (HAQ) and quality life by the Fibromyalgia Impact by digital goniometer. The position was maintained over 2 seconds
Questionnaire (FIQ). ANALYSIS: The data were analysed using by hamstring contraction to prevent the trunk from touching floor.
Descriptive, Baeysian and Interferential Analyses (Kruskal-Wallis, Isometric maximum hamstring contraction force was measured by a
Friedmam, ANOVA, with significance level of 5%) RESULTS: The 768 hand held dynamometer in prone position at the knee flexion angle
subjects were distributed in three groups: Without Pain (WP) – 185 of 60º. The subjects were divided by two groups at random. Sixty
individuals, Regional Pain (RP) – 388 individuals and Widespread seven of the subjects were assigned to the exercise group, and
pain (WpP). In the sub-sample of 304 subjects, the groups of the others were assigned to the control group. The exercise group
chronic widespread pain were classified in Fibromyalgia (FM), with 19 performed the Russian Hamstring exercise of 10 times everyday for
subjects, and Non-Fibromyalgia, with 87 subjects. The mean age was three months. All subjects were measured the decline angle and
47.9 (7.2) years old for 768 sample and 49.1 (6.8) for the 304 sub- hamstring strength before and after the three months. ANALYSIS:
sample. The prevalence of chronic widespread pain was 24%, with The correlation between the decline angle and hamstring strength
95% credibility interval [21%; 27%] and fibromyalgia prevalence was was analyzed using Peason’s correlation coefficient. Paired-t test
4.4%, with 95% credibility interval [2.6%; 6.3%]. CONCLUSIONS: was used to compare the mean values of the decline angle between
The fibromylagia prevalence in Embu, Brazil is similiar to other before and after the three months. P value of less than 0.05 was
countries for people aged between 35 and 60 years old. Pain, sleep considered statistically significant. RESULTS: The mean decline
disorders, fatigue, functional disability and quality of life were worse in angle was 27.0±8.3º, and the mean hamstring strength was 6.1±1.1
the FM Group, followed by WpP, RP and WP. IMPLICATIONS: The N/kg before the exercise. The decline angle and hamstring strength
physiotherapits should take care for fibromyalgia patients because showed significant correlations (r = 0.37, p = 0.0002). Significant
they are in large number in the world and with importants symptons. increase of the decline angle and hamstring strength was found in the
While fibromyalgia cure is not discoverd, physiotherapy is one exercise group (p < 0.05). CONCLUSIONS: These results showed
of the most effect treatment to improve the quality of life of that we could use Russian Hamstring as an assessment tool of
that patients. KEYWORDS: Prevalence, Fibromyalgia, Pain, Sleep hamstring function. In addition, we showed the baseline data of the
disorders, Fatigue, Disability evaluation, Quality of life. FUNDING Russian Hamstring among Japanese female high school basketball
ACKNOWLEDGEMENTS: Fundação para Amparo a Pesquisa e players. It is interesting that the decline angle and hamstring strength
Desenvolvimento do Estado de São Paulo – FAPESP (Sao Paulo were increased by such a simple and short-term exercise. Russian
State Fundation for Research and Development Support); Conselho Hamstring is simple, useful, and convenience to develop hamstring
Nacional de Desenvolvimento Cientı́fico e Tecnológico – CNPq strength and to assess their function of hamstring. We believe that
(National Committee of Scientific and Tecnology Development). the Russian Hamstring is one of the most effective exercises for
CONTACT: [email protected] prevention of ACL injury. It is necessary to compare between the
ETHICS COMMITTEE: Ethics Committee for Analyses of Research effect of Russian Hamstring and the other exercise in future study.
Studies of Clinical Hospital of Medicine School of University of Sao IMPLICATIONS: We showed the speriority of Russian Hamstring.
Paulo (process: 161/2004) KEYWORDS: Russian Hamstring, ACL injury, prevention. FUNDING
ACKNOWLEDGEMENTS: This study was done anything no grant
and commercial support. CONTACT: [email protected]
ETHICS COMMITTEE: The ethics committee of Hiroshima university
A SURVEY OF UNITED STATES PHYSICAL THERAPY FACULTY MUSCULOSKELETAL DYSFUNCTION IN FEMALE CHRONIC
ON ENTRY-LEVEL WOMEN’S HEALTH CURRRICULAR PELVIC PAIN: A BLINDED STUDY OF EXAMINATION FINDINGS
CONTENT Neville C1 , Fitzgerald C1 , Furno N1 , Hynes C1 , Badillo S1 , Tu F1,2 ,
Boissonnault J; University of Wisconsin-Madison Mallinson T3 ; 1 Rehabilitation Institute of Chicago, Dept. of Physical
Medicine and Rehabilitation; 2 Evanston Northwestern Healthcare
PURPOSE: To determine what US faculty in professional physical
Dept. of Obstetrics and Gynecology; 3 Rehabilitation Institute of
therapy (PT) programs believe are important women’s health
Chicago, Center for Rehabilitation Outcomes Research
content areas for inclusion in PT entry-level curricula. Additionally,
to contribute to the process of greater, and more standardized, PURPOSE: The purpose of this study is to determine if women
representation of women’s health PT content in US entry-level PT with chronic pelvic pain (CPP) present more commonly with positive
curricula. RELEVANCE: This survey research, in combination with musculoskeletal findings than women without CPP. RELEVANCE:
two other studies, has served as the basis for development of “Guide- Musculoskeletal factors significantly contribute to female pelvic pain.
lines for Women’s Health Content in Professional Physical Therapy No gold standard diagnostic tests exist for pelvic musculoskeletal
Curricula” published by the Section on Women’s Health(SOWH), problems. Studies defining such clinically useful tests are needed
APTA. These guidelines assist schools in development of specific to further refine a rational approach to CPP diagnosis and
women’s health content. PARTICIPANTS: Each of the 200 PT management. Blinded case control studies of musculoskeletal factors
programs in the USA METHODS: A mail survey was sent to each in female CPP are needed to confirm the validity of diagnostic
program. The survey asked respondents to determine importance for tests. PARTICIPANTS: Thirty-one non-pregnant female participants,
inclusion in entry-level and post-professional curricula each women’s 14 with CPP and 17 without pain, between the ages of 18 and
health academic content area listed. The survey tool was developed 55 were recruited. Cases must have reported a history of at
by Dr.Laura LaProta Crum and Dr. Susan Smith for use at Texas least 3 months of pelvic pain (not solely menstrual pain), while
Women’s University, Houston, TX, and had been used to survey control participants must have had no history of back or pelvic
a random sample of clinician-members of the SOWH. Responses pain. METHODS: Thirteen commonly used physical examination
from the current study’s cohort of academicians were statistically maneuvers were performed on all participants by one physiatrist and
compared with responses form the Crum/Smith cohort. Section 3 one physical therapist, respectively. All investigations were blinded
of the survey also asked questions about strategies and challenges as to the participants’ pain status. The physical examination included
in integration of women’s health content into current curricula. assessment of posture, pelvic joint function, core muscle strength,
ANALYSIS: 1.Section 1, Demographic information, was analyzed to hip joint status, and pelvic floor muscle status. ANALYSIS: The
determine whether respondenders varied from a antional database relative frequency of positive findings between groups was assessed
of PT faculty maintained byt he APTA. “Z” scores were computed using chi-squared test of proportion. P value <0.05 was considered
to provide statistical analysis on variables of faculty apoointment, statistically significant. RESULTS: Overall, on average pelvic pain
numbers of faculty in clinical practice, and full or part-time status. patients were more likely to have abnormal musculoskeletal exam
2.Fisher-Irwin Exact Test was employed to determine if membership findings identified by physical therapists, including pelvic floor muscle
in any of the demographic categories in section one influenced the weakness (57% vs 13%) and tenderness (64% vs 6%), abdominal
results of Section 2 (rating the content areas). 3.Fischer-Irwin Exact muscle weakness (93% v 59%), positive forced Faber’s (57% vs
Test was used to compare responses of Section 2 of this survey 12%), and positive standing forward flexion (100% vs 58%); all
with the Crum/Smith cohort. 4.Indepth analysis of the question (18) p values <0.05. Physicians found a higher frequency of positive
on propriety of training entry-level students in internal examination posterior pelvic pain provocation testing in pain patients only
was conducted to determine whether particular faculty demographics (21% vs. 0%). A total pelvic musculoskeletal dysfunction score
influenced the response to this controversial question using the was calculated after removing pelvic symmetry, Gillet’s, forward
Fisher-Irwin Exact Test. RESULTS: Survey response rate was 64%. flexion and active straight leg raise (due to lack of reliability or
1.Slight variances between the database for this survery from the discriminative ability), and was found to be higher for pain patients
APTA national database on percentages of full time appointments. on physical therapist evaluation (5.1±1.8 vs 2.6±1.5, p < 0.001) and
2.Demographic information collected did not influence responses to of borderline significance among physiatrists (3.9±1.2 vs 2.9±1.6,
Section 2 of the survey. 3.Analysis via a Fischer-Irwin Exact Test p = 0.06). Preliminary results of a three cluster analysis on the total
of Significance revealed no significant differences between cohorts. pelvic musculoskeletal dysfunction score (out of 9) suggests that
4.No significant differences were found relating demographics to a score of 0-2 positive findings is inconsistent with a diagnosis of
response to question 18. Descriptive statistics of frequency counts pelvic musculoskeletal pain dysfunction, while a score of 5 or higher
and percentages allowed generation of a list of content categories is consistent with global pelvic musculoskeletal pain dysfunction.
that 75% of respondents felt important to include in both entry- CONCLUSIONS: Findings, although preliminary, suggest that several
level and post-professional academic programs. CONCLUSIONS: frequently used and simple diagnostic tests can be used to identify
Academic faculty in the United States were able to identify and patients with musculoskeletal issues related to CPP. Future studies
differentiate areas of women’s health practice they felt important are needed to replicate results in similar patient cohorts, and to
to include in entry-level and post-professional physical therapy further refine an optimal battery of tests. IMPLICATIONS: Earlier
curricula. IMPLICATIONS: This survey ressearch of faculty opinions and more precise diagnosis of musculoskeletal pelvic pain will result
on women’s health content in entry-level and post-professional in earlier intervention and treatment, reducing chronic pain morbidity.
physical therapy curricula has assisted the SOWH of the APTA KEYWORDS: pelvic pain, chronic pain, musculoskeletal dysfunction.
in development of “Guidelines for Women’s Health Content in FUNDING ACKNOWLEDGEMENTS: This research was funded by a
Professional Physical Therapy Curricula”. KEYWORDS: Curricula, grant from the Section on Women’s Health of the American Physical
entry-level, women’s health. FUNDING ACKNOWLEDGEMENTS: Therapy Association. CONTACT: [email protected]
Women’s Health Academic Leadership Aswrd (AG 00744), a K- ETHICS COMMITTEE: This research was approved by the
07 grant from the National Institute on Aging, a division of the Northwestern University – Office for the Protection of Research
National Institute of Health. PI-Molly Carnes, MD MPH. CONTACT: Subjects (OPRS), Chicago, Illinois.
[email protected]
ETHICS COMMITTEE: Human Subject Review, University of
Wisconsin, School of Education. November, 2001
CELLULAR FEATURES OF SKELETAL MUSCLE INJURY AND THE EFFECT ON SELF-PERCEIVED COMPETENCE WHEN
APOPTOSIS IN THE VASTUS LATERALIS OF PEOPLE WITH USING “EMERGENCY RESPIRATORY ON CALL WORKING:
COPD GUIDANCE FOR PHYSIOTHERAPISTS” – A PILOT STUDY
Mathur S1,2 , Koehle M3 , Road J4 , Duronio V4 , Reid W1,2 ; 1 School Broad M1 , Cross J2 , Harden B3 , Quint M4 , Ritson P5 , Thomas S6 ,
of Rehabilitation Sciences, UBC, Vancouver, CANADA; 2 Vancouver Taylor A7 ; 1 Cardiff and Vale NHS Trust, Cardiff, UK; 2 University
Coastal Health Research Institute, Vancouver, CANADA; 3 School of East Anglia, Norwich, UK; 3 Winchester Health Trust, Winchester,
of Human Kinetics, UBC, Vancouver, CANADA; 4 Department of UK; 4 Queen Alexandra Hospital, Cosham, Portsmouth UK; 5 Royal
Medicine, UBC, Vancouver Canada Liverpool Childrens NHS Trust, Liverpool, UK; 6 University of
the West of England, Bristol UK; 7 Cardiff University, College of
PURPOSE: The purpose of this study was to quantify cellular
Medicine, Cardiff, UK
features of skeletal muscle injury and determine the presence of
apoptosis in the vastus lateralis (VL) muscle of people with chronic PURPOSE: To compare the self perceived competence of physio-
obstructive pulmonary disease (COPD). RELEVANCE: People with therapists using “Emergency Respiratory On Call Working: Guidance
COPD exhibit skeletal muscle dysfunction, which may be due to for Physiotherapists” (Known as Emergency Duty Guidelines – EDG)
abnormalities observed at the cellular level. Skeletal muscle injury with those who had not received this guidance. RELEVANCE: Out
and apoptosis are two cellular alterations that may contribute to of hours working and maintenance of competence is a problem
skeletal muscle dysfunction in people with COPD. Factors such as that has been addressed nationally within the UK. The Health
disuse, systemic inflammation and oxidative stress may make the Professions Council (HPC) requires that all physiotherapists are
skeletal muscle of people with COPD susceptible to skeletal muscle able to demonstrate their competence appropriately. The EDG
injury and apoptosis. PARTICIPANTS: Twenty people with COPD (9 were developed to support staff in identifying learning needs and
men, 11 women; aged 68.2 ±10.0 yrs, BMI = 26.6±4.7) and 20 aid in demonstrating competence in this field. This is the first
controls, matched for age, sex and body mass index participated study to investigate the effect on competence when using the
in the study. People with COPD had moderate to severe disease EDG. PARTICIPANTS: Seventy-six physiotherapists from 2 hospitals
and had a FEV1 /FVC = 52±14% compared to 77±9% in controls matched for size and speciality. The Intervention Group used
(p 0.001). METHODS: Needle biopsies of the VL were quick- the EDG; the Control Group did not. METHODS: A prospective
frozen, sectioned (10 mm thick) and stained with hematoxylin and
parallel group design with assessment of self perceived competence
eosin (H & E) to examine features of muscle injury under the
measured using a questionnaire. This questionnaire has previously
light microscope. Point counting was used to quantify area fractions
been piloted nationally and quantifies the elements identified within
(AA ) of normal muscle, abnormal muscle, connective tissue and
the EDG through the use of Likert scales. ANALYSIS: Data from
adipose. The presence of apoptotic myonuclei was detected using
completed questionnaires were analysed by calculating sum scores
TUNEL and immunohistochemistry against caspase-3. The number
and comparisons made using Mann Whitney U Tests. Comparisons
of positive myonuclei per 200 muscle fibres were counted using
were made between the total score, the scores of the four
an unbiased counting frame. ANALYSIS: One-way ANOVA was
individual sections of the questionnaire and between the different
used to compare the cellular features of muscle injury, number
grades of staff. Free texts comments were examined using content
of apoptotic nuclei detected by TUNEL and caspase-3 between
analysis. RESULTS: Sixty-five (85.5%) returned questionnaires, with
groups. Significance was set at p 0.05 and adjusted for multiple
equal representation of physiotherapy staff grades across the 2
comparisons. RESULTS: People with COPD had higher (AA ) of ab-
normal muscle compared with controls (0.9±0.2% versus 0.3±0.3%, hospital sites. Sum scores for each scaled item demonstrated
p = 0.011). The most common abnormal feature was small, angular no statistically significant difference in the overall scores for the
fibers. There were few apoptotic nuclei detected using TUNEL and 2 groups or the different physiotherapy grades within the study
caspase-3 in both the people with COPD and the controls. The groups. There was a non-significant trend for the intervention group
mean number of TUNEL positive nuclei was 2±2 and 2±3 in COPD to have higher scores. Subgroup analysis of the elements of
and controls, respectively (p = 0.30) and caspase-3 positive nuclei competence in the questionnaire (assessment, treatment and range
was 1±1 and 2±2, respectively (p = 0.15) per 200 muscle fibres. statements) highlighted four differences. Significance was taken as
CONCLUSIONS: People with COPD show cellular features that p < 0.05 − Treatment scores (the ability to plan implement and
are consistent with skeletal muscle injury and this may contribute revise treatments) were significantly higher for junior staff in the
to altered skeletal muscle function. Apoptosis does not appear to control group (p = 0.048). − Range statements scores (perceived
be present in this sample of people with COPD. IMPLICATIONS: competence in different situations) were significantly higher for senior
Chronic disuse, systemic inflammation and oxidative stress may II staff in the intervention group (p = 0.033). − Assessment scores
lead to cellular abnormalities in skeletal muscle of people with (different elements of the assessment process) were significantly
COPD that are consistent with muscle injury. Exercise prescription different in senior I staff (p = 0.027). There was also borderline
to optimize skeletal muscle function should be judicious in order to significance on range statement scores (p = 0.052) both were in
preserve and improve skeletal muscle function and minimize further favour of the intervention group. Content analysis of the open
injury in people with COPD. KEYWORDS: COPD, skeletal muscle, comments demonstrated junior staff had more concerns over training
apoptosis, muscle injury. FUNDING ACKNOWLEDGEMENTS: The and experience before working in the emergency duty setting.
study was supported by the Canadian Institutes of Health Research Senior staff had more concerns over non-respiratory issues and
and the British Columbia Medical Services Foundation. CONTACT: had more worry and anxiety concerns with regard to confidence
[email protected] in ability. CONCLUSIONS: Use of the EDG may improve self-
ETHICS COMMITTEE: This study was approved by the Clinical perception of competence as measured by questionnaire but a
Research Ethics Board at The University of British Columbia. larger study would be required to confirm this. IMPLICATIONS:
This was a pilot study to provide the necessary information to
design a larger pivotal study and has demonstrated some significant
differences between the study groups. However there are too
many variables around the different on call induction programmes
and ongoing training issues to confirm that these differences
relate directly to the use of the EDG alone. Further studies at a
national level are recommended. KEYWORDS: Physiotherapy, Com- Research Report Poster Display
petence, “On Call”. FUNDING ACKNOWLEDGEMENTS: Unfunded. 05-09 Tuesday 5 June 14:00
CONTACT: [email protected] VCEC Exhibit Hall B & C
ETHICS COMMITTEE: South East Wales Research Ethics Commit- STUDENT ATTITUDES AND PERCEPTIONS ABOUT
tee, UK COMPUTER-BASED NEUROANATOMY LEARNING MODULES:
FACTORS AND IMPLICATIONS FOR SUCCESSFUL COMPUTER
Research Report Poster Display BASED INSTRUCTION WITHIN CLINICAL EDUCATION
05-01 Tuesday 5 June 14:00 McKeough M1 , Leimone S2 , Bagatell N3 ; 1 Sacramento State
VCEC Exhibit Hall B & C University, Sacramento, Sacramento County; 2 Shenandoah
PERCEIVED USEFULNESS OF RECIPROCAL PEER TEACHING University, Winchester, Fredrick County; 3 University of Southern
(RPT) AMONG PHYSICAL THERAPY STUDENTS IN THE GROSS California, Los Angeles, Los Angeles County
ANATOMY LABORATORY PURPOSE: The purpose of this study was to examine students’
Youdas J, Krause D, Hellyer N, Hollman J, Rindflesch A; Program attitudes towards 3 computer-based neuroanatomy learning modules,
in Physical Therapy, Mayo Clinic College of Medicine, Mayo Clinic, to assess what components were primary factors in establishing
Rochester, MN 55905 these attitudes, specifically in relation to the Technology Acceptance
Model and the Self-Efficacy Theory, and to discuss the implica-
PURPOSE: The first purpose of this study was to assess the tions of these attitudes for successful computer based instruction
perceived usefulness of RPT among first year physical therapy within a clinical education environment. RELEVANCE: As more
students as a method for learning and teaching human anatomical clinical educational programs enlist the assistance of technology
relationships in the dissection laboratory. The second purpose was to improve learning outcomes it becomes essential to establish
to determine if exposure to RPT during a semester course in the efficacy of these adjuncts to traditional instructional techniques.
gross anatomy had an effect on students’ anatomy course grade. PARTICIPANTS: Seventy-seven entry-level health care professional
RELEVANCE: RPT could be a valuable resource for learning and students who were matriculated in an introductory neuroanatomy
teaching anatomical concepts whereby classmates alternate roles course served as subjects in this study. METHODS: Students
of tutor and tutee. PARTICIPANTS: The DPT Class of 2008 (RPT) reviewed 1, 2, or 3 neuroanatomy learning modules (Dorsal Column
consisted of 21 women and 6 men whose ages ranged from 21 Medial Lemniscal System, Spinothalamic System, and Central Visual
to 29 years. The DPT Class of 2007 (no-RPT) consisted of 15 Pathway). Students independently identified which modules they
women and 6 men whose ages ranged from 22 to 30 years. This would review and then used them as supplementation to the
study was approved by the Mayo Clinic Institutional Review Board. professor’s lectures. Students completed a survey to evaluate the
METHODS: The DPT Class of 2008 was exposed to RPT. During learning modules. ANALYSIS: Quantitative analyses were used
the semester each laboratory dissection group of 4 students was to assess student attitudes and satisfaction. SPSS version 13.0
responsible for teaching their classmates on 2 separate occasions. was utilized for analysis of quantitative data. Qualitative data were
Students serving as tutors worked in pairs and rotated among their theme-coded according to topic and compared with quantitative
classmates within the laboratory, illustrating anatomical concepts data. RESULTS: Quantitatively, students reported that they valued
previously discussed in the classroom. At the completion of the computers and their general use, they enjoyed using the learning
course students were queried about the perceived usefulness of modules, and they valued their use within the neuroanatomy
the RPT experience using a 12-item survey instrument that used course. Students did not prefer computer-based learning over
a 5-point Likert scale. The median antomy course grade (MACG) traditional lecture format. There were no significant differences
for the Class of 2008 (RPT) and Class of 2007(no-RPT)was also between groups using the various modules (p 0.05). Qualitative
compared statistically. ANALYSIS: Descriptive data was compiled analyses indicated that the modules were useful in learning or
for each item of the 12-item survey using frequencies for ordinal reinforcing neuroanatomical concepts and improving clinical problem
scale data. The internal consistency of the survey instrument was solving skills. Students reported that the visual representation
assessed by the Cronbach’s alpha. MACG for the Class of 2008 of the systems, the ability to control the use of the modules,
and Class of 2007 was compared statistically using a Mann-Whitney and the navigational fidelity of the modules were key usability
U-test. RESULTS: Cronbach’s alpha was 0.85. Students provided components. CONCLUSIONS: The results of this study extend the
the strongest responses for survey items that assessed teaching literature supporting the efficacy of computer-based instruction to
and learning (median Likert scores ranged from 4 to 5). MACG include introductory neuroscience education for entry-level health
for the Class of 2008 (MACG = 3.70)was significantly greater than care professionals. Generally students reported positive attitudes
MACG for the Class of 2007 (MACG = 3.30; Z = −2.19; p = .029). towards the computer-based neuroanatomy learning modules as
CONCLUSIONS: First year physical therapy students perceived the supplementation to traditional lectures. Specifically, usefulness
use of RPT in the dissection laboratory as a valuable resource for and usability were attributes that contributed to the effectiveness
learning and teaching anatomical concepts. The RPT experience of the modules. Increased clinical self-efficacy stemmed from
promoted cooperative learning among classmates. Based upon computer animation highlighting the anatomy and physiology of
MACG, The DPT Class of 2008 (RPT) developed a more effective functional systems and computer simulation of patient cases showing
learning strategy when learning anatomical relationships than the signs and symptoms of specific lesions. IMPLICATIONS: The
Class of 2007 (no-RPT). IMPLICATIONS: Classmates alternating computer-based learning modules examined in this study were
roles of tutor and tutee is an effective method for learning anatomical effective in helping entry-lebel health care students learn and
concepts stressed in the dissection laboratory. Additionally, first-year make clinical application of neuroanatomy information. KEYWORDS:
DPT students also perceived the RPT experience would be helpful Computer-based instruction, functional neuroanatomy, clinical self-
when communicating with patients. KEYWORDS: Physical therapist efficacy, introductory health care professional education. FUNDING
education. FUNDING ACKNOWLEDGEMENTS: This work was not ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
funded. CONTACT: [email protected] [email protected]
ETHICS COMMITTEE: Mayo Clinic Institutional Review Board ETHICS COMMITTEE: Institutional Review Board of Shenandoah
University
UNDERSTANDING EARLY PROFESSIONAL SOCIALIZATION PROFESSIONAL COMPETENCIES IN PHYSIOTHERAPY:
OF PHYSICAL THERAPY STUDENTS: A CRITICAL STEP IN COMPARING STUDENTS OF PHYSIOTHERAPY ON
FACILITATING PROFESSIONAL DEVELOPMENT POST-SECONDARY AND POLYTECHNIC LEVELS IN FINLAND
Bartlett D1 , Lucy D1 , Bisbee L1 , Conti-Becker A2 ; 1 School of Harjulehto E; South Carelia Polytechnic, Health Care and Social
Physical Therapy, The University of Western Ontario, London, Services, Lappeenranta, Finland
Canada; 2 Faculty of Health Sciences, The University of Western PURPOSE: Track 4: Education. Topics: Educational research.
Ontario, London, Canada Working as experts of social welfare and health care, physiotherapists
PURPOSE: To gain an understanding of the early professional need a high degree of professional competence in their working
socialization of physical therapy (PT) students. RELEVANCE: Prepa- life. During the 1990s, through educational reform in Finland, the
ration of students to enter current PT practice requires more than training of physiotherapists changed from a post-secondary level to
professional knowledge and therapeutic skills. Today’s graduates the polytechnic or university level. Relatively few studies comparing
are required to have highly-developed professional behaviours and the education on the post-secondary level to the education on the
critical thinking and clinical reasoning skills to deal with rapidly polytechnic level have been carried out, and none of these have
changing environments from the outset. PARTICIPANTS: Forty- concerned the training of physiotherapists. One purpose of this study
two students, 32 women and 10 men (mean age at admission was to compare how the students from both levels viewed their
of 24.0 (SD = 1.6) years), enrolled in the 1st class of our newly professional competencies upon graduation. Another goal was to
developed masters program provided data in the form of reflective evaluate and improve teaching. RELEVANCE: The research helps
journals. Forty-four students, 33 women and 11 men (mean age the teachers to develop their teaching and gives advice about
of 24.0 (SD = 3.0) years), enrolled in the 3rd class participated in choosing the educational methods. It also provides information
member checking. METHODS: Students in the 1st class wrote 3- on the professional competence of the students. PARTICIPANTS:
page reflective journals on a critical learning incident after each of The research population consists of students of physiotherapy who
their second junior, intermediate, and final senior clinical experiences. attended South Carelia Polytechnic (formerly Health Care College)
Students in the 3rd class, who had also written reflective journals during 1990–2003. 65 students from both levels of education filled in
at the same points, provided member checking of results from the questionnaire measuring professional skills. METHODS: Student
the 1st class at the corresponding times. ANALYSIS: Reflective professional skills were measured using a questionnaire developed
journals were analysed separately at the three points. At each for this purpose by South Carelia Polytechnic. The questionnaire
occasion, journal passages were coded into 4 conceptual areas consisted of 59 questions covering all areas of physiotherapy care.
comprising communicative, cognitive, professional, and affective ANALYSIS: The material was analyzed using SPSS software. Factor
domains. Each domain contained 4 to 6 subdomains. Each author and regression analyses were carried out and the material was tested
independently reviewed the passages collated by subdomains and for differences between the two levels of education. The results
together we identified major themes. RESULTS: At the junior level, of the analyses were used to describe the variances in readiness
the major themes were emotions, self confidence, professionalism for self-directedness, and to compare professional competencies
in the real world, communication, and learning by doing. At the between post-secondary level graduates and polytechnic graduates.
intermediate stage, major themes were idealism versus realism, RESULTS: Regarding professional skills, seven elements emerged
depth of communication with clients, and breadth of communication as crucial: co-operative skills, the ability to work as a part of
with family members and colleagues. Aspects of clinical learning a multidisciplinary professional team, the ability to improve the
were variable at this point and self-confidence remained important. proficiency of the organization, the ability to improve one’s own
After the senior placement, most students were deeply engaged professional skills, physiotherapeutic skills, interpersonal skills and
with their clients and self confidence had developed to the point the ability to educate oneself and assess oneself. All down the line,
of self-efficacy. Tensions between the ideal and the pragmatics students at the post-secondary level evaluated themselves as better
of actual practice strengthened and self as mentee (rather than than polytechnic students in their own assessments. In regard to
object of evaluation) or mentor emerged. Each theme is supported physiotherapeutic skills, which require manual skills, there was a
by representative quotes. The themes were subsequently verified, nearly statistically significant difference between the two levels of
and enhanced, by the member-checking process. CONCLUSIONS: education. The variance of professional skills, on the other hand, was
These results, compiled in a booklet, contribute to foundation similar on both levels. (Students who were about to graduate from
knowledge required by PT educators, including clinical instructors, post-secondary level emphasized the importance of multidisciplinary
by explicitly describing the early professional socialization of PT interaction to a greater extent than their peers at polytechnic level.)
students. IMPLICATIONS: This booklet is a resource to Clinical CONCLUSIONS: Based on the results of this study, it is possible
Instructors and Academic Faculty to guide students. Students can to formulate recommendations for further action at polytechnics.
use and reflect on these results to assure and support their learning. Improvements should be made especially in the fields of educational
Future work will focus on the correspondence between students’ content, teaching methods, and working habits. IMPLICATIONS:
and faculty members’ judgments about reflective pieces being “as The Physiotherapy education on polytechnic levels in Finland should
expected”, “more advanced than expected”, or “less advanced than facilite more the student’s manual skills. The students need also
expected” for students at different stages of professional preparation. supporting and encouragement from their tutors. KEYWORDS:
KEYWORDS: professional socialization and development. FUNDING professional skills, expertise, vocational training, polytechnics –
ACKNOWLEDGEMENTS: This study was funded by the Provost’s physiotherapy. FUNDING ACKNOWLEDGEMENTS: Funding ac-
Academic Support Fund of The University of Western Ontario. knowledgements: South Carelia Polytechnic, Lappeenranta, Finland.
CONTACT: [email protected] CONTACT: eeva.harjulehto@scp.fi
ETHICS COMMITTEE: The University of Western Ontario Research ETHICS COMMITTEE: Ethics approval was granted by the Dean of
Ethics Board for Health Sciences Research Involving Human the School of Health Care and Social Services, Dr. Taru Juvakka.
Subjects
Research Report Poster Display and functional advantages. PARTICIPANTS: As part of a multi-
08-01 Tuesday 5 June 14:00 centre study of 24 subjects who participated to assess a new,
VCEC Exhibit Hall B & C ‘WalkAide2’ (WA2), foot-drop stimulator, 6 are reported on who,
THE EFFECTS OF TREADMILL RUNNING AFTER THE in the opinion of the investigators, derived significant benefit from
APPLICATION OF THERAPEUTIC HEATING ON PREVENTING WA2 use. METHODS: The WA2 provided the option of ‘tilt sensor’
MUSCULAR ATROPHY control eliminating the need for a connected insole ‘heel sensor’.
As per the study design walking speed was assessed under 2
Sakaguchi A1 , Oki S2 , Kanai S2 , Hasegawa M2 , Shimizu M2 , Ono T2 ,
conditions, with and without the WA2, for normal walking speed
Otsuka A2 ; 1 Prefectural University of Hiroshima, Graduate school
over a 10m straight course and normal walking speed around a
Comprehensive scientific research, Program in Health and Welfare:
10m figure of 8 during which physiological cost index (PCI) was
Mihara City, Hiroshima, Japan; 2 Department of Physical Therapy,
also calculated. Usage (hours/day) and numbers of stimulus trains,
Prefectural University of Hiroshima: Mihara City, Hiroshima, Japan
representing steps/day,were also downloaded from the WA2 usage
PURPOSE: Therapeutic heat has long been used clinically to log. WA2 use was for a period of 3 months, subjects brought in
increase tissue extensibility, decrease muscle spasm and raise the monthly for follow-up testing. The six subjects reported on were all
pain threshold. On the other hand, in recent studies, it has been programmed to walk using ‘tilt sensor’ as the control mechanism
reported that heating therapy can be used to prevent muscular for the stimulation. Almost all continued using the WA2 after their
atrophy. We studied the effects of therapeutic heating before active 3 month retest. Those who continued beyond the 3 months were
exercise on preventing muscular atrophy. RELEVANCE: Heat alone retested after 6 months of WA2 use. ANALYSIS: Comparisons were
may prevent muscular atrophy, but it may be more effective clinically made between the therapy using the WalkAide2 and the subject’s
to use therapeutic heat together with therapeutic exercise to get preferred method of walking which included an ankle support (AFO
better effects. PARTICIPANTS: Female Wistar rats(12 weeks old) or Malleoloc Ankle Support) and/or a cane for the 6 subjects in
were used in this study. METHODS: The ankle joint was immobilized this presentation. This allowed for the separation of the specific
in full planter flexion by a cast. The rats were divided into six groups. effects of the device and the effects of increased walking and
The first group was the control (Control). In the second group, the strengthening of muscles that may have resulted secondarily from the
ankle of each rat was immobilized without therapy performed (cast). Peroneal Nerve Stimulation, (PNS). Statisitical tests were conducted
In the third group, the cast was removed daily, and treadmill running to justify pooling data from various Centres. Tests compared any
was performed once a day (treadmill). In the forth group, the non- influence of patient demographics, (e.g., age, weight, sex, preferred
casted leg of each rat was immersed in a hot bath (42 degrees) walking aids), baseline PCI and walking speed on the outcomes.
once a day (heat). In the fifth group, the casted leg of each rat was RESULTS: 6 subject’s who showed significant benefits from WA2
immersed in a hot bath once a day (cast and heat). In the last group, use are described most providing additional clinical challenges that
the cast of each rat was removed daily, and immersed in a hot bath had to be met before the benefits could be realized. The WA2
before treadmill running (heat and treadmill). We compared the wet preambulation clincial considerations were many and are listed. The
weight of the soleus muscles after one week. ANALYSIS: The Tukey final subject described would not have been accepted under the
multiple comparison (SPSS, version1.3) was used for the comparison inclusion criteria but knowledge of the WA2’s ability to facilitate
between groups. RESULTS: Muscular atrophy occurred in the the whole stepping action plus clinical assessment demonstrating
cast, treadmill, and cast and heat groups. There was a significant that this was his main problem allowed this subject to ahieve an
decrease (p < 0.01) in the wet weight of the soleus muscles for important functional goal. CONCLUSIONS: Technology may have
these groups. However the heat and heat and treadmill groups were more widespread application if therapeutic considerations are a
similar to the control group. CONCLUSIONS: As a result, we have fundamental part of the assessment process. IMPLICATIONS: Very
demonstrated the effectiveness of therapeutic heating before running slow walkers and even non-ambulatory individuals were shown in this
exercise on preventing muscular atrophy in rats, and we believe study to eventually benefit with meaningful functional gains. Adjunct
that the same results may be found in future studies on human. therapy administered prior to programming the WA2 appeared
IMPLICATIONS: A combined physical therapy treatment program to facilitate better outcomes. Without a full clinical assessment
of heat and exercise may be beneficial for preventing muscular candidates who could benefit from this technology might be over-
atrophy in patients. KEYWORDS: therapeutic heating, therapeutic looked. KEYWORDS: Walkaide2; Functional Electrical Stimulation;
exercise, muscular atrophy. FUNDING ACKNOWLEDGEMENTS: Clinical. FUNDING ACKNOWLEDGEMENTS: Dr. Richard B Stein,
None. CONTACT: [email protected] University of Alberta, Edmonton, Principal Investigator for the
ETHICS COMMITTEE: This experiment received the approval of the ‘Multicentre Prospective Study to assess the WalkAide2’. CONTACT:
prefectural Hiroshima University animal experiment ethics committee. [email protected]
ETHICS COMMITTEE: The University of British Columbia Office of
Research Ethics
CLINICAL PERSPECTIVES IN FITTING THE WALKAIDE2 08-09 Tuesday 5 June 14:00
FOOT-DROP STIMULATOR VCEC Exhibit Hall B & C
Robertson J1 , Whittaker M2 ; 1 Physical Therapy, Acquired Brain ELECTRICAL STIMULATION OF MYOBLASTS DEVELOPS
Injury Program, G.F. Strong Rehabilitation Centre, Vancouver, B.C., SPONTANEOUSLY CONTRACTING MUSCLE FIBERS
Canada; 2 Physical Therapy, Spinal Cord Program, G.F. Strong Kawahara Y1,3 , Yamaoka K2 , Umeda C1 , Yoshimoto R1 ,
Rehabilitation Centre, Vancouver, B.C., Canada Kajiume T2 , Sasaki A1 , Wu S1 , Nitta J1 , Manabe T1 , Kanno M1 ,
Nakagawa K1 , Naminohira K1 , Fushimi T1 , Fujimura M1 , Yuge L1,3 ;
PURPOSE: To show that clinician observations and assessments 1 Graduate School of Health Sciences, Hiroshima University,
provide researchers with clinical insights and observations that
Hiroshima, Japan; 2 Graduate School of Biomedical Sciences,
may provide a better understanding of the reasons for success
Hiroshima University, Hiroshima, Japan; 3 Space Bio-Laboratories
or failure of devices designed to improve gait in people with
Y. K., Hiroshima University, Hiroshima, Japan
neurological conditions. RELEVANCE: Clinical observations and
rationale around the fitting of a Functional Electrical Stimulation (FES) PURPOSE: Electrical stimulation has been clinically used for treat-
program for foot-drop may help bring these devices, often stuck ment of muscle atrophy. However, the effect of electrical stimulation,
in research labs, into the clinical setting with resulting treatment physiological and molecular biological effects on myoblasts during
cell differentiation, has remained to be elucidated. RELEVANCE: We Imaging the activity of individual muscles is useful for exercise
investigated that relationship between physical stimuli and in vitro cell prescriptions for rehabilitation and sports science and for evaluation
culture model for electrocal stimulation effects. PARTICIPANTS: L6 of rehabilitation tools. PARTICIPANTS: Ten healthy young males
rat myoblast cells (IFO50364; Health Science Research Resources aged 20–29 years. METHODS: The subjects underwent FDG PET
Bank, Osaka, Japan). METHODS: L6 were seeded in 100-mm culture twice during walks for 50 min, which were done with or without a SAS.
dishes, at a density of 2.5 x 105 cells per dish, and maintained in a The PET scans were conducted using a Headtome-V (Shimadzu
high-glucose Dulbecco modified Eagle’s medium (DMEM) containing Corp., Kyoto, Japan) in the two-dimensional mode. The images
10% fetal bovine serum (FBS). When L6 cells reached confluence were reconstructed using a back-projection algorithm with a second-
on culture day 6, they were transferred into FBS-free medium and order low-pass filter with a 1.25 cycles/cm cutoff frequency. Eleven
then exposed to electrical stimulation via field electrodes (5min) on regions of interest (ROIs) in the central or activated regions of
days 6, 8, 10, and 12 (group E) using a stimulator (SEN-2201; skeletal muscles were studied. The ROIs were identified bilaterally
Nihon Koden, Tokyo, Japan) to pass rectangular current pulses on three successive slices of PET images related to a CT image.
(2.0 msec, 50 V, 0.5 Hz) between two platinum wires placed in The total volumes of ROIs ranged between 4.2 cm3 and 4.4 cm3.
the culture medium. Control cells were not exposed to electrical Glucose metabolism in ROIs was estimated from the standard
stimulation field during experimental period (group C). ANALYSIS: uptake value (SUV) for FDG, which was defined as SUV = C/D/w,
The effect of electrical stimulation was examined for an ability where C (Bq/ml), D (Bq), and w respectively represent radioactivity
to induce morphological, physiological, and molecular biological present in the tissue, the injected dose, and body mass. ANALYSIS:
effects on myoblasts during cell differentiation. RESULTS: Spindle- Student’s t-test was used to assess differences in walking ratios
shaped myoblasts were observed on culture day 1. Some myoblasts measured over 500 steps in each subject with and without the
began to fuse by day 5, forming myotubes with multiple nuclei. SAS. A paired t-test was conducted to assess differences in FDG
On day 7, thin, single nuclear-chain myotubes were formed in uptake with or without the SAS. RESULTS: Walking ratios of seven
control cultures, whereas myotubes in the electrically stimulated subjects were increased significantly by the SAS. Three subjects who
cultures were fused laterally to form thick myotubes. On day 14, decreased their walking ratios were excluded from further analyses
numbers of thick myotubes clearly increased in group E (7 to 8 because we discussed the usefulness of FDG PET under well-
myotubes), whereas fewer myotubes were present in group C. The worked conditions of the SAS. In paired t-tests, the SAS significantly
electrical stimulation accelerated the appearance of myotubes, and increased FDG uptakes by the tibialis posterior and the medial
subsequently produced spontaneously contracting muscle fibers. gastrocnemius. The FDG uptake ratios, defined as the SUV after
Measurement of membrane potential showed that the contracting L6 walking with the SAS divided by that after walking without the SAS,
cells had functional ion channels and gap junctions. In the electrically of the tibialis posterior and medial gastrocnemius were, respectively,
stimulated cells, protein expression of MyoD family, myogenin and 2.12 and 2.37. The SAS demonstrated no significant effects on
Myf-6, was enhanced. Expression of gap junction protein, connexin any of the other muscles. CONCLUSIONS: We verified that FDG
43, was increased and maintained at a high level in the electrically PET is useful for quantitative evaluation of muscle activity during
stimulated cells by western blot analysis and immunostaining. walking with or without the SAS. Glucose utilization of the tibialis
CONCLUSIONS: The differentiation of myoblasts was accelerated posterior and medial gastrocnemius increased when walking ratios
by the application of electric stimulation, and even striated muscle were increased using SAS. IMPLICATIONS: FDG PET is particularly
cells were obtained. These results suggest the possibility that beneficial for measuring the activity of deep muscles for evaluation
electric stimulation, effectively used in clinical therapy of muscle of rehabilitation tools. KEYWORDS: walking assistance, FDG, PET.
atrophy, facilitates not only the development of existing muscle FUNDING ACKNOWLEDGEMENTS: This study received no funding
fibers but also the differentiation of myoblasts. IMPLICATIONS: support. CONTACT: [email protected]
This experimental system may also help clarify the mechanisms ETHICS COMMITTEE: Tokyo Metropolitan Institute of Gerontology,
underlying the beneficial effects of physical stimulation that are often Tokyo, Japan
seen in the field of physical medicine. KEYWORDS: myoblast, electri-
cal stimulation, differentiation. FUNDING ACKNOWLEDGEMENTS:
None. CONTACT: [email protected] Research Report Poster Display
HAND VOLUME ESTIMATES FROM METRIC MEASUREMENTS
VCEC Exhibit Hall B & C Hill C, Sims N, Mayrovitz H, Hernandez T, Greenshner A, Diep H;
Nova Southeastern University, Ft. Lauderdale, FL USA
THE USE OF POSITRON EMISSION TOMOGRAPHY AND
[18 F]FLUORODEOXYGLUCOSE FOR IMAGING OF MUSCULAR PURPOSE: The purpose of this study was to develop and test a
ACTIVITY DURING EXERCISE WITH A STRIDE ASSISTANCE metric measurement procedure and algorithm that could usefully
SYSTEM estimate hand volumes as an alternative to water displacement.
RELEVANCE: Determining upper extremity limb volume and its
Shimada H1,3 , Kimura Y2 , Suzuki T3 , Hirata T4 , Ishii K2 , Ishiwata K2 ;
1 Research Fellow of the Japan Society for the Promotion of Science, change during therapy for edema or lymphedema is needed to
assess treatment efficacy and outcomes. A near circular cross-
Tokyo, Japan; 2 Positron Medical Center, Tokyo Metropolitan
section of the arm permits its volume to be accurately estimated with
Institute of Gerontology, Tokyo, Japan; 3 Tokyo Metropolitan Institute
tape-measure-determined circumferences and suitable calculation
of Gerontology, Tokyo, Japan; 4 Honda R&D Co., Ltd., Fundamental
formulae. However, because of the hand’s shape, circumference-
Technology Research Center, Saitama, Japan
determined-volumes may not be accurate. PARTICIPANTS: Both
PURPOSE: This study investigated the use of positron emission hands of thirty volunteers were evaluated. METHODS: The method
tomography and [18 F]fluorodeoxyglucose (FDG PET) for quantitative tested uses a caliper to measure hand dimensions at standardized
and objective evaluation of muscle activity during walking. For this locations and calculates volume (Vm) by a mathematical algorithm.
study, we evaluated regional changes in glucose metabolism of ANALYSIS: Vm was compared to volumes measured by water dis-
the skeletal muscles of the lower extremities that were induced by placement (Vw) and tape-measure-circumferences (Vt) in 30 subjects
an automated stride assistance system (SAS). We validated the (60 hands) using regression analysis and limits of agreement (LOA).
usefulness of FDG PET for investigating muscle activities during RESULTS: Vw and Vm (mean±standard deviation) were similar
various walking patterns induced by the SAS, which was developed being 368±102 ml vs. 369±98 ml respectively and were highly
by Honda (Honda R & D Co. Ltd., Wako, Japan). RELEVANCE: correlated: Vm=0.949Vw + 20.6 ml, r = 0.987, p 0.001. The LOA
for absolute volume differences and percentages were respectively Research Report Poster Display
±33.3 ml and ±9.9%. Circumference-determined-volumes (Vt = 11-05 Tuesday 5 June 14:00
485±134 ml), overestimated hand volume compared to Vm and VCEC Exhibit Hall B & C
Vw (p 0.001). CONCLUSIONS: Results indicate that this metric THE CHARACTERISTICS OF THE POSTURAL CONTROL IN
method is useful when hand volumes are needed, but water PATIENTS WITH TYPE 2 DIABETES
displacement is either not available or is contraindicated, as when
Nagy E1 , Feher Kiss A1 , Horvath G2 , Barnai M1 , Varkonyi T3 ;
open wounds are present. IMPLICATIONS: For those practices that 1 University of Szeged Faculty of Health Department of
don’t have access to water displacement equipment or the water
Physiotherapy; 2 University of Szeged Faculty of Medicine
displacement is contraindicated, the metric method is a viable al-
Department of Physiology; 3 University of Szeged Faculty of
ternative. KEYWORDS: hand volumetric measurements. FUNDING
Medicine Department of Internal Medicine
ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
ETHICS COMMITTEE: Nova Southeastern University’s Internal PURPOSE: The objective of the present study was to compare the
Review Board different postural mechanisms adopted by diabetic patients measured
by single force platform. RELEVANCE: Postural instability is a
well-known feature for patients with diabetic sensory neuropathy.
Peripheral neuropathy has been significantly associated with falling
09-21 Tuesday 5 June 14:00 and repetitive falls. PARTICIPANTS: 17 middle aged patients with
VCEC Exhibit Hall B & C type 2 diabetes recruited from a diabetes clinic took part in the study.
FREQUENCY ANALYSIS METHOD USING SURFACE ELEC- METHODS: The COP displacement was quantified in Romberg
TROMYOGRAPHY – COMPARISON BETWEEN DWT AND CWT position under two visual conditions (eyes open (EO) and eyes closed
Nagase S1 , Tsurusaki T2 , Hirata K1 , Hamamoto T1 ; 1 NagasakiYurino (EC)) on a stable and foam surface. Three successive trials have
Hospital; 2 Graduate School of Health Sciences, Nagasaki University been performed in each condition. The mean sway velocity (MSV)
was determined by Neurocom Basic Balance Master. According to
PURPOSE: Wavelet transformation (WT) is used as the time- the MSV values measured on the foam surface the subjects were
frequency analysis for surface electromyography (SEMG).Data are divided into three groups: Normal (N), High (H) and Fixing (F).
presently processed using the continuous wavelet transformation (Subjects were considered as F if they have high MSV in EO and
(CWT) to derive an average scalogram, from which the instanta- normal MSV in EC condition). First the sway path was calculated
neous mean frequency (IMNF) is calculated.However, because the in anteroposterior (AP) and mediolateral (ML) directions. Secondly
frequency component of the IMNF consolidated, to comprehend the the data were analysed by fast Fourier transformation in various
distribution frequency is difficult using the IMNF.We supposed that frequency bands (low: 0.-0.1 Hz; middle low: 0.1-0.5 Hz; middle
the data can be processed using the discrete wavelet transformation high: 0.5-1 Hz; high: 1-3 Hz). ANALYSIS: All data were subjected
(DWT) to derive the distribution frequency.The present study to analysis of variance in order to make comparisons between the
compares DWT and CWT on the same SEMG. RELEVANCE: The groups and the experimental situations. The post hoc test was the
SEMG might be able to assess muscle contraction. PARTICIPANTS: LSD multiple comparisons test. RESULTS: The sway path on foam
Twenty healthy female volunteers (mean age 23.4±1.3 y) provided surface was significantly larger with EC than EO in all groups, except
written, informed consent to participate in the study. METHODS: in ML direction, where the F group did not showed difference with
We obtained SEMG signals from the biceps brachii with the elbow changing the visual condition. In the AP direction both the F and
joint flexed at 90º. Disposable electrodes were pasted onto the H groups displayed a significantly higher sway path with EO than
biceps brachii at intervals of 20 mm centre-to-centre and then the N group, whereas in ML direction only the F group did. In
the elbow was continuously and incrementally loaded to extension the EC condition the H group differs significantly from both the F
using water.Isometric elbow flexion force and muscle torque was and N group in both directions. The frequency analysis revealed
measured when the participants were no longer able to maintain that in the AP direction in each frequency band in all groups the
the elbow joint flexed at 90º. ANALYSIS: Data were recorded in lack of visual input increased the frequency power except in the
a computer at a sampling frequency of 1 kHz and the IMNF was high frequency band in the F group. More interesting differences
calculated using MATLAB 6.5.1.Wavelet analysis comprises high- were observed in the ML direction where the frequency power with
scale, low-frequency components (approximations) and low-scale, EO was significantly higher in the F group than in the N and H
high-frequency components (details). The decomposition process groups in each frequency band, however, that with EC seemed
can be iterated with successive approximations being decomposed to be normal. CONCLUSIONS: About one third of our patients
in turn, so that one signal can be broken down into many lower have chosen a fixing strategy to maintain upright standing on foam
resolution components.Parameters were the power of detail level j surface, especially in the ML direction that might be explained by
(PD(j)), the summation of each level of PD(j) (TPw) and the PD(j) the increased personal threat caused by unstable base of support.
minus the TPw ratio (RPD(j)).Analytical parameters were calculated However, interestingly they showed extreme large power with EO
by performing the DWT at Daubechies 5 and decomposition level condition, which might be as a results of better utilising of visual
5.The SEMG data were statistically evaluated using a two-way information allowing a greater degree of freedom in the control of their
analysis of variance (ANOVA). RESULTS: The IMNF and RPD (3) hip joint. IMPLICATIONS: In fixing patients the physiotherapeutic
decreased, whereas the RPD (4) increased based on the increase interventions have to focus on the control of ML balance which is
in %MVC. CONCLUSIONS: Early studies indicated that slow type under hip control. Additional research is needed to clarify the effect of
motor units are reflected in a lower frequency and that fast type motor physiotherapy on the postural performance. KEYWORDS: diabetes,
units are reflected in higher frequency.The IMNF in fact increased postural control, fixing. FUNDING ACKNOWLEDGEMENTS: This
and decreased the frequency at muscle contraction.DWT analysis work is an unfunded work. CONTACT: [email protected]
allowed visualization of muscle contraction according to frequency ETHICS COMMITTEE: University of Szeged Etics Committe
level. IMPLICATIONS: The DWT parameters could assess muscle
contraction with respect to individual motor units (MU). Subject of
future investigation, changing each level of PD(j) was reflected in MU
according to DWT analysis. KEYWORDS: surface electromyography
(SEMG), instantaneous mean frequency (IMNF), discrete wavelet
transform (DWT). FUNDING ACKNOWLEDGEMENTS: The funding
source of this study was the General Research Fund of Nagasaki
University(Nagasaki,JAPAN). CONTACT: [email protected]
THE TRUNK VELOCITY OF PATIENTS IS IMPORTANT FOR DOES FUNCTIONAL REACH TEST REFLECT
THEIR EASY STANDING UP MULTIDIRECTIONAL BALANCE CONTROL ABILITY?
Momose K1 , Miwa M2 , Suzuki K2 , Ihashi K2 ; 1 Division of Shiomi T1 , Saito A1 , Maruyama H1 , Fujita H; 1 International
Physical Therapy, Shinshu University School of Health Sciences; University of Health and Welfare, Otawara, Tochigi, Japan
2 Department of Physical Therapy, Yamagata Prefectural University
PURPOSE: Among dynamic balance measures, Functinal reach
of Health Sciences
test(FRT) is one of the commonly used. FRT was desined to
PURPOSE: It is important that the position of the lower extremity measure the limit of stability in anterior direction during standing. It
and upper body movement velocity for standing up. When patients is, however, unknown that FRT measures really mean multidirectional
sit with knee extension, patients can not stand up slowly. On the balance ability. The purpose of the present study was to determine
other hands, it is easy that patients move their trunk fast. The whether FRT reflects the limits of stability in multidirection and
relationship of the trunk velocity and lower extremity position is stand for an index of dynamic control ability. RELEVANCE: Balance
not clear. The purpose of this study is to estimate of the velocity ability is one of the essential components of motor function and
of the trunk for successful standing up. Standing up is one of its evaluation is prerequisite for the physical therapy intervention.
the difficulty movements for person with a stroke. RELEVANCE: The ability to maintain dynamic balance control is critical for the
During the treatment of person with a stroke, physical therapist successful performance of most daily living. Dynamic balance is
take advantage of kinesiology for analyzing patient movement and complex, and no single measure that tests all aspects of the dynamic
teaching to be suitable moving methods for each patient. This study balance control is available. PARTICIPANTS: Thirtythree young and
provides one of the causes of failed standing up and makes target seventeen elderly volunteered participated in this study. Subjects
velocity clear for successful standing up. PARTICIPANTS: Seven consisited of a group of the younger(N=33;15 males and 18 females)
young subjects participated in this study. They did not have any and of the elderly(N=17; 10 males and 7 females).The mean height
neuromuscular disease and problem of bones and joints. Subjects and weight were 165.4±7.6cm, 59.1±8.8kg,for the younger and
understood informed consent in this study. METHODS: Seven 154.8±10.1cm, 55.5±10.7kg for the elderly, respectively. METHODS:
cameras were used to record subjects’ performance. Three force Three dynamic balance tests were conducted in this study.FRT:
plates were used to collect ground-reaction force. Each segment measuing the maximal distanse that subjects could reach forward
angular velocity and joints moment were calculated by computer. horizontally while maintaining on a fixed base of support. Cross
Electromyography was detected from 7muscles. The subjects sat on test(CRT):volutarily leaning their bodies as much as possible forward,
the chair with knee flexion 80 degree, and hip flexion 90 degree backward,rightward, and leftward in a standing position. Rotation
and trunk perpendicularly. The subjects want to stand up with test(ROT):shifting their bodies in such a manner as large circle
variety trunk velocities. The velocity changed from slow to fast. as possible possible may be drawn with center at their feet in
At first, the subjects did not stand up some slow velocities, and a standing position. The excursion sway distance of center of
then they could stand up some fast velocities. Then, they sat with pressure(CP) of each test was measured by the posturogram(Active
knee flexion 90, 100, 110, 120 and 130 degree. They tried to Balancer,ANIMA,JAPAN). ANALYSIS: The measurements of three
successful standing up as slow as possible. ANALYSIS: Student’ tests were expressed by means and standard deviations. The signif-
t test was used for comparison of difference between unsuccessful icant differences of means and standard deviations were determined
stand up and successful stand up velocities. The association between by using the t-test. Pearson’s product moment correlation coefficient
velocity and knee joint moment measured by correlation coefficient. was used to calculate correlations among the measurements data.
RESULTS: With knee flexion 80 degree, mean the trunk velocity of RESULTS: The younger group had significantly greater excursion
successful standing up, 112.8 deg/sec, was significantly (p < 0.01) sway distance of CP in CRT, ROT, and the FRT compared with the
faster than that of unsuccessful stand up, 41.3. The 80 deg/sec erderly group (p < 0.05).Functional reach measures were associated
is divided successful and unsuccessful standing. Forward bending with the anteroposterior excursion sway distance of CP. The Peason’s
angle of trunk was not significant, mean bending angle was 63.5 correlation coefficient was 0.67 and the R2 using linear regression
and 59.7 degree both successful and unsuccessful standing up with was 0.45. In both group, a significant correlation existed between
knee flexion 80 degree. Trunk velocity with knee flexion 80 degree CRT and ROT in a range generated by forward and backward
was significantly faster than the other knee flexion angle. The body exursion sway distance of CP(X), a range generated by rightward
bending angle was decrease when knee joint flexed from 80 degree to and leftward sway of CP(Y), and area(XY)(p < 0.001). No signifiant
130degree. CONCLUSIONS: The trunk velocity, bending angle and correlation existed between FRT and CRT or FRT and ROT in X,Y,and
knee joint angle are important for successful standing up. Subjects XY(p < 0.05),respectively. CONCLUSIONS: FRT in an index for
can stand up with fast trunk movement during knee extension position determining forward limit of stability and indicates only unidirectional
with large trunk bending. When knee flexion position from 90 to balance control stability, so never reflecting multidirectional balance
130 degree, subjects can stand up with very slow trunk movement control ability. IMPLICATIONS: Careful consideration will be needed
with small trunk bending angle. IMPLICATIONS: It is easy to stand for interpreting the FRT measurement data. KEYWORDS: Functional
up with fast trunk movement, even if knee joints extended. Normal reach test, dynamic balance test, multidirectional balance. FUNDING
subjects can stand up any knee joint position. On the other hand fast ACKNOWLEDGEMENTS: This work was unfunded. CONTACT:
movement is difficult for person with a stroke. Therefore, they have to [email protected]
bend their knee joints to stand up safety. KEYWORDS: trunk velocity, ETHICS COMMITTEE: This reserch was approved by the In-
standing up, motion analysis. FUNDING ACKNOWLEDGEMENTS: ternational University of Health and Welfare ethics comittee in
N.A. CONTACT: [email protected] 20/APR/2005.
ASSESSING BALANCE WITH THE STAR EXCURSION BALANCE REPOSITION ACCURACY AND COORDINATION OF THE LOWER
TEST IN PRE-ELDERLY EXTREMITY IN SUBJECTS WITH KNEE OSTEOARTHRITIS
Sasaki R, Urabe Y, Tanaka K; Hiroshima University Wang T1,2 , He H1 , Shih Y1 , Chen W1,2 , Yen L2 ; 1 Faculty of
Physical Therapy, National Yang-Ming University, Taipei, Taiwan;
PURPOSE: The ratio of elderly population older than 65 years has 2 Department of Rehabilitation Medicine, Cheng-Hsin Rehabilitation
reached over 20% of our whole population, and it becomes increased Medical Center, Taipei, Taiwan
year by year in Japan. Falling is one of the most serious health
issue in elderly. Fractures by falling, especially in femoral neck, would PURPOSE: The purposes of this study were 1) to compare the lower
greatly compromise activities of daily living in elderly people. Balance extremity (LE) proprioception and coordination between subjects with
is an important factor to prevent falling. Clinically, static balance knee osteoarthritis (OA) and their matched controls; 2) to determine
tests such as single-leg stance, functional reach test were often the relationships between the LE proprioception and coordination and
used to evaluate of balance capability in elderly. However, it may be their related factors; 3) to determine the relationships between the
important for the elderly to assess their balance in dynamic situation. LE proprioception, coordination and physical function. RELEVANCE:
Therefore, the purpose of this study was to assess dynamic balance Although proprioceptive and coordination training become more pop-
by using the star excursion balance test (SEBT) and compare with ular when treating subjects with knee OA, there have been few clinical
static balance in pre-elderly people. RELEVANCE: Assessing the methods to evaluate the neuromuscular control ability of the entire
dynamic balance by using the SEBT may be helpful for fall prevention lower limb. In addition, the factors which affect the proprioception and
in elderly. PARTICIPANTS: Eighteen healthy pre-elderly volunteered coordination of the entire LE are not clear. PARTICIPANTS: Forty-
in this study. Participants were 13 males and 5 females, whose mean two participants (7 males, 35 females; mean age=61.76±8.24 yrs)
age (± SD) was 62.8 ±6.1 years, height was 160.3 ±8.6 cm, and with knee OA and 42 age- and gender-matched healthy volunteers (7
body weight was 56.3 ±10.0 kg. No participants had any significant males, 35 females; mean age=61.62±10.81 yrs) participated in this
musculoskeletal disorder. METHODS: We used the SEBT which study. METHODS: After an initial evaluation, all subjects were tested
measures reach distance of each limb in 8 directions. The reliability by the Functional Squat System (Monitored Rehab System B.V., 2031
of it was reported by Kinzey in 1998. The reach directions were CW Haarlem, The Netherlands) for quantifying their LE propriocep-
guided by 8 lines: anterolateral (AL), anterior (ANT), anteromedial tion and coordination. Pain was recorded using a numerical rating
(AM), medial (MD), posteromedial (PM), posterior (PO), posteorateral scale during each test for subjects with knee OA. Western Ontario
(PL), and lateral (LAT). The reach distances were normalized to and McMaster Universities Osteoarthritis Index (WOMAC)disability
subjects’ height. In addition to the SEBT, we measured single-leg score was also obtained for the OA group. Five times sit-to-stand test,
stance time with opened and closed eyes. Single-leg stance can timed up and go test, and nine-step stair climbing and descending
assess static balance. ANALYSIS: Pearson’s correlation coefficients test were used to assess the physical function for both groups.
were performed to assess correlations between reach performance ANALYSIS: Two-way mixed ANOVAs with pairwise comparisons
of the SEBT and the duration of the single-leg stance with eyes- were used to determine the between- and within-group differences
open/closed conditions. The data were analyzed by using Stat View J in all study parameters. Stepwise multiple regressions were used
5.0(SAS Institute Co., USA). The significance level was set at P < 0.05 to explore the relationships between the related factors and the
for all analyses. RESULTS: The correlation between the SEBT and LE proprioception or coordination parameters. Pearson’s correlation
eyes opened single-leg stance ware not statistically significant in coefficients were used to determine the relationships between LE
this study. The PM reach direction was most strongly related to the proprioception or coordination parameters and physical function. The
eyes-closed single-leg stance (r = 0.58). In addition, the correlation level of statistical significance for each test was set at a < 0.05.
between the eyes-opened single-leg stance and PO was r = 0.57, RESULTS: Results of this study showed that subjects with knee OA
and PL was r = 0.52, respectively (p < 0.05). CONCLUSIONS: We demonstrated decreased coordination than their matched controls
measured the SEBT and the single-leg stance time with eyes- both in the affected and unaffected limbs, but no statistical differences
opened and closed. Statistical analysis showed the distance of were found between the affected and unaffected limbs in the knee
3 reach directions (PM, PO, PL) was significantly correlated with OA group. However, the LE proprioceptive reposition accuracy was
single-leg stance time with eyes-closed. The result of SEBT in 3 not significantly different between the patient and the control groups.
directions, PM, PO and PL, might play an important role in balance There were no significant differences in all LE proprioceptive testing
evaluation because these results include both static and dynamic parameters for either leg in the knee OA group. Resistance, testing
balance components. IMPLICATIONS: Dynamic balance training of limb position, stair climbing and descending activity, knee range
3 directions may be useful to prevent the falling in the future for pre- of motion, body mass index, and exercise habit were found to
elderly. KEYWORDS: star excursion balance test, falling prevention, be significant factors related to the LE proprioception of patients
pre-elderly people. FUNDING ACKNOWLEDGEMENTS: This study with knee OA. Resistance, movement phase, age, BMI, exercise
was not supported by any grant or commercial resource. CONTACT: habit, radiographic status, knee range of motion, and disability score
[email protected] were found to be significant factors related to the coordination in
ETHICS COMMITTEE: The Ethics Committee of Hiroshima Univer- subjects with knee OA. Physical function tests were found to be
sity associated with the LE coordination parameters in the control group.
CONCLUSIONS: Using this testing equipment, we found subjects
with knee OA exhibited motor control deficits both in their affected
and unaffected limbs. IMPLICATIONS: Rehabilitation program for
knee OA should include neuromuscular control training for increasing
the LE proprioception and coordination in both the affected and
unaffected legs. KEYWORDS: proprioception, coordination, knee
osteoarthritis, testing. FUNDING ACKNOWLEDGEMENTS: The
work was supported by a grant from the National Science Council,
the Executive Yuan, Taiwan (NSC93-2213-E-010-012). CONTACT:
[email protected]
ETHICS COMMITTEE: Institutional Review Board, Cheng-Hsin
Rehabilitation Medical Center, Taipei, Taiwan
Research Report Poster Display to running over a narrow range of speeds. We consider that a
14-05 Tuesday 5 June 14:00 difference between pelvic and upper trunk rotation is needed in
VCEC Exhibit Hall B & C walking, the inertia moment of the trunk is large, it is conversely
RELATIONSHIP BETWEEN TIBIAL ROTATION STRENGTH AND disadvantageous that the trunk rotates significantly in faster running.
ROTATION OF THE TIBIA DURING SINGLE-LEG DROP LANDING PARTICIPANTS: The subjects were six male sprinters.: average age,
19.7±0.52 years, 100 meter best record time, 11.0±0.28sec. No
Kiriyama S1 , Sato H2 ; 1 Graduate school of medical science, Kitasato
subjects were injured during this experiment. METHODS: Running
University; 2 Kitasato University, School of Allied Health Sciences
conditions were as follows: 2.5 m/s, 4.5 m/s 6.5m/s and maximum
PURPOSE: Female athletes have a higher incidence of sustaining speed for running. Running was recorded using three high speed
a serious noncontact anterior cruciate ligament (ACL) injury than video cameras and ground reaction force. After digitizing the 29
male athletes participating in the same sport. The aim of this study landmarks, each partial coordinates value was calculated. Matsui’s
was to investigate the relationship between tibial rotation strength coefficient of the body segment inertia parameter was used in
and rotation of the tibia during a single-leg drop landing. We also this research, and the body’s center of gravity was computed.
compared gender differences in muscle strength and degree of The horizontal movement of the center of gravity estimated the
rotation of the tibia. RELEVANCE: It is important to make functional average gait speed over 2 steps. Positive rotation of the pelvis
risk factors known in order to provide an effective training and and trunk about the vertical axis of the global coordinate system
rehabilitation program to prevent ACL injury. PARTICIPANTS: Eighty- occurred on the transverse plane ANALYSIS: Cross-correlation
one female and 88 male healthy young subjects, 14 to 23 years of analysis was measured to identify the phase difference (%) between
age, volunteered to participate in this study. METHODS: Subjects pelvic and trunk rotation. When the phase difference (%) was
performed single-leg drop landings from 20-cm heights. Femoral 50%, the relationship of phase shift between pelvis and trunk
and tibial kinematics were measured using three-dimensional motion indicated a complete inverse-phase. When the phase difference (%)
analysis techniques during the drop landings. Maximal isometric was 0%, the relationship of phase shift between pelvis and trunk
tibial rotation strength was measured at 30 degrees of knee indicated complete synchronicity. The relationship between the phase
flexion in a supine position using a dynamometer. ANALYSIS: difference (%) and actual gait speed (m/s). The statistical procedures
Internal rotation angles of the tibia with respect to the femur were used Pearson’s regression analysis. RESULTS: The phase difference
calculated using MATLAB software. Muscle strength was normalized between pelvis and trunk rotation (%) decreased significantly with
with respect to body mass. An independent t-test was used to the running speed (r = 0.70, p < 0.001). CONCLUSIONS: The result
compare between genders for maximum tibial internal rotation of this research revealed that shift difference between pelvis and
angle, tibial rotation strength and external-rotator-to-internal-rotator trunk rotation varied with changes in running speed. It is quite
strength ratio. A Pearson correlation coefficient was measured to inverse-phase between pelvis and trunk in slow running speed.
compare maximum tibial internal rotation angles with tibial rotation However, it became a coordinate phase in increased with running
strength. The level of significance was set at 0.05. RESULTS: speed. IMPLICATIONS: The result of this research revealed the shift
Females exhibited significantly greater tibial internal rotation angles difference between pelvis and trunk rotation increased with running
than males during single-leg drop landing (female: 12.0±12.57º, speeds. The decrease in shift difference at faster running may be
male: 7.9±7.91º, p<0.05). Females also had significantly less tibial an effective strategy to induce a rigid trunk. KEYWORDS: Running
rotation strength compared to males (external rotator: female; speeds, pelvis, Phase shift. FUNDING ACKNOWLEDGEMENTS:
0.27±0.069Nm/kg, male; 0.38±0.084Nm/kg, p<0.001, internal rota- Nothing. CONTACT: [email protected]
tor: female; 0.34±0.087Nm/kg, male; 0.40±0.081Nm/kg, p<0.001) ETHICS COMMITTEE: Ethics Committee of Kansai vocational
and a significantly lower external-rotator-to-internal-rotator strength college of medicine
ratio compared with males (female: 0.82±0.192, male: 0.98±0.265
p<0.001). There was a significant correlation between tibial internal
rotation angles during single-leg drop landing and tibial external
rotation strength (r =-0.24, p<0.01). CONCLUSIONS: Lower strength 15-13 Tuesday 5 June 14:00
of tibial external rotator muscles, which inhibit internal rotation of VCEC Exhibit Hall B & C
the tibia, may lead to large tibial internal rotation movement during THE INFLUENCE EXERTED BY DETAIL OF KNOWLEDGE OF
the single-leg drop landing. Therefore, it was suggested that these RESULTS(KR) ON PERFORMANCE IN A PARTIAL WEIGHT
factors increase the risk of ACL injury in females. IMPLICATIONS: BEARING(PWB) TASK
Improving biceps femoris muscle strength training and rehabilitation Watanabe M, Tani H; Department of Physical Therapy, School
might help to decrease rates of ACL injury. KEYWORDS: rotation, of Nursing and Rehabilitation Sciences at Odawara, International
gender, ACL. FUNDING ACKNOWLEDGEMENTS: NA. CONTACT: University of Health and Welfare,Kanagawa,Japan
[email protected]
PURPOSE: In the initial process of motor learning, it is reported
that feedback is one of the most powerful variables influencing motor
Research Report Poster Display learning. But the optimal relative frequency for giving feedback is
14-09 Tuesday 5 June 14:00 not 100 percent. In this research, the influence that differences in
VCEC Exhibit Hall B & C the detail of KR used as a feedback, exerted on motor learning was
SHIFT PHASE BETWEEN PELVIS AND TRUNK MOTION examined in PWB task. RELEVANCE: PWB is a skill that physical
INCREASED WITH RUNNING SPEEDS therapists often teach. For example, PWB is practiced for hemiplegia
or fracture using a mirror or a scale feedback. But it is difficult for
Nishimori T1 , Ito A2 ; 1 Department of Physical Therapy, Kansai
the patients to achieve the correct weight. PARTICIPANTS: The
Vocational College of Medicine, Osaka, Japan; 2 Osaka University
participants were 18 healthy adults. The content of the experiment
of Health and Sport Sciences, Graduate School, Laboratory of
was explained by document and oral presentation beforehand, and
Sport Biomechanics
the participants’ consent was obtained. The participants were divided
PURPOSE: This study investigated the phase difference between into 2 groups: Group D(detailed group) was told the difference from
pelvic rotation and trunk rotation during running. RELEVANCE: In the target weight in kilograms, and Group C(coarse group) was told
1987, Hinrichs described that the action of the arms and upper the difference by 9 broad statements. METHODS: The task was
trunk provide most of the angular momentum in the horizontal plane to assume a load of 1/3 body weight on the left leg from right leg
needed to put the legs through their alternating strides in running as standing. The start posture was right leg standing on a parallel bar
well as walking. However, these studies have mainly been limited internal detector, and the participants were orally prompted to start
the task. After the signal had been amplified with a strain amplifier the Blocked-TMS groups for the temporal parameter. TMS degraded
(Kyowa YB-503A), it was input to a computer through an analog to both temporal (p = 0.03) and spatial (effect size = 0.94) parameter
digital converter. KR was presented to the participants orally on the learning compared with that for the Random-Control group. This
basis of that value. The experiment schedule was composed of a was not the case for the blocked practice groups, which performed
pre-acquisition phase (3 trials), an acquisition phase (15 trials) and a similarly at retention. CONCLUSIONS: These results, together with
retention phase of 5 min after and 24 hr after (3 trials each). KR being those from the Sham TMS groups suggest that the contextual
presented every 3 trials in the acquisition phase. At the end of the interference effect in motor learning is primarily mediated through
experiment the participants answered a questionnaire on the difficulty temporal parameter learning and that cortical stimulation during
of the task and the focus of their attention. ANALYSIS: Absolute practice leads to greater attenuation in random compared with
error (AE) for blocks of 3 trials was calculated as an independent blocked practice condition. IMPLICATIONS: Understanding the role
variable for analysis. Performance in the acquisition and retention of motor cortex in learning of movement kinematics will contribute to
blocks was evaluated using two-way analysis of variance. RESULTS: evidence-based physical therapy practice for rehabilitation of patients
There was no difference in AE between groups C and D in the with brain damage. KEYWORDS: motor learning, kinematics, motor
pre-acquisition phase. In the acquisition phase, AE decreased from cortex, practice order, transcranial magnetic stimulation. FUNDING
51.3% to 17.2% in Group D, and from 44.4% to 13.1% in Group ACKNOWLEDGEMENTS: This study was supported in part by the
C. A main effect for block [F(4,64) = 9.55, p < 0.001] was observed. California Physical Therapy Association (CW, CL), a student research
But a main effect for group was not observed. In the retention award (CL) from North American Society for the Psychology of Sport
phase, a main effect was observed for neither block nor group. and Physical Activity, and NINDS K23-NS045764 (AW). CONTACT:
CONCLUSIONS: In this study, KR was effective for both groups in [email protected]
PWB task. Thus, a difference in the detail of KR does not influence ETHICS COMMITTEE: Institutional Review Board of the University
motor learning. IMPLICATIONS: The results suggest that patients of Southern California Health Science Campus.
do not need detailed feedback in motor learning tasks. However,
from the results of the questionnaire, there was a slight difference
between the two groups regarding the perceived difficulty of the
task. The relationship between perceived difficulty of the task and 15-21 Tuesday 5 June 14:00
the detail of KR should be investigated in the future. KEYWORDS: VCEC Exhibit Hall B & C
Knowledge of result,Motor learning,Partial weight bearing. FUNDING ACL INJURY PREVENTION PROGRAM AND THE EFFECT
ACKNOWLEDGEMENTS: I thank participants who had this study ON DECREASING ACL INJURY INCIDENCE IN FEMALE HIGH
cooperate and Professor Hiroaki Tani whom I taught it to. CONTACT: SCHOOL BASKETBALL PLAYERS
[email protected] Urabe Y1 , Sasaki R, Tanaka K, Matsui H, Koshida S, Miyashita K;
1 Department of Sports Rehabilitation, Graduate School of Health
Research Report Poster Display Sciences, Hiroshima University

15-17 Tuesday 5 June 14:00 PURPOSE: Many studies have been investigated to identify the
VCEC Exhibit Hall B & C mechanism of non-contact anterior cruciate ligament (ACL) injury.
CONTEXTUAL INTERFERENCE EFFECT IN MOTOR LEARNING It is currently accepted that the ACL injuries occur during stopping,
IS ATTENUATED BY CORTICAL STIMULATION IN HUMAN cutting, or jump-lading with slight knee flexion and knee vulgus. The
MOTOR CORTEX: A KINEMATIC ANALYSIS number of ACL injury incidence has not been successfully decreased
yet. Therefore, we developed the ACL injury prevention program.
Lin C1 , Wu A2 , Winstein C1,3 ; 1 Division of Biokinesiology and
The purpose of this study is to report the effect of the ACL injury
Physical Therapy at the School of Dentistry, University of Southern
prevention program after 12 months period. Our program requires
California, Los Angeles, CA, USA; 2 Department of Neurology,
only 10 minutes, whereas the programs reported previously requires
David Geffen School of Medicine, University of California, Los
approximately 30 minutes. RELEVANCE: If our ACL program is able
Angeles, CA, USA; 3 Department of Neurology, Keck School of
to decrease the number of ACL injury incidences, it will enhance
Medicine, University of Southern California, Los Angeles, CA, USA
the current knowledge of ACL injury prevention. PARTICIPANTS:
PURPOSE: Our previous research showed that the contextual 180 female basketball players from ten local high schools were
interference (CI) effect in motor learning is attenuated by cortical participated in our study. The subjects were divided by two groups at
stimulation applied over human motor cortex (M1). Here, we random. 92 subjects attended the ACL prevention program (exercise
applied kinematic analysis to determine the locus of this effect group). They were instructed to perform the exercise program
in the learning of three arm movement tasks, each with unique before every regular practice session. 88 subjects attended only
spatial and temporal components and under CI practice conditions regular practices (control group). METHODS: The exercise program
including either blocked (low CI) or random (high CI) task practice. consists of strengthening, balance, and jump-landing exercises.
RELEVANCE: Learning more about the role of human motor cortex Exercise attendances, injury profiles, and the physical fitness levels
in motor learning can inform the development of evidence-based of all subjects were measured in every three months. In addition,
clinical practice strategies for rehabilitation of patients with brain proprioceptive function is important for neuromuscular system. We
damage. PARTICIPANTS: Sixty one young adults were randomized used our original instrument for the measurement of joint position
into one of six practice groups, resulting from three stimulation sense. ANALYSIS: Paired t-test was used to compare the data
conditions (Control, TMS, Sham-TMS) and two levels of CI (Blocked, between before and after the exercise and between two groups.
Random). METHODS: For the stimulation groups, single-pulse TMS The level of statistical significance was set at 0.05 in this study.
was delivered after each of 144 movements, over the biceps- RESULTS: The compliance of the ACL injury prevention program
hotspot of M1 at 120% of motor threshold. ANALYSIS: Performance after 12months was 85% (78 subjects) in the exercise group and
accuracy in temporal (time) and spatial (amplitude) parameters 75% (66 subjects) in the control group. Two ACL injuries occurred
was measured across acquisition and two no-stimulation retention during the intervention period in the exercise group. The calculation
(immediate and delayed) phases. RESULTS: For the acquisition of the ACL injury ratio was 0.037 per 1,000 practice hours. Four
phase, all groups improved with practice, p < 0.05. In delayed (0.080) ACL injuries occurred in the control group. There was no
retention, the Random-Control group showed better retention of the notable finding in the characteristics of ACL injured subjects. The
temporal, but not spatial parameter than for the Blocked-Control results of the physical fitness measurement after 12months were
group (p = .02, p = 0.197, respectively). TMS attenuated the CI effect: increased from 19 to 41% in the exercise group. The control group
there was no significant difference between the Random-TMS and showed relatively lower improvement of the physical fitness when
compared to the exercise group. Absolute errors, which represent decreases in MHC 2d and MHC 2b were also observed in SDS-
the joint position sense, were found to be from 4 to 10 degrees. PAGE. CONCLUSIONS: The diaphragm muscle is continuously and
There was no significant difference in joint position sense between stereotypically activated throughout life to maintain ventilation. The
pre and post-program period and between ACL injured and non- denervated hemidiaphragm of hypertrophy has been attributed to the
injured subjects. sense. CONCLUSIONS: The calculation of the ACL repetitive, unopposed stretching of the denervated hemidiaphragm
injury rate in the female athletes was found to be from 0.2 to 0.5 per resulting from the rhythmic contractions of the intact, contralateral
1,000 practice hours in this study. Our results showed lower incidence hemidiaphragm. These findings suggest that decreased sensitivity
rate of ACL injury in the exercise group, which was about half of to mechanical stress prevents adaptation of skeletal muscles to
control group. Since the program requires only 10 min, subjects various exogenous factors in old rats. Although stretching has been
were able to continue the prevention program. IMPLICATIONS: used as a therapeutic technique in the field of physical therapy, an
Although shorter time is required for the single exercise session in our animal model of respiratory intermittent stretch used in this study
program, the greater effect on decreasing the ACL injury incidence may be a novel therapeutic technique that is useful for preventing
was observed compared with previous studies. KEYWORDS: ACL muscle atrophy or increasing muscle strength. IMPLICATIONS:
injury prevention, proprioceptive function, female athletes, basketball. These results clarified that aging decreases the stretch sensitivity. In
FUNDING ACKNOWLEDGEMENTS: This study was suported by the future, it is necessary to investigate in ways of how to prevent age-
JSPS KAKENHI 18500405. CONTACT: [email protected] related changes in skeletal muscles. KEYWORDS: Rat diaphragm
ETHICS COMMITTEE: Graduate School of Health Sciences, muscle, aging, denervation. FUNDING ACKNOWLEDGEMENTS:
Hiroshina University None. CONTACT: [email protected]
ETHICS COMMITTEE: The Animal Use Committee at Yamaguchi
University which followed the Japanese Physiological Society Animal
Care Guidelines
FUNCTIONAL AND MORPHOLOGICAL ADAPTATIONS OF
DIAPHRAGM MUSCLE TO INTERMITTENT STRETCH IN AGED 17-09 Tuesday 5 June 14:00
RATS VCEC Exhibit Hall B & C
EFFECT OF IMMOBILIZATION ON COLLAGEN IN RAT SOLEUS
Imagita H1 , Kanemura N2 , Moriyama H3 , Miyata H4 ; 1 Department
MUSCLE
of Physical Therapy, Faculty of Health Sciences, Kio University;
2 Graduate School of Health Sciences, Hiroshima University; Hibino I1 , Okita M2 , Inoue T3 ; 1 Department of Physical Therapy,
3 Department of Physical Therapy, Faculty of Health Sciences, Japan College of Medical Care and Welfare,Nagoya,Japan; 2 Faculty
Saitama Prefectural University; 4 Department of Biological Science, of Care and Rehabilitation, Seijoh University,Tokai,Japan; 3 Program
Graduate School of Medicine, Yamaguchi University in Physical and Occupational Therapy, Graduate School of Health
Sciences, Nagoya University,Nagoya,Japan
PURPOSE: The purpose of this study, we evaluated age-related
changes in the rat diaphragm and changes in muscle fibers PURPOSE: Immobilization of a joint induces decreased muscle
after unilateral phrenic nerve denervation (DNV). RELEVANCE: To elasticity, a condition called muscle contracture, but the mechanism
determine physiological, histochemical and biochemical properties is still not clear. Collagen has several important functions as the
of diaphragm muscle (DIA). PARTICIPANTS: Young (2.5-month, major structural component of muscular connective tissue. In the
n=18) and Old (24-month, n=18) male Wistar rats were used in mechanism of the muscles contracture, we have assumed that the
this study. METHODS: The unilateral diaphragms of nine rats in increase of collagen’s intermolecular cross-links and/or the change
each age group was denervated by cutting the phrenic nerve at of expression of collagen’s species in muscular tissue. The aim of
the cervical level, and sham operation was performed on the other our study was to clarify the mechanism of muscle contracture in
nine in each. The undenervated side diaphragms of young and old the rat by determining changes in ankle joint mobility and collagen
sham rats were studied to investigate the age-related changes. Four in muscular tissue after immobilization. RELEVANCE: Muscle
weeks after the denervation, isometric contraction properties, fiber contracture remains perhaps the single most frequent problem faced
type composition, and expression of myosin heavy chain (MHC) by physical therapists. This study provides some information on the
isoforms in all groups were observed. All procedures used in this mechanism of muscle contracture. PARTICIPANTS: Twenty male
study were approved by the Animal Use Committee at Yamaguchi Wistar rats, 8 weeks old, were divided randomly into control (n=10),
University which followed the Japanese Physiological Society Animal and experimental (n=10) groups. METHODS: The experimental
Care Guidelines. ANALYSIS: Each treatment group was compared protocol was approved by the Ethics Review Committee for Animal
to sham groups or between age groups with similar treatments by an Experimentation at our institution. In experimental group, bilateral
unpaired Student’s t-test. P value of less than 0.05 was regarded to ankle joints of each rat were fixed in full plantar flexion with plaster
be statistically significant. RESULTS: Age-related changes included casts, the soleus muscles being immobilized in shortened position.
prolongation of isometric contraction time and one-half relaxation The ankle joint was immobilized for 1 and 3 weeks, five rats
time, increases in cross-sectional areas of muscle fibers such as being used in each immobilization period. Five untreated control
slow-twitch oxidative (SO) and fast-twitch oxidative glycolytic (FOG) rats also were tested weekly. ANALYSIS: At 1 and 3 weeks after
fibers, and relative increases in myosin heavy chain 1 (MHC 1), immobilization, rats were anesthetized with pentobarbital sodium and
resulting in fast to slow transition of diaphragmatic muscle fibers. the range of motion (ROM) on dorsiflexion of the ankle joint was
DNV induced characteristic changes in diaphragmatic muscle fibers measured with a goniometer. After the measurement of ROM in each
such as hypertrophy of FOG fibers and inhibition of SO fiber atrophy, immobilization period, bilateral soleus muscles was excised, weighed
in addition to regressive changes such as decreases in contraction and were used as a sample of biochemical analysis. The changes
force and peak twitch force, prolongation of isometric contraction in the ratio of type III to type I collagen after immobilization were
time and one-half relaxation time, and rapid atrophy of fast-twitch examined on polyacrylamide gel electrophoresis. Hydroxyproline
glycolytic (FG) fibers. These changes were also observed in young was determined for estimation of the insoluble collagen content
rats. In old rats, DNV did not induce significant changes in the in muscular tissue. RESULTS: Ankle joint mobility decreased with
peak twitch force, isometric contraction time and one-half relaxation longer periods of immobilization. The ratio of type III to type I collagen
time. In addition, cross-sectional areas of SO, FOG, and FG fibers was increased after immobilization. The insoluble collagen content to
decreased in old rats. In particular, FG fibers were atrophied by 50% represent as a percent of wet weight was increased 3 weeks after
or more. Moreover, significant increases in MHC2a and significant immobilization, but did not show change 1 week after immobilization.
CONCLUSIONS: Our results suggested that muscle contracture therapy they have received has not met their needs. A smaller
occurred after 1 week immobilization, and progressed with longer group of individuals, with a high SOC score, many resources
periods of immobilization. Consequently, muscle contracture is and the ability to be flexible, are able to set meaningful goals
caused by the increase of the ratio of type III to type I collagen for their own rehabilitation. CONCLUSIONS: Self-evaluated health
in the early stage of immobilization, and the insoluble collagen resources have a significant impact on how individuals with low
content was increased 3 weeks after immobilization. This change back pain manage their rehabilitation process. When rehabilitation
indicate that the intermolecular cross-links become more stable is not organized according to individual goals, but has been chosen
and mature, it may play a progressive role in muscle contracture according to the method used by the social and healthcare system,
in the late stages of immobilization. IMPLICATIONS: The results the majority of participants believe their resources are inadequate
of the present study may be provided new information on the with regard to achieving their personal goals. It is recommended
mechanism of muscle contracture. KEYWORDS: Immobilization, that futures studies consider the significance of the organization
Muscle contracture, Collagen. FUNDING ACKNOWLEDGEMENTS: of the rehabilitation process. IMPLICATIONS: It is recommended
This study was supported in part by a Grant-in-Aid for Scientific physiotherapist to highlight and involve personal healthcare re-
Research from the Ministry of Education, Science, Sports and Culture sources in the rehabilitation process as well as map out the barriers
of Japan (Grant no. 18500428). CONTACT: [email protected] individuals experience when trying to reach their personal goals.
ETHICS COMMITTEE: The experimental protocol was approved by KEYWORDS: low back pain, self-evaluated healthcare resources
the Ethics Review Committee for Animal Experimentation at Seijh and rehabilitation. FUNDING ACKNOWLEDGEMENTS: The study
university is unfunded. CONTACT: [email protected]
ETHICS COMMITTEE: The ethics committee of Vejle and Fyns
county. [email protected]
THE SIGNIFICANCE OF SELF-EVALUATED HEALTH CARE 18-17 Tuesday 5 June 14:00
RESOURCES IN THE REHABILITATION PROCESS FOR VCEC Exhibit Hall B & C
INDIVIDUALS WITH LOW BACK PAIN AN INVESTIGATION INTO PHYSICAL THERAPY TREATMENTS
Knudsen H1,2 , Møller H1 ; 1 Master of Science in Rehabilitation, FOR LUMBAR SPINAL STENOSIS
University of south Denmark, Odense, Denmark; 2 CVSU Fyn, Tomkins C, Crites-Battie M, Forman H, Gordon E, McPhail J,
Physiotherapy, Odense, Denmark Wong J, Andrew K; University of Alberta
PURPOSE: It is a fact in international literature that low back PURPOSE: Lumbar spinal stenosis (LSS) is a common cause
pain (LBP) derives from multiple factors, including biological, of lower back and leg pain in older adults. Physical therapy is
psychological, social, and business-related and cultural factors. In considered a non-surgical treatment option for LSS. The purpose
the future, the patient’s own self-evaluation of their health and of this investigation was to determine what treatments are being
resources during rehabilitation will be a significant factor in the accessed by patients, as well as what treatments are being offered by
rehabilitation process. Previous studies and healthcare reports physical therapists for LSS patients in Canada. RELEVANCE: Little
state that it is vital that the individual takes a central role in is known regarding the current provision and use of physical therapy
the rehabilitation process. Rehabilitation is a goal driven, time treatments for patients with LSS. Further information on this topic
limited process of cooperation between the individual, relatives and would be helpful to inform physical therapists and others of current
professionals. The objective is that the individual, who runs the practices for this patient group, as well as to guide future research
risk of back-related functional limitation, achieves an independent regarding efficacy of physical therapy for LSS. PARTICIPANTS: The
and meaningful life. Rehabilitation is based upon the individual’s study participants were part of a multi-centre prospective cohort
entire lifestyle, and consists of a coordinated, integrated and science- study of prognostic factors and outcomes of LSS being conducted
based strategy. As such, the goal of the study has been to achieve in Alberta, Canada. The participants had been referred by general
an increased understanding and insight into the rehabilitation of practitioners or specialists to any of four adult imaging facilities for
individuals with low back pain, and to consider the consequences lumbar spine imaging. All subjects had LSS confirmed on imaging,
of the use of self-evaluation resources in relation to achieving as well as through a subsequent visit to an orthopaedic or neuro-
individual rehabilitation goals. RELEVANCE: It is necessary for surgeon (n=75). In addition, physical therapists working in clinics
physiotherapists to understand the significance of self-evaluation in the Edmonton region of Alberta were invited to complete a
healthcare resources for individuals with low back pain to be able separate mailed clinician survey. METHODS: All participants with
to plan a physiotherapeutic intervention as part of the patient’s LSS completed a telephone interview following their lumbar imaging
comprehensive rehabilitation. PARTICIPANTS: The study included that included whether or not current treatment was being received,
seven participants. Participants were selected based on the following and if so, what kind, using a standardized questionnaire. A separate
criteria: Individuals who have previously had LBP, and who are mail survey was developed and distributed to physical therapists
evenly distributed across Antonsky’s Sense of Coherence (SOC) regarding how they treat LSS. The survey included questions on
scale, with a uniform distribution of gender and age. METHODS: therapist characteristics, treatment goals, treatments offered, and
The research methodology uses the qualitative research method beliefs about physical therapy and surgical treatment efficacy for
with semi-structured interviews. ANALYSIS: The selected analytical LSS patients. ANALYSIS: The data from patient and therapist
strategy is based on Huberman and Mile’s interactive model and the surveys were summarized using descriptive statistics. RESULTS:
hermeneutic spiral. RESULTS: The study shows that participants The responses from 75 LSS patients indicated that 25 (33%) had
experiencing a meaningful rehabilitation, have a greater degree of recieved passive physical therapy (PT), and 24 (32%) received active
self-motivation and increased desire to control their own situation, PT. Of the patients indicating that they had received passive PT, the
regardless of the resources available. The majority of participants majority reported massage (48%), followed by heat/ice (24%). Of
experience a barrier in the form of insufficient coordination in relation those indicating they received active PT, most received strengthening
to their overall rehabilitation programme, which means that they (42%), flexibility exercises (33%) and aerobic conditioning (25%).
do not achieve their personal goal. In this situation, the majority The physical therapists indicated that they offer a broad array of
of the participants experience that their personal resources are treatments to LSS patients, including therapeutic exercise (96%),
inadequate. These individuals do not experience a meaningful or patient education (96%), modalities (90%) and manual therapy
fully coordinated process of rehabilitation, thus feeling that the (88%). CONCLUSIONS: Our results indicate wide variability in the
treatment types being offered to and accessed by patients with dislocation to gain better strength and endurance. The therapy and
LSS. The more commonly reported treatments such as manual exercise concept will consequently be investigated in a further study.
therapies, and various types of therapeutic exercise may be priorities KEYWORDS: Immobilization, surgical hip dislocation, conditional
for randomized clinical trials of treatment efficacy of physical therapy deficits. FUNDING ACKNOWLEDGEMENTS: Swiss Association of
for LSS, which are currently lacking. IMPLICATIONS: The results of Physiotherapy, Switzerland. CONTACT: [email protected]
this investigation may help in setting priorities for clinical research ETHICS COMMITTEE: The study was approved by the Ethics
into the use and efficacy of physical therapy treatments for patients Committee of Canton Berne, Switzerland
with LSS. KEYWORDS: Lumbar spinal stenosis, treatment, physical
therapy. FUNDING ACKNOWLEDGEMENTS: Support was received
from the Health Research Fun administered by the Alberta Heritage
Foundation for Medical Research for the patient survey portion of the
study. CONTACT: [email protected]
ETHICS COMMITTEE: Human Research Ethics Board at the
University of Alberta 20-09 Tuesday 5 June 14:00
COMPARISON OF THE EFFECTIVENESS OF A BEHAVIOURAL
Research Report Poster Display GRADED ACTIVITY PROGRAM AND MANUAL THERAPY IN
18-21 Tuesday 5 June 14:00 PATIENTS WITH SUB-ACUTE NECK PAIN
Pool J1 , Ostelo R1,2 , Bouter L1 , De Vet R1 ; 1 EMGO institute VU
CONDITIONAL DEFICITS AFTER SURGICAL HIP DISLOCATION
University medical centre Amsterdam; 2 Department of Allied Health
Rocourt M1 , Luder G, Deschner G, Radlinger L; 1 Physiotherapy Care Research, Amsterdam School for Allied Health Care Education
Research, University Hospital Berne, Switzerland
PURPOSE: The objective was to assess if a behavioural graded
PURPOSE: The aim of this study was to characterize the
activity programme is more effective than manual therapy in patients
deficits concerning conditional aspects such as strength, power
with sub-acute neck pain. RELEVANCE: Neck pain is a common
and endurance 3 and 12 months after surgical hip dislocations.
musculoskeletal disorder and approximately one-third of all adults
RELEVANCE: After this surgery the persons walk with reduced
will experience neck pain during the course of 1 year.The evidence
weight-bearing (15 kg) for 8 weeks. Due to this partial immobilization
hypotrophy of muscles and other tissue can be expected 3 months regarding the effectiveness of conservative therapies for neck pain
after surgery. The identification of subsequent deficits is important for is still inconclusive but manual therapy, a typical hands-on therapy
the establishment of an adequate therapy and exercise programme. seems to be an effective therapy for neck pain. It is hypothesized
The fact that these persons do not have physical therapy allows us that psychological and social aspects play an important role in
to evaluate the extent to which these deficits are resolved by natural the transition from sub-acute to chronic pain. Behavioural Graded
improvement one year after surgery. PARTICIPANTS: This cross- Activity, a typical hands-off therapy, can influence pain behaviour and
sectional prospective study involved a total of 91 persons 3 months pain intensity by focussing on those aspects, and shows promising
after surgical hip dislocation (G3, n=29, 28.1±5.8 years, 76.7±17.1 results in other pain conditions. PARTICIPANTS: i46 patients were
kg), 12 months after surgery (G12, n=28, 30.1±5.1 years, 80.4±15.7 included in the study.The inclusion criteria were: non-specific neck
kg) and a control group (G0, n=34, 28.0±4.9 years, 67.4±11.0 kg) pain, age between 18 and 70 years, and a new episode of pain.
consisting of healthy individuals without any pain or disability in METHODS: At baseline, 146 patients completed a questionnaires on
the lower limbs or back. METHODS: The following measurements demographic variables as well as primary and secondary outcomes.
have been performed with all persons: maximum voluntary isometric Primary outcome measures are Global Perceived Effect, the Neck
contraction (MVIC) and rate of force development (RFD) for hip Disability Index and Pain. Secondary outcome maesures are the
abduction and knee extension (force sensor) combined with surface 4 dimension psychological symptomatology questionnaire (4DSQ)
EMG of the relevant muscles (M. gluteus medius and M. tensor fascia to measure: somatisation, distress, depression and fear, and the
latae respectively M. vastus medialis) and aerobic threshold (cycle Pain Coping and Cognition List PCCL to measure: catastrophysing,
ergometer). ANALYSIS: The strength and endurance measurements coping, and internal and external pain control. The Tampa Scale
were normalized to body weight. Descriptive statistics and group for Kinesiophobia (TSK)and the level of chronicity was assessed
differences (nonparametric: Kruskal-Wallis-H; Mann-Whitney-U-test) with the Graded Chronic pain Scale (GCPS). Follow-up measures
were computed using SPSS. RESULTS: For hip abduction strength were conducted at 6, 13, 26 and 52 weeks. ANALYSIS: A multilevel
we have seen a significant deficit 3 months and one year after analysis was performed, with two levels: patients and therapists.
surgery in comparison to the control group. The mean MVIC for For continuous data a linear regression model was used and
hip abduction was 1.7±0.37 N/kg for G0, 1.02±0.48 N/kg for G3
for dichotomous outcomes a logistic regression model was used
and 1.37±0.53 N/kg for G12 with differences of −40% and −19%
in which the odds ratio (OR) and 95% confidence interval (CI)
between G0 and G3 (p = 0.000) respectively G12 (p = 0.009). The
were calculated. RESULTS: Prelimary results showed no significant
mean RFD for hip abduction was 28.6±12.0 Nm/s/kg for G0,
difference between either interventions in the short term as well
14.6±10.3 Nm/s/kg for G3 and 19.4±8.8 Nm/s/kg for G12 and
as in the long term results. Both therapies showed a significant
showed deficits of −49% and −32% between G0 and G3 (p=
0.000) respectively G12 (p = 0.000). The mean power at aerobic decrease of pain within 13 weeks which maintained at 52 weeks,
threshold was 1.24±0.45 Watt/kg for G0, 0.75±0.29 Watt/kg for G3 and a percieved effect of 79% for BGA and 76% for manual
and 0.82±0.35 Watt/kg for G12. Differences of −39% and −34% therapy at 52 weeks. CONCLUSIONS: Both therapies are effective
between G0 and G3 (p = 0.000) respectively G12 (p = 0.000) were in patients with sub-acute neck pain. Taking into account the effort
found. CONCLUSIONS: Significant differences between persons of training physical therapist to conduct the BGA program, and the
after surgical hip dislocation and healthy for strength, power and number of treatment sessions used, usual care manual therapy is
endurance still persist one year after surgery. This shows that probably more useful in this population. IMPLICATIONS: Manual
an adequate therapy is necessary to reach a normal condition therapy is more useful in sub-acute neck pain KEYWORDS: Neck
at the level of healthy persons. This could be important for the Pain, randomised clinical trial, Behavioural Graded Activity, Manual
functional stability of the hip and might reduce the negative process Therapy. FUNDING ACKNOWLEDGEMENTS: ZonMW Pain-2 grant
of osteoarthritis. IMPLICATIONS: Based on these results we suggest 940-31-060. CONTACT: [email protected]
that physical therapy would be useful for patients after surgical hip ETHICS COMMITTEE: VU university ethical committee
THE RELATIONSHIP OF KNOWLEDGE TO PREVALENCE OF INFLUENCE OF FOOT POSITION AND HIP ADDUCTION ON
OSTEOPOROSIS, FALL AND FRACTURE RISK FACTORS IN MUSCLE EMG ACTIVITY OF THE LOWER EXTREMITY DURING
COMMUNITY DWELLING ELDERS A WALL SQUAT
Burke-Doe A1,3 , Hudson A2 , Werth-Allen H4,5 ; 1 Assistant Professor Jeno S, Relling D, Romanick M, Mabey R, Eken J, Jesperson A,
Department of Physical Therapy, California State University, Sletten H, Mohr T; Department of Physical Therapy, University
Fresno; 2 Assistant Professor Department of Nursing, California of North Dakota School of Medicine and Health Sciences, Grand
State University, Fresno; 3 Fellow Central California Healthy Aging Forks, USA
Institute, Fresno, California; 4 Physical Therapist Kaiser Hospital PURPOSE: The purpose of this study was to determine the influence
Vallejo, California; 5 Fellow Kaiser Permanente Vallejo Physical of foot position and contraction of the hip adductors on EMG
Orthopaedic Manual Therapy & Musculoskeletal Primary Care activity in muscles of the lower extremity during a wall squat.
RELEVANCE: Clinically, many different techniques are utilized to
PURPOSE: Many seniors are unaware of osteoporosis risk factors increase recruitment of the vastus medialis oblique (VMO) for
despite available information and public awareness programs on patients with lower extremity dysfunction, specifically patellofemoral
prevention and treatment. The purpose of this study was to pain or dysfunction. The wall squat is a common exercise utilized
identify the relationship of osteoporosis knowledge to prevalence early in the intervention progression for patellofemoral dysfunction
of risk factors for osteoporosis, fractures, and falls in an affluent and has been theorized to recruit the VMO. While an adduction
independent community-dwelling elderly population. RELEVANCE: contraction during a free standing squat demonstrates increased
Community based osteoporosis education and screening should be VMO activity, the influence of foot position and adductor contraction
comprehensive, personalized and provided by a healthcare team on recruitment of lower extremity musculature has not been fully
elucidated. PARTICIPANTS: Eleven healthy females (ages 22-24
that includes a physical therapist who is knowledgeable about
years) without history of knee or hip pathology voluntarily participated
osteoporosis in order for informed decisions about bone health to
in this IRB approved study. METHODS: Through the use of surface
be developed. PARTICIPANTS: The study assessed 49 community
electrodes, EMG activity was recorded for the adductor longus
dwelling seniors residing in an independent living community. Forty (AL), vastus lateralis (VL), VMO, biceps femoris (BF), gastrocnemius
one females, 8 males with ages ranging from 78-98 years and (GN), and tibialis anterior (TA) muscles of the subject’s dominant
a mean age of 84.4 years participated in the study. METHODS: leg (10 right, 1 left). Each subject performed a series of 3 wall
Forty-nine seniors completed a series of questionnaires and clinical squats to a depth of 45 degrees of knee flexion in each of 3
testing procedures to identify health history, osteoporosis knowledge, different randomized foot positions [neutral rotation, 30 degrees
balance confidence, general health, osteoporosis risk, fitness and internal rotation (IR), and 30 degrees external rotation (ER)] with and
activity levels, home safety, calcium and vitamin D intake and fall without a self-selected, submaximal isometric adduction contraction.
risk. ANALYSIS: All data analysis was conducted using SPSS ANALYSIS: MyoResearch® XP software (Noraxon Inc, Scottsdale,
version 11.0 for Windows (SPSS Inc. Chicago, Ill.) Participant AZ) was used to rectify, smooth (RMS 50), and normalize the EMG
demographic characteristics were summarized using conventional data. EMG activity in the experimental conditions was normalized
descriptive statistics. Bivariate correlations were performed to to a free standing squat. A repeated measures ANOVA was used
determine the relationship between osteoporosis knowledge and to compare the muscle activity in the 3 different foot positions
osteoporosis risk factors, as well as, physical activity and physical with and without the adduction contraction. Alpha equals 0.05 for
all analyses. RESULTS: Statistically significant differences were
performance measures. Spearman rho and Pearson’s correlation
observed in EMG activity between conditions for all muscle groups.
coefficients were calculated depending on the data (nominal, ordinal
LSD post hoc comparisons revealed EMG activity of the VMO and
or continuous). RESULTS: Participants had limited knowledge of VL was greatest during wall squats with hip adduction regardless
osteoporosis risk factors; with the average number of risk factors of foot position; BF and TA activity was greatest in ER with hip
present being 5.5 and only 57% of participants had previously adduction; AL activity was greatest in neutral with hip adduction; and
received bone density testing. Participants had limitations in agility, GN activity was greatest in IR with hip adduction. CONCLUSIONS:
balance, strength and flexibility in upper and lower extremities. The results of this study indicate that for healthy subjects, the
Inadequate calcium and vitamin D intake was identified with only 48% addition of a self-selected, submaximal isometric contraction of the
reporting calcium supplementation. Correlations were found between hip adductors augments the EMG activity of the muscles in the lower
osteoporosis knowledge and both balance efficacy (r = 0.294, P extremity during a wall squat activity. Specifically, the increased VMO
= 0.043) and fall risk (r = 0.472, P = 0.001). CONCLUSIONS: and VL activity with adduction may benefit rehabilitation programs
Despite an increase in effective identification and treatment for specific to patellofemoral dysfunction. Foot position affected the EMG
osteoporosis in the last decade, participants demonstrated gaps activity for BF, TA, and GN muscles. Further research is warranted
in knowledge of osteoporosis, perception of risk and limited risk employing this protocol with clients experiencing patellofemoral
reduction strategies. IMPLICATIONS: Physical therapy clinicians pain or dysfunction. IMPLICATIONS: Clinically, combining a wall
squat and submaximal hip adduction contraction augments muscle
should include intake questions in the areas of height, weight,
recruitment in the lower extremity. Specifically, VMO and VL activity
fall and fracture history, current medications and supplements and
can be increased by holding a ball between the knees. At the same
use specific functional fitness and balance measures to determine
time, increased recruitment of leg musculature during a wall squat
fall and fracture risk and to devise a comprehensive individualized activity suggests care must be exercised with clients rehabilitating
treatment plan. KEYWORDS: osteoporosis, knowledge, risk factor, foot or ankle dysfunction. KEYWORDS: biomechanics, wall squat,
prevention. FUNDING ACKNOWLEDGEMENTS: Funding for this EMG. FUNDING ACKNOWLEDGEMENTS: None.
research was sponsored by the Central California Center for Health ETHICS COMMITTEE: University of North Dakota Institutional
and Human Services, California State University, Fresno. CONTACT: Review Board – project #IRB-200603-289
[email protected]
ETHICS COMMITTEE: This study was approved by the Institutional
Review Board of California State University, Fresno which insured
protection of human subjects.
DIFFICULTIES ENCOUNTERED BY ADULTS WITH PARTIAL BODY WEIGHT SUPPORT TREADMILL TRAINING IN
DEVELOPMENTAL CO-ORDINATION DISORDER(D.C.D.) AND AN INDIVIDUAL WITH SPINO-CEREBELLAR ATAXIA: A PILOT
THEIR COPING STRATEGIES STUDY
Lee M, Yoxall S, Smith G; Lee Medical Practice, Denham, England Zucker-Levin A, Hatten M, Shrank A, Thompson K, Venczel J;
The University of Tennessee, Health Science Center
PURPOSE: The aim of this study was to determine whether
problems associated with D.C.D. persisted into adulthood and also PURPOSE: To determine the effectiveness of parital body weight
whether they became more manageable. The authors hoped to support treadmill training (PBWSTT) in an individual with spino-
determine what strategies had been identified as being useful to cerebellar ataxia (SCA), unknown type. RELEVANCE: SCA is a
overcome any difficulties that may have persisted. RELEVANCE: progressive disorder causing degeneration of the Cerebellum and
Whilst the awareness of physical co-ordination difficulties has been sometimes the spinal cord. Treatment is palliative including rehabili-
well documented, little appreciation has been given to the other, tiation to address functional impairments. The use of PBWSTT for
less obvious, aspects of D.C.D. These may include poor short- individuals with neurologic disorders is well documented suggesting
term memory, lack of self-confidence, reduced self-esteem, and that improvement of funtional performance is often attributed to
poor organisational and social skills. All ultimately impacting on “central pattern generator” activation at the spinal cord level. The
the activities of daily living. By gathering information on adult effects of PBWSTT for individuals with SCA is not reported in the
perspectives the study could help to ensure that therapy programmes literature. PARTICIPANTS: A single 57 year old female with an
for children do not focus purely on physical aspects but address the 8 year history of SCA. She was independent for all ADL/IADL’s
other areas highlighted above. Coping strategies for all environments with the use of a rolling walker. Meds: Tizanidine, 2mg Qd.
could then be facilitated earlier. PARTICIPANTS: 186 questionnaires This study was approved by the Institutional Review Board of
were sent to the parents and relatives of children receiving the University of Tennessee, Health Science Center and informed
physiotherapy treatment for D.C.D at one clinic. METHODS: This was consent was obtained prior to testing. METHODS: Single subject
a qualitative design questionnaire based study looking to determine time series case design (O1,X,O2,O3). Initial baseline performance
which of the respondents indicated a familial predisposition to D.C.D. (O1) was established, re-evaluation after 6 weeks of intervention
ANALYSIS: Responses were analysed using Microsoft Office Excel (O2) and then again 6 weeks after treatment was discontinued (O3).
2003 spreadsheet RESULTS: A total of 107 (58%) questionnaires Dependent variables included: Temporo-spatial gait parameters of
were returned. Of these 50 (46%) indicated a familial pre-disposition step length and walking velocity measured by the GAITRite™ system
to D.C.D. giving a participant group of 50 for analysis. Of this: (GAITRite™ Gold, CIR Systems, PA, USA), The Berg Balance
* Ten (20%) reported co-morbidity of dyslexia and D.C.D. * Forty Scale (BBS), timed 25 foot walk, and the Paced Auditiory Serial
(80%) reported a detrimental impact on school life. This was related Addition Test (PASAT). The Biodex Offset Unweighing System and
to a poor ability to focus and concentrate; poor memory; poor Rehabilitation Treadmill 600 (Biodex Medical Systems, Inc, NY, USA)
handwriting; poor ability to read and spell; poor self-confidence and was used to unweigh the participant during the intervention phase
self-esteem and difficulty with completing tasks. * Twenty four (48%) of the study. PBWSTT was performed TIW for 6 weeks with the
reported that their difficulties had an impact on their willingness participant walking a maximum of 3 walks per session. Body weight
or ability to participate in sports. * Twenty six (52%) reported that support (BWS) started at 30% and treadmill speed was set to
they do not participate in regular sporting activities as adults. * participants comfort. Alteration of walking speed and modification of
Twenty three (46%) reported an adverse effect on their ability to BWS was based on observational gait analysis of the participants gait
socialise. * Twenty four (48%) reported difficulties continuing to quality. Session duration was determined by participant endurance
impact into adulthood. * Twenty two (44%) had developed coping with a maximum of 20 minutes per walk allowing a 5 minute rest
strategies which included: Using a computer; Listing jobs; Having break between walks. ANALYSIS: Single subject analyses and
assistance of another adult; Carefully preparing for new situations; pre/posttest analyses were conducted on all data. O1 to 02, 02 to
Practising specific skills. CONCLUSIONS: The study confirmed that 03 and 01 to 03 comparisons were made using the C-statistic for
problems with D.C.D. do persist into adulthood. Participants within single subject design. RESULTS: Total distance, average velocity,
the study reported continued difficulties with short-term memory, and total time while walking on the treadmill significantly increased
social and organisational skills, time management, concentration, (p < 0.05) from pre to post treatment (O1-O2). Walking velocity
handwriting speed and self-confidence IMPLICATIONS: The study overground decreased as did step length from pre to post treatment
highlighted the difficulties associated with D.C.D. in adulthood. (O1-O2) and then returned to pre-treatment (O1)numbers after 6
Consequently treatment programmes for children with D.C.D should weeks “off” treatment (O2 -O3). BBS improved 01-02 and was
encompass strategies to cope with difficulties beyond the purely maintained from O2-O3; 25’ walk time and PASAT did not significantly
physical. This will encourage children with D.C.D. to develop change. CONCLUSIONS: PBWSTT improved performance while
ways to cope with any persisting areas of weakness, which may walking on the treadmill and on the BBS. Post intervention (O2) step
continue to impact on their daily life in adulthood. KEYWORDS: length and walking velocity decreased when walking overground;
D.C.D., adulthood, strategies. FUNDING ACKNOWLEDGEMENTS: however, this decrease was not maintained 6 weeks “off” training.
Equazen 31 St Petersburgh Place, London W2 4LA, England. The researchers hypothesize that this decrease in walking speed
CONTACT: [email protected] and step length was due to better control when walking. This pilot
study indicates PBWSTT should be studied in individuals with SCA
using a greater sample size and a greater duration of treatment
time. IMPLICATIONS: PBWSTT may improve gait and balance
in individuals with SCA. KEYWORDS: Spino-Cerebellar ataxia,
gait. FUNDING ACKNOWLEDGEMENTS: University of Tennessee,
Health Science Center Department of Physical Therapy. CONTACT:
[email protected]
ETHICS COMMITTEE: The University of Tennessee, Health Science
Center Internal Review Board
THE EFFECT OF A WALKING AID ON GAIT IN NON-AMBULANT INFLUENCES OF WALKING SPEED ON DYNAMIC FOOT
PEOPLE AFTER STROKE PRESSURE AND CENTER-OF-PRESSURE (COP) PATTERNS IN
Tyson S1 , Rogerson L2 ; 1 Centre for Rehabilitation and Human HEMIPLEGIC PATIENTS FOLLOWING STROKE: A PRELIMINARY
Performance Research, University of Salford, Salford UK; 2 South STUDY
Manchester PCT, Manchester UK Lin S1 , Tang P1 , Chen S; 1 School and Graduate Institute of
Physical Therapy, College of Medicine, National Taiwan University,
PURPOSE: To assess the effect of a walking aid on gait impairments
Taiwan (R.O.C.)
(speed, and affected step length), walking disability and patient
satisfaction in non-ambulant people with stroke who were under- PURPOSE: The purpose of this study was to investigate how walking
going rehabilitation RELEVANCE: More than two-thirds of people speed affect the dynamic foot pressure and COP patterns of both
with stroke who are able to walk use a walking aid. However the lower extremities in hemiplegic patients after stroke. RELEVANCE:
use of walking aids, particularly during rehabilitation is controversial. This investigation advances the understanding of the relationship
This is because some physiotherapists, particularly those following a between gait speed and foot dynamics in hemiplegic stroke.
‘traditional’ Bobath approach (also called the Neuro- Developmental PARTICIPANTS: Seven hemiplegic patients with mild-to-moderate
Theory) believe that using a walking aid can have a detrimental stroke (mean age=56.7±12.5 years old, post-stroke time=10.3±7.9
effect on hemiplegic gait. We aimed to test this clinical belief. months) participated in this study. METHODS: Each subject walked
PARTICIPANTS: 20 people with a hemiplegia following a 1st-time along a 6-m-long walkway at three different self-perceived walking
stroke were recruited from the stroke rehabilitation units of four speeds- the slow, comfortable, and fast speeds. Dynamic foot
NHS Trusts (UK). They were all receiving physiotherapy to restore pressure data included the gait cycle time, normalized loading
walking. They were unable to walk in every-day life but were time, normalized force impulse, and average force in the whole-
able to walk 5m with stand-by assistance during physiotherapy. foot and three specific-foot regions (heel, mid-foot, and forefoot
Their mean age was 65.6 years (sd = 10.3 yrs), mean time regions). COP data, including COP excursion (COPEx ), COP A-P
since stroke was 6.45 weeks (sd = 5.7 weeks), 14 (72%) had velocity (COPAPV ), and COP trajectory smoothness index (COPSI =
a left hemiplegia. METHODS: A same-subject randomised cross- COPEx /COP displacement), were also analyzed. Dynamic foot
over design was used in which participants walked with a walking pressure and COP data were collected by using the Pedar in-shoe
stick (or cane) and no aid (the control condition) in a randomised measurement system (Novel gmbh, Munich, Germany). Walking
order. The following measures were taken; gait speed and affected speed was determined by the GaitMatII system (E.Q. Inc., USA).
step length (10m walk test) walking disability (Functional Ambulation ANALYSIS: A one-way repeated measures (RM) ANOVA was
Category, FAC) and participant satisfaction (questionnaire) in a one- performed to determine differences among the three walking speeds.
off session; the participant having been fitted with the walking aid The 3 (Speed) by 2 (Limb) two-way RM ANOVAs were used to
and given an opportunity to practice earlier in the day. ANALYSIS: compare the effects of walking speed and lower extremity on the
Wilcoxson Signed Rank Tests RESULTS: There was a significant dynamic foot pressure and COP parameters. RESULTS: Walking
improvement in walking disability when walking with the aid (FAC= speeds of the fast- (1.02±.34m/s), comfortable- (.68±.04m/s), and
1.8 (sd=0.51) vs 1.1 (sd=0.3) without and aid (p = 0.000)), but slow-speed (.45±.01m/s) conditions were significantly different from
the walking aid had no effect on the gait impairments. Mean each other (p < 0.001). As the walking speed increased, gait cycle
speed with an aid was 0.28 m/s (sd=0.15); without an aid it was time (p < 0.001) and normalized loading time (p < 0.001) significantly
0.3m/s (sd= 0.14) (p = 0.143). Mean step length on the affected shortened, regardless of the extremities. For both lower extremities,
leg was 0.53m (sd=0.16) with an aid; without an aid it was 0.51m normalized force impulse of the forefoot region (p = 0.014), average
(sd=1.7) (p = 0.726). Participants were positive about the aid; 45- force of the whole foot and the forefoot regions (p = 0.011 and
65% (n=9-13) felt it improved different aspects of their gait, 80% 0.013), and COPAPV (p = 0.016), were significantly greater while
(n=18) found the appearance acceptable, 70% (n=14) would choose walking fast compared to walking comfortably. Significantly longer
to walk with an aid now (in every-day life) rather than delay COPEx in the slow-speed walking, compared with comfortable-
walking until a better quality gait pattern without an aid had been speed walking, was observed in the affected (p = 0.013), but not
achieved. CONCLUSIONS: A walking aid can have a significantly the unaffected, lower extremity. COPSI was significantly greater in
beneficial effect on walking disability but not gait impairments in the slow-speed walking than comfortable-speed walking (p = 0.011),
non-ambulant people with stroke and patients feel positive about indicating the greater COP curvature was observed in slow speed
using it. IMPLICATIONS: The clinical belief that using a walking walking. CONCLUSIONS: Patients with mild-to-moderate stroke
aid can have a detrimental effect on hemiplegic gait in people were able to adopt different walking speeds volitionally. Such gait-
used-going rehabilitation to restore walking has not been supported. speed adaptability was accompanied by changes in their dynamic
To the contrary, the use of a walking had a beneficial effect on foot pressure and COP patterns of both unaffected and affected
functional mobility (walking disability). KEYWORDS: Stroke, walking, lower extremities. The ability of these patients to generate greater
walking aids, physiotherapy. FUNDING ACKNOWLEDGEMENTS: force, especially in the forefoot region of both lower extremities,
Physiotherapy Dept of North Manchester Hospital, Pennine Acute appears to be associated with their ability to walk fast. Compared
NHS Trust, Association of Chartered Physiotherapists in Neurology, to the other two speeds, slow-speed walking poses a greater
Physiotherapy Research Society, Halo Healthcare Ltd, Medistox Ltd. direction control challenge on these patients, as revealed by
CONTACT: [email protected] the greater COP smoothness index. IMPLICATIONS: Adopting
ETHICS COMMITTEE: North Manchester Local Research Ethics different walking speeds alters the foot dynamics and difficulty of
Committee direction control of the forward progression in hemiplegic patients
following stroke. KEYWORDS: Stroke, Foot pressure, Walking speed.
FUNDING ACKNOWLEDGEMENTS: National Science Council,
Taiwan (R.O.C.). CONTACT: [email protected]
ETHICS COMMITTEE: NTUH 90-06098
A FOLLOW-UP OF TWO DIFFERENT PHYSICAL THERAPY PREVALENCE OF THE COMPONENTS OF METABOLIC
REGIMES ON PARTICIPATION AND ACTIVITY ACCORDING TO SYNDROME IN PATIENTS PARTICIPATING IN STROKE
ICF. A RANDOMISED CONTROLLED TRIAL REHABILITATION
Langhammer B1 , Lindmark B2 , Stanghelle J3 ; 1 Oslo University MacDonald C1 , MacKay-Lyons M1,2 ; 1 Capital District Health
College, Faculty of Health, Physiotherapy Programme, Norway; Authority; 2 Dalhousie University
2 Uppsala University, Institution of Neurosciences,Physiotherapy
Programme, Sweden; 3 Sunnaas Rehabilitation Hospital, PURPOSE: To document the prevalence of the components of
Nesoddtangen, Norway metabolic syndrome(MetS) in individuals participating in stroke
rehabilitation. RELEVANCE: MetS is comprised of a constellation
PURPOSE: Our main objective in this study was to evaluate two of risk factors for cerebrovascular and cardiovascular disease. The
different exercise approaches during the first 12 months post stroke, National Cholesterol Education Program(NCEP) defines MetS as
and to study the possible effects of these two regimes on I-ADL, the the presence of 3 or more of the following: fasting plasma glucose
6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Timed Up >6.1 mmol/l, triglycerides >1.7 mmol/l, high density lipoproteins (HDL)
and Go (TUG), grip strength and Modified Ashworth Scale (MAS). <1.0 mmol/l in males and <1.3 mmol/l in females, blood pressure
A second objective was to find out to what extent parameters such >130/85 mmHg and/or medication, waist circumference >102 cm in
as gait performance, postural control, grip strength and muscle tone males, 88 cm in females. While the prevalence of MetS in the general
could be considered explanatory factors of I-ADL 3 months and 12 population is known to be approximately 23.7%, its prevalence in
months post stroke. RELEVANCE: The study evaluates effects of the stroke population has not been well documented. Because of
two different exercise approaches in the post stroke period which is the role that exercise plays in moderating the components of MetS,
highly relevant for physiotherapy practice. PARTICIPANTS: A double- prevalence figures are of particular clinical relevance for the subgroup
blind longitudinal randomised trial of first-time-ever stroke patients. of patients post-stroke who are involved in physical rehabilitation
Seventy-five patients were included: 35 in an intervention group (IG) (25-30% of the total stroke population). PARTICIPANTS: A review
and 40 in a regular training group (RG). After discharge from acute was conducted of the health records of 156 patients (81 males, 75
rehabilitation, patients allocated in IG had regular physiotherapy for females: 66 ±12.8 years of age) who participated in an in-patient
a minimum amount of 80 hours during the first year. Patients in stroke rehabilitation program. METHODS: The presence of the
RG were not recommended any specific therapy besides treatment components of MetS in patients participating in stroke rehabilitation
when needed. METHODS: Information on I-ADL, 6- Minute Walk was recorded. Variables included resting blood pressure, presence
of anti-hypertensive medications, body mass index(BMI), triglyceride
Test (6MWT), Berg Balance Scale (BBS), Timed Up and Go (TUG),
and HDL levels, albumin, presence of diabetes mellitus(DM)
grip strength (Martin Vigorimeter), Modified Ashworth Scale (MAS),
and fasting blood glucose level. In addition sex, age, cardiac
and pulse monitoring during activities. ANALYSIS: A two- way
history, smoking history, stroke location, time post-stroke, Locomotor
analysis of variance (ANOVA) was used for 6MWT and TUG, and
Functional Independence Measure, # of co-morbidities and # of
the Friedman two-way analysis of variance by rank for I-ADL by
medications were recorded. ANALYSIS: Descriptive statistics (i.e.
Fillenbaum, BBS and MAS. The significance level was set at p < 0.05.
means, standard deviations and percentages) were calculated for all
Spearman rank correlation coefficients were calculated to search
variables. RESULTS: 52 (33%) of the sample were hypertensive,
for the associations between I-ADL by Fillenbaum and other tests.
132 (84%) were either hypertensive or on hypertension medications,
A stepwise linear regression analysis was performed in the two
99 (63%) had decreased HDL, 53 (34%) had elevated triglycerides,
groups, with the scores I-ADL 2 and I-ADL 7 entered as dependent
47 (30%) had DM, 44 (28%) had elevated fasting blood glucose
factors, and total scores for 6 MWT, BBS, TUG, grip strength and
levels and 20 (13%) had a BMI >30 kg/m2 . 48 (30.6%) met the
MAS entered as independent factors on two different occasions:
NCEP criteria for MetS; 29 females and 20 males with a mean
at 3 months and at 12 months. The significance level was set at age of 67.5 years (±9.98) and an average time post-stroke of 7.8
p < 0.05. RESULTS: One year post stroke both groups showed higher weeks (±7.5). 84% of those with MetS were hypertensive or on anti-
participation in all items of I-ADL and improved 6MWT, BBS scores, hypertensive medications. Within the group of those with MetS, mean
TUG and grip strength. At 3, 6 and 12 months of follow-up there value for BMI was 28.6kg/m2 (±6.0), mean triglyceride level was
were significant differences in favour of RG. 6MWT and BBS showed 2.5mmol/l (±2.1), HDL mean was 0.87mmol/l (±0.21) and fasting
significant associations with the different I-ADL items; TUG displayed blood glucose mean was 6.8mmol/l (±2.25). CONCLUSIONS: The
moderate correlations to some of the I-ADL items. Grip strengths prevalence of MetS in patients participating in a stroke rehabilitation
were moderately associated with I-ADL items. CONCLUSIONS: I- program was substantially higher than in the general population.
ADL, gait, balance and grip strength improved to similar degrees Moreover, the vast majority of this patient population had one or more
in both IG and RG. The test occasions themselves were probably of the components of the syndrome. A limitation of the study is that
strong motivators for training, irrespective of group allocation. This only patients participating in post-stroke rehabilitation were reviewed.
indicates the importance of regular follow-up in the motivation for 70-75% of the total stroke population do not participate in stroke
regular exercise post stroke. IMPLICATIONS: Patients with stroke physical rehabiliation, therefore; further study may be warrented in
cannot attain the level of function of healthy counterparts, and it is examining the prevalence of MetS in this subgroup. IMPLICATIONS:
therefore urgent that supportive services from the community are These findings underline the critical need for physiotherapists to
provided, as well as regular exercise opportunities. The possibilities educate patients participating in stroke rehabilitation that lifestyle
for adapted physical activities and supportive services need to be modifications (i.e., daily physical activity and proper nutrition)
strengthened and made varied and flexible, so that the services play a key role in secondary prevention of cerebrovascular and
can meet the requirements of stroke patients. KEYWORDS: I-ADL, cardiovascular disease. KEYWORDS: Stroke; Metabolic syndrome;
6MWT, BBS, grip strength, tonus, post-stroke exercise, long-term Cardiovascular risk factors. FUNDING ACKNOWLEDGEMENTS:
follow-up. FUNDING ACKNOWLEDGEMENTS: No extra funding. The work was unfunded. CONTACT: [email protected]
CONTACT: [email protected] ETHICS COMMITTEE: Capital Health Research Ethics Board
VALIDITY OF A VIRTUAL REALITY ENVIRONMENT FOR MOTOR DOES CLOSED KINETIC CHAIN ACTIVITY IMPROVE HAND
LEARNING IN STROKE FUNCTION IN PATIENTS WITH STROKE? A RANDOMIZED,
DOUBLE-BLINDED, CONTROLLED STUDY
Knaut L1,3 , Subramanian S2,3 , Henderson A3,4 , Levin M2,3 ; 1 School
of Rehabilitation, University of Montreal; 2 School of Physical & Alattas A1 , Sabbahi M2 , Roddey T2 , Hamilton M2 , Olson S2 ,
Occupational Therapy, McGill University; 3 Jewish Rehabilitation Alnaser M2 ; 1 King Faisal Specialist Hospital & Research Center,
Hospital site of CRIR; 4 Department of Neurology and Neurosurgery, Riyadh, Saudi Arabia; 2 Texas Woman’s University
McGill University
PURPOSE: Clinicians utilize closed kinetic chain (CKC) activities
PURPOSE: Our goal was to study the validity of making pointing in stroke rehabilitation to enhance recovery, increase function of
movements in a virtual reality environment (VE) created to optimize the hand, decrease muscular tone, and facilitate activation of weak
motor learning after stroke. Performance outcomes (precision, speed, muscles. However, there is no published study that has evaluated
and smoothness) and behavioral measures (arm movement patterns) the effect of the CKC activity over an extended time period using
of pointing movements made by patients with hemiparesis made electrophysiological tests, motor capacity, or functional status of the
in a VE were compared to those made in a physical environment upper extremity. The aim of this study was to evaluate the effect of a
(PE – “real-world”). RELEVANCE: Interventions done in VE may four-week, CKC home training program on the reflexive, volitional,
be effective in diminishing sensorimotor impairments in patients and functional levels of upper extremity capability for moderate-
with stroke. This new approach allows therapists to incorporate level stroke patients. The moderate-level was defined as obtaining
important elements of motor retraining that induce experience- a score between 10 and 18 out of 56 in the Fugl-Meyer score of
dependent plasticity such as: task-specificity, repetition intensity, the upper extremity section. RELEVANCE: Evidence-based support
feedback and motivation. However, it is unknown if people execute of common treatment procedures is needed stroke rehabilitation.
movements in VEs similarly to those performed in PEs and if this PARTICIPANTS: Eleven subjects at least 1-year post-stroke (4
is a necessary element for training gains to be transferred to the females and 7 males), mean age of 66 years (±10.3), and of any
“real-world”. PARTICIPANTS: Adults with chronic hemiparesis due ethnicity participated as a sample of convenience from a local stroke
to stroke and Chedoke-McMaster Arm Scores ranging from 3-6 out support group in the study. Inclusion Criteria: normal or impaired
of 7, indicating moderate to severe motor impairment, were recruited sensation to light touch or pinprick, passive wrist extension of 40º,
from 3 establishments associated with the Centre for Interdisciplinary a score of 24 on the Mini-Mental State Examination (MMSE),
Research in Rehabilitation of Montreal (CRIR). Healthy age-matched had a stroke involving the middle cerebral artery as confirmed by
magnetic resonance imaging (MRI) or computerized tomography
subjects were also recruited. METHODS: Subjects were asked to
(CT) report. METHODS: Using a double-blinded, placebo-controlled,
point as quickly and as accurately as possible to 6 targets (12
randomized design, subjects were placed either in treatment or
trials/target, randomized) placed in different areas of the sagittal
control groups. The treatment group (4 subjects) performed one
ipsilateral and contralateral 3D workspace. Movement to each target
minute of weight bearing on the palm of the hand with full elbow
had different levels of difficulty and required different arm movement
extension for five repetitions, using 10% of her/his body weight,
patterns. In the PE, the targets consisted of 6 x 6 cm squares
three times per day. The control group performed bilateral shoulder
placed at 2 heights at arm’s length. In the VE, the size and location
flexion exercises with unimpaired arm assisting the impaired arm 30
of the targets were identical to those in the PE but they were
times per session, 3 sessions per day. Four dependent variables
viewed in a fully immersive and interactive environment via a head-
were collected in a random sequence before and after one month of
mounted display. Arm and trunk kinematics were recorded in both
the treatment. The dependent variables included flexor carpi radialis
environments with an Optotrak Motion Analysis System (6 markers,
(FCR) Hoffman reflex (H-reflex), surface electromyography (SEMG)
100 Hz, 5 s). ANALYSIS: The values obtained were analyzed with
from extensor indices and FCR muscles, Klein-Bell Activities of Daily
SPSS 10.0 for Windows. Two-way ANOVAs with repeated measures Living (ADL) scale score, and Upper Extremity Fugl-Meyer scale
and factors “environment” (physical vs. virtual) and “group” (healthy score. The peak-to-peak amplitude of the FCR H-reflex was recorded
vs. stroke subjects) were used to evaluate the relationship between from the impaired arm while bearing weight on the palm at 10%
those variables. Minimal significance level was p < 0.05. RESULTS: of body weight. Sixteen traces were collected during four trials (4
Pointing in VEs and PEs was similar in terms of movement patterns traces / trial). SEMG was recorded during the CKC activity. Four
in both healthy subjects and in patients with stroke. Furthermore, traces were collected during four trials (one trace/ trial) from both
arm kinematics were related to the severity of stroke impairment. muscles. ANALYSIS: Two analyses of covariance (with pre-test as
Overall, participants rated the activity in VE as being more engaging the covariate) were conducted for the FCR H-reflex and the SEMG
and motivating than moving in the PE. CONCLUSIONS: For most data. Two Mann-Whitney U tests were conducted for the Fugl-Meyer
patients with stroke, movements made in VE are similar to those scale score and Klein-Bell ADL score. Alpha was set at 0.0125 for
made in PE. The question of whether this is a necessary feature each of the four tests. RESULTS: No statistically significant difference
for motor gains to be transferred to real-world activities needs to was found in the four tests after the intervention with p value of 0.053
be addressed. IMPLICATIONS: Movement training performed in for H-reflex, 0.075 for the EMG, 0.042 for Klein-Bell ADL scale, and
fully immersive virtual environments may be a means by which to 0.11 for the Fugl-Meyer scale. CONCLUSIONS: The CKC activity did
introduce more motivating and challenging training environments into not show significant effect measured by the four dependent variables
rehabilitation programs aimed at maximizing motor recovery of the although data show a trend toward improvement in the treatment
paretic arm in patients with stroke. KEYWORDS: Arm movement, group. IMPLICATIONS: More research needed KEYWORDS: Closed
hemiparesis, and exercise. FUNDING ACKNOWLEDGEMENTS: Kinetic Chain, electrophysiological test, stroke, functional tests, motor
This study was supported by Canadian Institutes of Health Research functional test. FUNDING ACKNOWLEDGEMENTS: A scholarship
(CIHR) and Canadian Foundation for Innovation (CFI). CONTACT: from King Faisal Specialist Hosptial and Research Center, Riayadh,
[email protected] Saudi Arabia. CONTACT: [email protected]
ETHICS COMMITTEE: Centre for Interdisciplinary Research in ETHICS COMMITTEE: INSTITUTIONAL REVIEW BOARD at Texas
Rehabilitation of Montreal (CRIR) Woman’s Unviersity, Houston, TX, USA.
Research Report Poster Display <60 years (yr) of age have similarly been indicated. On the other
26-13 Tuesday 5 June 14:00 hand, males are more susceptible to mental fatigue than females
VCEC Exhibit Hall B & C among white-collar workers. Furthermore, although higher self-rated
PASSIVE SITTING VS. ACTIVE SITTING IN A ROCKING CHAIR unhealthy risk prevails in males of>60 yr of age, studies on the
Väänänen I; Lahti University of Applied Sciences, Innovation relationship between self-rated health and exercise performance
Centre, Lahti, FINLAND have not been attempted. The present study elucidated to analyze
the relationship between self-rated health and the actual exercise
PURPOSE: The purpose of this study was to research and develop performance status in retired males. RELEVANCE: Self-rated health
rocking chair as an auxiliary aid furniture for older people‘s reha- not only affects life expectancy such as mean life expectancy, but
bilitation. RELEVANCE: Physical inactivity is a common problem. also serves as a useful health index. This study demonstrated
Yesterday‘s playing human (Homo ludens) is now sitting human the necessary support of physical therapy related with the habit
(Homo sedens). It is accepted that regular physical activity promotes of continuous exercise in contribution to enhancement of self-rated
health and the ability to function and work. The therapeutic qualities health in male retirees. PARTICIPANTS: The subjects were 654 male
of the rocking chair have been studied. Furthermore, an adapted retirees (>55 yr of age) who had retired from Japanese corporations
version has been developed from an ordinary rocking chair for use in within the past 3 yr. Of these subjects, 552 were in the middle-age
rehabilitation, but the benefits of the rocking in a rocking chair are not group with age <65 (mean age: 60.9±1.6) yr, while the remaining 102
known. PARTICIPANTS: To the first and second part of this study par- were in the elderly group with age>65 (66.4±1.6) yr. METHODS: The
ticipated eight male subjects (77±3 y). In the third part of this study study was conducted via the mail system. Performance of exercise
nine female subjects (78±7 y) rocked 30 minutes and sat 30 minutes was evaluated with a 2-stage assessment system by asking the
in an office chair separate days. METHODS: In the first part the subject if he was “performing” or “not performing” exercise/sports
electromyographic muscle activity (EMG) level of m rectus abdominis at the time of the study. In monitoring the actual status of exercise
while rocking in a rocking chair was quantified. The EMG activities performance, the increase and decrease of performance frequency
while rocking were compared with the EMG level during maximal of exercise/sports was compared with the status before retirement,
voluntary isometric contraction. In the secondly part, the training using a 5-stage assessments scoring system. Based on a 4-stage
effects of the six weeks rocking chair training to m rectus abdominalis evaluation system, self-rated health was scored according to the
compared to the traditional resistance strength training with elderly self-rating health assessment method of Haga et al. ANALYSIS:
men were clarified. Subjects rock daily 30 minutes in a rocking chair, By homogeneity analysis, the category of each assessment index
and controls had resistance strength training twice a week. Sit-up test was scored and distributed on 2-dimensional coordinates, and
was used to evaluate the training effects. In the third part the changes the position relationships of the middle-age and elderly groups
of the volume of the lower extremity after 30 minutes rocking in a with the respective categories were compared. RESULTS: Based
traditional rocking chair and sitting in an upright chair with armrests on the results of homogeneity analysis, scores of the respective
were compared. The volume measurement of one leg was done be- quantified categories were plotted, and categories with position-
fore and after. ANALYSIS: The differences between the groups were proximity correlation included “performing”, “increased”, “unchanged”,
evaluated with t-test. RESULTS: The EMG activity during rocking was “very healthy” and “just healthy” in the middle-age group. As for the
5% of the maximum EMG level. The rocking chair group increased elderly group, the categories were “performing”, “decreased”, “just
their sit-up test repetitions by 44% (P = 0.054) and the strength healthy” and “not healthy”. CONCLUSIONS: In the middle-age group,
training group by 29% (P = 0.25). After the rocking the volume of the the performance frequency of exercise/sports in current exercise-
lower extremity decreased 34 ml and after sitting on an office chair it performers was either increased or unchanged compared with the
increased 161 ml (P = 0.047). CONCLUSIONS: The first part of this status before retirement; a tendency of excellent self-rated health
study showed that rocking in a rocking chair activates the m rectus was indicated. On the other hand, the performance frequency of
abdominis, and therefore rocking in a rocking chair could be used as exercise/sports in current exercise-performers of the elderly group
a training method for neuro-muscular activation in rehabilitation with indicated a mixed outcome; a tendency with good and poor self-
elderly men. The significant training effect to the abdominal muscles rated health. IMPLICATIONS: Less than half of the Japanese
remained open because the preliminary character (small number of population harbor excellent self-rated health. The findings in this
the subjects) of the second part of this study. The third part of the study demonstrated that the middle-age male retirees performed or
study showed that rocking in a rocking chair could protect the swelling continued to perform exercise/sport at the same or greater frequency
of the lower extremities instead of sitting in an upright chair with arm- compared with the status before retirement, probably contributing to
rests. IMPLICATIONS: These results indicate that rocking chair could excellent self-rated health. Accordingly, educational activities from the
be used as a training method for neuro-muscular activation in reha- aspect of physical therapy related to the habit of continuous exercise
bilitation and active sitting method in prevention of the oedema of the are considered necessary. KEYWORDS: male retirees, self-rated
lower extremities in cases of inactive elderly to put into practice with- health, exercise. FUNDING ACKNOWLEDGEMENTS: This study
out expensive equipments and staff in home. KEYWORDS: Rocking was supported by grants from the Health Promotion Service for the
chair, sitting, eldery people. FUNDING ACKNOWLEDGEMENTS: Elderly, Ministry of Health, Japan (2000).
Finnish Furniture Foundation, Eimi Kaluste Padasjoki FINLAND. ETHICS COMMITTEE: The service funds granted by Ministry of
CONTACT: ilkka.vaananen@lamk.fi Health, and the Committee of Health Promotion and Definite Aim
ETHICS COMMITTEE: The ethical committee of the Social and in Life.
Health Services department of the City of Lahti, Finland

EFFECTS OF EXERCISE ON SELF-RATED HEALTH IN RETIRED
MEN IN JAPAN
Morita H, Sato H; Department of Physical Therapy, Aomori
University of Health and Welfare, Aomori, Japan
PURPOSE: It is known that the exercise performance status
influences self-rated health, and findings on middle-age males of
SAFETY VERSUS PRIVACY – ELDERLY PERSONS’ COULD THE KINESIO TAPING REPLACE THE BANDAGE
EXPERIENCES OF A MOBILE SAFETY ALARM IN THE DECONGESTIVE LYMPHATIC THERAPY FOR
Melander Wikman A1 , Fältholm Y2 , Gard G3 ; 1 Luleå University POSTMASTECTOMY LYMPHEDEMA?
of Technology, Department of Health Science, SE-971 87 Luleå, Tsai H1 , Hung H2 , Tsauo J2 ; 1 Department of Rehabilitation,
Sweden. Phone +46 920 49 34 58 Fax. +46 920 49 38 50 e-mail: National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan;
[email protected]; 2 Luleå University of Technology, 2 School and Graduate Institute of Physical Therapy, College of
Department of Work Science, Luleå, Sweden; 3 Luleå University Medicine, National Taiwan University, Taipei, Taiwan
of Technology, Department of Health Science, Luleå, Sweden
PURPOSE: Decongestive lymphatic therapy (DLT) is a common
PURPOSE: The purpose was to develop and test mobile information management for lymphedema. Patients have poor compliance in
and communication technology (mICT), in the form of a mobile using short-stretch bandage and compression garment due to the
safety alarm, and to explore how this mobile safety alarm was humid climate in Taiwan. Applying Kinesio-tape (K-tape) becomes
experienced from an empowerment perspective. RELEVANCE: a new choice in the field of physical therapy. The inventor Dr.
Future demographic development means an increased elderly Kase claimed that the K-tape can improve circulation and remove
population in Sweden. One of the greatest challenges for a society congestion. However, there is insufficient evidence to show the
with an ageing population is to provide high-quality health and social clinical effects of K-tape. The purpose of this study is to investigate
care. Many elderly people stay active and healthy at higher ages; the treatment effects of traditional decongestive lymphatic therapy
however, an increased mean age does not always mean increased and modified decongestive lymphatic therapy which replace bandage
health. The demographic development is often described as a huge with K-tape and compare the treatment effects between these
problem but there is also an approach where “the elderly boom”, two treatments. RELEVANCE: This study provides information
seen as a cluster, also can be seen as an opportunity for growth. New about clinical management of lymphedema. PARTICIPANTS: Forty-
information and communication technology (ICT) and services aiming one women with unilateral breast-cancer-elated lymphedema who
at the improvement of the health, comfort and safety of elderly people have suffered lymphedema for at least 3 months were recruited
are being developed and tested. From research it is well known that in this study. METHODS: All subjects were randomized to DLT
dimensions of empowerment have an impact on preserving health; group (bandage group) or modified DLT group (taping group) and
and it is also important for the individual to feel safe. In order to enable evaluated for 3 times, before and after 4-weeks of control period
elderly people to stay at home as long as possible, various kinds and after intervention period by a physical therapist blinded to
of assisted technology are often used: safety alarms are common the randomization. The evaluation items included physical therapy
and are used by elderly people and also by those with functional assessment, the severity of swelling, water composition of the
limitations. PARTICIPANTS: The participants that tested the mobile upper extremity, severity of fibrosis, lymphedema related symptoms,
safety alarm were five elderly people with functional limitation (for the upper extremity function and quality of life. Subjects in each
example, after a stroke) and four healthy elderly people from a group received treatments including skin care, 30-minute manual
pensioners’ organisation. METHODS: The methodology used was lymphatic drainage, 1-hour pneumatic compression therapy and 20-
an intervention with a mobile alarm containing a drop sensor and a minute exercise during the intervention period. Otherwise, subjects in
positioning device, as well as qualitative interviews with the research bandage group received additional bandage treatment and subjects
persons. ANALYSIS: In order to analyse the results, qualitative in taping group received additional K-tape treatment. Each group
content analysis was used. RESULTS: The result showed that the were treated 2hour/seccion, 5session/week with the entire course
mobile safety alarm that was developed and tested was seen as taking 4 weeks. ANALYSIS: Independent two samples t-test/Mann-
offering increased opportunity for mobility, both in terms of being able Whitney U test/ chi square test were used to analyze the differences
to be more active and as an aid to self-determination. The fact that of all the confounding factors, outcome variables at baseline and
the test participants were located by means of the positioning device total improvements between groups. RESULTS: Both groups had
was not experienced as violating privacy as long as it was clear that significant reduction (p < 0.05) in severity of swelling, imbalance of
the person her/himself could decide to use the alarm. The mobile water composition, and lymphedema related symptoms during the
safety alarm that was tested was a prototype in development and intervention period. Bandage group had significant increases of
the research persons saw themselves as participants closely and fibrosis over dorsal area of the upper arm during the control period.
actively involved in the development process, who contributed their Taping group had improvements in role function which is one of the
recommendations for improvement. CONCLUSIONS: Conclusions items in quality of life measurement during the intervention period.
that can be drawn are that it is important for elderly persons to actively The upper extremity function scores had no significant changes
participate in the development process of new assistive technologies. during the control and intervention periods in both groups. There
In development, methodologies for empowerment of the elderly was no significant difference between groups except the severity
should be used. IMPLICATIONS: Mobile safety alarms can in the of fibrosis. The reduction of fibrosis in bandage group is more
future make it easier for elderly persons to be active and mobile and than in taping group in dorsal area of the upper arm and ventral
this might increase the options for elderly people to stay healthy. area of the forearm. The acceptance of Kinesio Tape is better than
KEYWORDS: Elderly, Information and Communication Technology bandage including longer using time, less difficulty, more comfortable
(ICT), Mobility, Privacy, Safety,. FUNDING ACKNOWLEDGEMENTS: and convenient (p < 0.05). CONCLUSIONS: Kinesio Taping could
Norrbotten Research Council, Sweden and Centre for Distance- replace the bandage in DLT. Further study should investigate the
spanning Healthcare (CDH), Luleå University of Technology, Luleå, rationale of the Kinesio Taping. IMPLICATIONS: Findings suggest
Sweden. CONTACT: [email protected] that patients with unilateral breast-cancer-related lymphedema may
ETHICS COMMITTEE: Committee of research ethics at Umeå have another choice for treatment by Kinesio Taping. KEYWORDS:
university postmastectomy lymphedema, taping, decongestive lymphatic ther-
apy. FUNDING ACKNOWLEDGEMENTS: National Science Council
of Taiwan. CONTACT: [email protected]
ETHICS COMMITTEE: ethics committee of NTUH
Research Report Poster Display The authors would like to acknowledge the funding received from
29-13 Tuesday 5 June 14:00 the Allied Health Research Fund, University Health Network, Toronto,
VCEC Exhibit Hall B & C Canada. CONTACT: [email protected]
CURRENT MOBILIZATION PRACTICES WITH PATIENTS WITH ETHICS COMMITTEE: University Health Network Research Ethics
INDWELLING FEMORAL LINES WITHIN UNIVERSITY HEALTH Board, and University of Toronto Research Ethics Board
NETWORK, TORONTO, CANADA
Fenton A1 , Cote N2 , Hawn T3 , Quan V4 , Chen A5 , Hoy C6 , Research Report Poster Display
McIntyre K7 , O’Brien M8 , Heck C9 ; 1 University Health Network, 29-17 Tuesday 5 June 14:00
Toronto, Canada; 2 University Health Network, Toronto, Canada; VCEC Exhibit Hall B & C
3 University Health Network, Toronto, Canada; 4 University Health
RATIONALE FOR ADHERENCE TO PHYSICAL THERAPY HOME
Network, Toronto, Canada; 5 University of Toronto, Toronto, EXERCISE PROGRAMS IN ADOLESCENCE WITH ORTHOPEDIC
Canada; 6 University of Toronto, Toronto, Canada; 7 University of CONDITIONS OR CEREBRAL PALSY
Toronto, Toronto, Canada; 8 University of Toronto, Toronto, Canada;
9 University Health Network, Toronto, Canada Stiller C, Brosko E, Salla K, Shea K, Stewart N; Oakland University
PURPOSE: To determine current mobilization practices of physical PURPOSE: Just as with other populations, adolescents often
therapists (PT), physicians and nurses with patients with indwelling display difficulty consistently performing a home exercise program
femoral lines, and to make recommendations regarding promoting (HEP). The purpose of this qualitative study was to identify the
safe practices for healthcare professionals working with this popula- rationale for adherence and nonadherence with HEPs in adolescents
tion. RELEVANCE: In clinical practice, early mobilization in patients with orthopedic conditions or cerebral palsy. RELEVANCE: In
with indwelling femoral lines may be delayed due to the belief that the pediatric population, a lack of adherence to a HEP may
mobilization may result in perforation of the vessel, movement of the cause delayed development, unnecessary alterations of a treatment
line, and/or dislodgement of the line. While there is little reported in program, and diminished clinical outcomes. Identification of the
the literature regarding safety concerns to support the restriction of rationale for adherence and nonadherence in this population will
mobilization there is also a lack of studies to support the promotion help physical therapists facilitate compliance with HEPs, leading
of mobilization in this population. PARTICIPANTS: In phase one, 31 to greater attainment of therapeutic goals and increased functional
nurses, 17 PTs and 13 physicians completed a questionnaire regard- outcomes for patients. PARTICIPANTS: A convenience sample of
ing their mobilization practices. In phase two, three focus groups were 22 adolescents (14 males/8 females), ages 12 to 18 years old,
conducted: one with nine PTs, two with nursing groups, each with 11 with orthopedic conditions and 11 with cerebral palsy, who
eight participants. METHODS: A two-phase, cross sectional, mixed had received a HEP as part of their physical therapy treatment
methodological design was used. Phase one involved the distribution participated in the study. METHODS: Following completion of a
of an electronic questionnaire. Domains of the questionnaire included demographic questionnaire, subjects participated in one-on-one
demographics, characteristics of current working environments, interview consisting of twenty-eight open-ended, guiding questions
current mobilization practices with four types of femoral lines (arterial, designed to elicit subjects’ opinions regarding the importance of a
central venous, rigid and semi-rigid vascular catheters) issues, HEP, their reasons for adherence or nonadherence with the HEP,
concerns, and rationale supporting current practice. Phase two and their insight into techniques physical therapists might employ to
consisted of three, 30-60 minute focus groups designed to further improve adolescent adherence to a HEP. ANALYSIS: Median age,
explore the issues surrounding current mobilization practices and average length of physical therapy treatment and adherence rates for
safety concerns identified in phase one. ANALYSIS: Descriptive both groups were calculated. Interview data was transcribed and the
statistics were used to characterize the demographic profile of the constant comparative method of qualitative data analysis was used to
subjects. Analysis of variance was used to determine between group identify themes and concepts and formulate a conceptual framework
differences (professional groups and types of femoral lines). Content to improve adherence to physical therapy HEPs in adolescents.
of the audio-taped focus groups was transcribed verbatim and RESULTS: Subjects with orthopedic conditions had a median age of
analyzed using the method of constant comparison and organized 15.6 years old and an average length of physical therapy treatment
using NVivo computer software to identify key themes. RESULTS: of 6.7 months. The median age for subjects with cerebral palsy was
Approximately two thirds of all respondents were female, with the 14.4 years and the average length of treatment was 45.4 months.
physicians comprising the majority of male respondents. The majority Average adherence rates for subjects with orthopedic conditions
of respondents had received Baccalaureate degrees (49.2%), worked was 80.5%, compared to 38.0% for those with cerebral palsy.
full-time (90.3%), and had over ten years of work experience (66.7%). Qualitative analysis of interview data revealed seven major factors
Half of respondents practiced in the Medical Surgical Intensive Care that facilitated adherence in these subjects, including: motivation, ed-
Unit. Over 50% reported mobilizing patients by dangling, transferring, ucation, perceived benefits, independence, type of goals, perceived
and performing hip range of motion (ROM) up to 60º with all lines. seriousness and perceived absence of barriers. Both groups of
Of the factors guiding clinical practice, safety concerns and clinical subjects could identify benefits of adherence, serious consequences
experience were identified by all groups. However, significantly fewer of nonadherence and barriers to completing the HEP. Subjects with
physicians compared to PTs and nurses reported that line occlusion, orthopedic conditions, however, demonstrated more traits related to
breaking and shifting, as well as internal/external bleeding, present the seven factors (such as internal motivation, independence when
safety concerns. From the focus groups, four themes were identified exercising and short term, personal goals) compared to their peers
(mobilization, variations in current practice, critical incidences and with cerebral palsy. CONCLUSIONS: Adolescents with both chronic
precautions). CONCLUSIONS: Patients with indwelling femoral lines conditions, such as cerebral palsy, and more acute problems, such
are currently mobilized at UHN with the belief that the benefits as orthopedic conditions are influenced by similar factors related to
outweigh the risks. IMPLICATIONS: To maximize the safety of these adherence to a HEP. Those with orthopedic conditions, however,
mobilization practices, patients should be screened by the healthcare display more traits related to the seven factors identified as important
team for cognitive status and overall medical condition. Furthermore, for adherence by the subjects in this study. Future studies should
proper orientation and education about the structure, purpose, and focus on repeating this study with adolescents with other chronic and
inherent risks of each type of femoral line should be encouraged acute conditions and on prospective quantitative studies with larger
for all healthcare professionals within and across units at UHN sample sizes. IMPLICATIONS: Therapists can facilitate adherence
to increase the practice of mobilization. KEYWORDS: mobilization in their adolescent patients by incorporating the principles, such
practices, femoral lines, arterial lines, central venous lines, vascular as short term and personal goals, internal motivation, appropriate
catheters, physical therapy. FUNDING ACKNOWLEDGEMENTS: education and independence, related to the seven factors described
by the subjects in this study. KEYWORDS: home exercise program, Research Report Poster Display
adherence, adolescents. FUNDING ACKNOWLEDGEMENTS: This 31-01 Tuesday 5 June 14:00
study was supported by a Graduate Student Research Grant from VCEC Exhibit Hall B & C
Oakland University. CONTACT: [email protected] CONGENITAL MUSCULAR TORTICOLLIS: RETROSPECTIVE
ETHICS COMMITTEE: Oakland University Institutional Review STUDY ON THREE DIFFERENT PHYSIOTHERAPY TREATMENT
Board PROTOCOLS COMPARING FUNCTIONAL AND COSMETIC
RESULTS AT 12 MONTHS
Research Report Poster Display Davidson A, Innocenti D; Physiotherapy Dept., Meyer Paediatric
30-21 Tuesday 5 June 14:00 Hospital, Florence, Italy
VCEC Exhibit Hall B & C PURPOSE: Considering the lack of homogeneity in physiotherapy
FACTORS INFLUENCING ADHESION TO A GUIDANCE COURSE treatment of congenital muscular torticollis (CMT) in Tuscany,
FOR CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY this retrospective study compares the efficiency and efficacy of
Mazzitelli C1,2 , Santos Melo M1 , Pimentel Piemonte M1 ; the three different protocols applied. RELEVANCE: The interna-
1 Department of Physical Therapy, Faculty of Medical Science, tional literature underlines the effectiveness of early conservative
University of São Paulo, São Paulo, Brazil; 2 Physical Therapy physiotherapy in preventing functional and cosmetic sequelae in
Course, Universidade Metodista de São Paulo, São Bernardo do babies presenting CMT. Aside from the general agreement of
Campo, Brazil the importance of the differential diagnosis and that stretching,
active ROM exercises and positioning are the basis of successful
PURPOSE: To verify factors surrounding caregivers of children with treatment, controversy remains on modality and intensity of stretching
Cerebral Palsy that may influence adhesion to a home exercise techniques, complementary exercises and home program. Protocols
guidance program. RELEVANCE: Cerebral Palsy is acknowledged to must consider the cost–benefit impact of the treatment strategies
be the most common neurological pathology in children. Given that chosen, preferring the minimal complexity and use of resources
motor deficits in such patients are life-long, long-term physiother- which garantee maximum results. PARTICIPANTS: Physiotherapy
apeutic care is needed, overloading physiotherapy services made treatment performed was examined in 109 babies affected with CMT
available for this patient group. Therefore, the family becomes an seen in the Physiotherapy Department of Meyer Pediatric Hospital
important ally in the rehabilitation process, as through their support, between 1995-2003. METHODS: Three different treatment groups
therapeutic benefits can be both enhanced and widened. However, were compared: protocol A= medium intensity and complexity;
in underdeveloped countries, besides poor health infrastructure protocol B1 = less intense and complex than protocol A; protocol
hampering these children’s access to quality rehabilitation services, B2 = more intense and complex than protocol A. The three groups
generally low education also hinders cooperation and support of the were also compared to a control group C of untreated babies.
families. Few studies have been performed to assess and identify the Three functional and cosmetic results were measured (spontaneous
relevant factors for a good family-therapist partnership, where such posture in inclination of neck, passive rotazione of neck to affected
information is essential in enabling a guidance program to be devised. side, facial hemi-hypoplasia) and compared at the age 12 months
PARTICIPANTS: Twelve caregivers of children with Cerebral Palsy to examine which protocol was the most efficient. The complexity
were randomly selected, aged 38.78 ±10.58 years, comprising 10 fe- and intensity was based on the amount of stretching done at home
males and 2 males with schooling of 9.82 ±6.01 years, a depression by parents and relatives, the number of people involved in the
level of 7.82 ±7.51, Mini-mental score of 26.8 ±4.42 and a socio- stretching exercises, the frequency of ambulatory treatments and the
economic level of 18.5 ±7.38 (class range from A2-D). METHODS: type of complementary corrective exercises carried out. ANALYSIS:
Following selection and consent, caregivers were assessed on the Neck ROM and posture was quantified by goniometric reading,
Beck’s Scale, Mini Mental State Exam, the Brazilian Economic Clas- and facial hemi-hypoplasia by presence or absence. RESULTS:
sification Criteria to ascertain socio-economic level, along with ques- The protocol of medium intensity and complexity proved the most
tions on Schooling. Subsequently, guidance was given for 5 exercises efficient (cost-benefit ratio) in preventing a negative functional and
to be carried out at home on the child. Guidance encompassed pro- cosmetic outcome in that it produced the same results as the more
vision of a drawing of the exercise together with explanatory descrip- intensive and complex programme. Both proved better that the less
tion, demonstration and explanation by the therapist, finalizing with intense protocol.The study also showed the important preventive
performing of exercises by the carer to enable checking of the manner effect of physiotherapy in this condition: only 2% of the treated babies
of execution and to allow any necessary corrections to be made. needed corrective surgery compared to 36% of the untreated babies.
Carers and children were followed for 12 months with bimonthly CONCLUSIONS: In CMT stretching carried out by one person at
reassessments to check exercise evocation (spontaneous recall, home three times a day and minimal ambulatory sessions proved
upon seeing drawing, or cannot remember) and application (good, efficient in obtaining maximum results. More intensive and complex
reasonable or poor). ANALYSIS: Data collected were analyzed treatments do not seem to give better results. As treatment is actually
using correlation tests to verify correlation amongst different carer proposed in all cases of CMT, more studies for a classification based
characteristics and the reassessments on guidance. RESULTS: A on prognostic signs are needed which would allow the exclusion from
significant correlation was observed between the carer’s mental state treatment of babies who will have a good spontaneous recovery.
and their ability to evoke exercises (correlation: −0.9410 / p = 0.0001), IMPLICATIONS: Careful consideration must be given to not under
between carer’s mental state and application (correlation: −0.7892 or over treat babies with CMT. KEYWORDS: Congenital Torticollis –
/ p = 0.011) and between socio-economic level and number of Physiotherapy. FUNDING ACKNOWLEDGEMENTS: No funding
exercises evoked (correlation: −0.7252 / p = 0.027). CONCLUSIONS: support was used for the study. CONTACT: [email protected]
The present study revealed that social aspects interfere with adhesion
to a home guidance program, whereby carers with lower socio-
economic levels and compromised mental state tended to exhibit
lower adherence to the guidance. IMPLICATIONS: Characterizing
the profile of caregivers of children suffering from Cerebral Palsy
contributes toward better planning of a guidance program of home
exercises, enabling greater adhesion and improved therapeutic
outcomes in the children. KEYWORDS: cerebral palsy, guidance,
socio-economic status. FUNDING ACKNOWLEDGEMENTS: None.
SELF REFERRAL(DIRECT ACCESS) TO PHYSIOTHERAPY: THE MANAGEMENT OF PRESSURE ULCERS BY HOSPITAL
WHAT DO THE PHYSIOTHERAPISTS AND REFERRING PHYSIOTHERAPISTS IN THE GAUTENG PROVINCE, SOUTH
DOCTORS THINK? RESULTS OF A NATIONAL TRIAL AFRICA
Webster V1 , Holdsworth L2 , McFadyen A1 ; 1 Glasgow Caledonian Mothabeng J, Nel M, Stevens R, De Kock C, Swart M; University
University, Glasgow Scotland; 2 Forth Valley NHS, Stirlingshire, of Pretoria, Pretoria, South Africa
Scotland; 3 NHS Scotland PURPOSE: Pressure ulcers are a serious and prevalent medical
PURPOSE: Within the UK recent healthcare reforms have called problem encountered in the medical and rehabilitation setting, often
for the development of services which put patients at the centre interrupting rehabilitation. Although physiotherapists have various
of healthcare delivery. This has prompted the development of a modalities that can be used to enhance wound healing, the
range of services including patient self referral to physiotherapy. researchers noticed that in some hospitals pressure ulcers were not
RELEVANCE: Patient self referral has for many years been resisted treated by physiotherapists. The purpose of this pilot study was to
by the NHS due to the belief that services would be inundated. A investigate the management of pressure ulcers by hospital physio-
recent multi-centred trial conducted in Scotland reported that this therapists in the Gauteng Province, South Africa. RELEVANCE: The
was not the case and self referral was feasible and appropriate. presence of pressure ulcers interrupts the progress of rehabilitation,
This follow up study aimed to identify the views and perceptions resluting in unnecessarily prolonged hospitalization. Physiotherapy
of all stakeholders. PARTICIPANTS: 64 Clinical Physiotherapists can contribute to the holistic management of pressure ulcers and
(PTs) and 97 General Practitioners (GPs) from 26 primary care facilitate the rehabilitation process. PARTICIPANTS: Seventy five
locations representing a range of socio-economic and geographical physiotherapists out of the one thousand one hundred members
settings and who had participated in the trial were contacted. The of the South African Society of Physiotherapy working in the
response rate was 73.5% for Physiotherapists and 72.2% for General Gauteng provice consented to participate in the survey. METHODS:
Practitioners (n=47 and n=70 respectively). METHODS: At the end A descriptive survey using a web-based questionnaire was em-
of the trial, questionnaires were sent to clinical physiotherapists and ployed. ANALYSIS: Descriptive statistics were used to analyse
GPs involved in the study to ascertain their views and perceptions the data. RESULTS: Seventy five completed questionnaires were
of self referral and any impact it had. ANALYSIS: All questionnaires received. Sixty seven percent indicated that PU are not treated
were analysed using PinPoint software using appropriate descriptive by physiotherapists in their hospitals, and the main reason for no
and non-parametric tests. Frequency distributions were reported in treatment was that patients were not referred. Almost all (93%)
percentages. Comments were transcribed verbatim and analysed to of the respondents indicated that they had undergraduate training
identify themes. RESULTS: The majority of GPs (71.4%) noticed no in the physiotherapeutic management of PU, but not all were
change in the number of musculoskeletal patients consulting them implementing it for varying reasons. CONCLUSIONS: The results
but. 56.5% of PTs thought their referral rates had increased uring of this survey indicate that most physiotherapists in this sample
the study year. 95.8% of GPs were either confident or very confident do not treat pressure ulcers for various reasons. IMPLICATIONS:
in physiotherapists abilities to diagnose and treat appropriately The results cannot be generalized to all the physiotherapists in the
musculoskeletal conditions. 71% of GPs and 76.6% of PTs were Gauteng province due to the low response rate. The results however
comfortable or very comfortable with physiotherapists acting as first highlight an important gap in the holistic management of pressure
point of contact, although 48.9% of PTs thought not all physio- ulcers in the South African context. South African Physiotherapists
therapists were experienced enough. Only 34% of physiotherapists need to market their adjunctive role in the management of
considered the public were knowledgeable regarding physiotherapy. pressure ulcers for the benefit of the patients. KEYWORDS:
37% GPs did not support physiotherapist issuing repeat prescriptions Pressure ulcers, physiotherapy modalities, rehabilitation. FUNDING
compared to 10% of physiotherapists. Vast majority of GPS (91.4%) ACKNOWLEDGEMENTS: There was no external funding for this
and PTs (90%) indicated they thought physiotherapists should be project. CONTACT: [email protected]
able to request X rays. Only 10% of Physiotherapist felt issuing ETHICS COMMITTEE: The Faculty of Health Scinces Research and
repeat prescriptions should not be a physiotherapy role. 87.2% of Ethics committee of the University of Pretoria
GPs and 70% PTs thought it was possible for physiotherapists to
monitor work related sickness absence. Interestingly 21% GPs and
20% PTs did not want physiotherapists to issue repeat sickness Research Report Poster Display
certificates. Only 2.8% of GPs questioned did not want Self referral 36-21 Tuesday 5 June 14:00
to physiotherapy to continue. Many areas for discussion were raised VCEC Exhibit Hall B & C
by both GPs and PTs in their comments. CONCLUSIONS: Both DEVELOPMENT OF A FRAMEWORK FOR EVIDENCE-BASED
General Practitioners and Physiotherapists were overwhelmingly in CHOICE OF OUTCOME MEASURES IN NEUROLOGICAL
favour of the continuation of self referral to physiotherapy. High levels PHYSIOTHERAPY
of support were identified for physiotherapists acting as first point
Watson A1 , Tyson S1,2 , Moss S1,3 , Troop H4 , Dean-Lofthouse G5 ,
of contact practitioners. Areas for role extension were identified and
Jorritsma S6 , Shannon M7 ; 1 Physiotherapy Directorate, University
supported by almost two thirds of both groups IMPLICATIONS: This
of Salford, UK; 2 Centre for Rehabilitation and Human Performance
study has found that the majority of stakeholders were fully supportive
Research, University of Salford, UK; 3 Salford Primary Care Trust,
of this development but some issues were identified by both
UK; 4 Tameside National Health Service Trust, UK; 5 Physiotherapy
physiotherapists and general practitioners. When developing new
Private Practice, UK; 6 Trafford National Health Service Trust, UK;
physiotherapy services it is essential that the views of stakeholders 7 Salford Royal Hospital Trust, UK
are sought. KEYWORDS: Self referral (direct access), views and
perception, national trial. FUNDING ACKNOWLEDGEMENTS: This PURPOSE: This paper reports on the first stage of a project
work was undertaken with the support of the participating sites and to identify the most robust outcome measures (OMs) for use in
from our employer organisations Glasgow Caledonian University and neurological physiotherapy. The aim of this stage of the project
NHS Forth Valley. CONTACT: [email protected] was to identify the domains that physiotherapists need to measure
ETHICS COMMITTEE: Ethical approval for the study was granted during a neurological assessment. RELEVANCE: Neurological
by the Multi-centred Research Ethics Committee (Scotland) ref. No. physiotherapists recognise the need to include standardised OMs
MREC/02/0/37. in clinical practice but lack of information about the OMs available
hampers utilisation. DESCRIPTION: Focus groups were held using 3 the maximum scores at admission and discharge. There was a
patient vignettes to represent the acute, rehabilitation and community significant change (discharge minus admission) in the COVS sitting
settings. Thirty senior neurological physiotherapists participated scores (P < 0.001), but not for the BBS scores (P>0.05). The effect
and were asked “what would you observe, test or measure if sizes were small and moderate respectively for the BBS and the
assessing this patient” . Each of the authors analysed the data COVS sitting items. Patients with maximum scores on the BBS
using independent thematic content analysis to identify and define sitting balance showed that they had more sitting ability going by
the items and domains. Internal and external member checking their scores on COVS (P < 0.001). CONCLUSIONS: Sitting balance
ensured validity. EVALUATION: Items from the data collection item of the BBS exhibits ceiling effect compared to the COVS. The
were classified in to 17 domains that physiotherapists need to BBS sitting item did not show any change in sitting ability from
measure: weakness; range of movement / contracture; pain; muscle admission to discharge despite evidence to the contrary for the
tone / spasticity; sensation; ataxia / co-ordination; personal fatigue; COVS sitting item. IMPLICATIONS: The COVS may be a more
oedema; subluxation; postural impairment; balance impairment; appropriate choice for evaluating sitting balance in patients with
walking impairment; upper limb; balance disability; walking disability; sub-acute stroke undergoing rehabilitation. KEYWORDS: Stroke,
mobility disability and falls. CONCLUSIONS: The 17 domains that Berg Balance Scale, Clinical Outcome Variables Scale, Sitting
physiotherapists need to measure during clinical assessment were balance. FUNDING ACKNOWLEDGEMENTS: Paid time of the
identified. IMPLICATIONS: In the second stage of the project these Health Records officer was supported by the East Central Health.
domains will instruct systematic reviews to identify the most robust CONTACT: [email protected]
outcome measures for use in clinical practice. KEYWORDS: neu- ETHICS COMMITTEE: Community Research Ethics Board of
rological physiotherapy, outcome measures, assessment. FUNDING Alberta, Canada.
ACKNOWLEDGEMENTS: This work was unfunded but supported ‘in
kind’ by the University of Salford and NHS Trusts and Primary Care
Trusts across Greater Manchester and Merseyside UK. CONTACT:
[email protected] 37-05 Tuesday 5 June 14:00
PSYCHOMETRIC EVALUATION OF WORK DISABILITY
Research Report Poster Display OUTCOME MEASURES FOR INDIVIDUALS WITH
37-01 Tuesday 5 June 14:00 MUSCULOSKELETAL INJURIES: A SYSTEMATIC REVIEW
Williams R1 , Allwood S, Sanchez M, Shea R, Wang J, Wark G;
SITTING BALANCE IN PATIENTS WITH SUB-ACUTE STROKE 1 School of Rehabilitation Science, McMaster University, Hamilton,
UNDERGOING REHABILITATION: COMPARISON OF TWO Ontario. Canada
OUTCOME MEASURES
PURPOSE: This systematic review evaluated the psychometric
Amusat N; Rehabilitation Center, Two Hills Health Centre, Two
properties of outcome measures used to assess work disability
Hills, East Central Health, Alberta, Canada
in individuals with musculoskeletal injuries. RELEVANCE: Although
PURPOSE: Independent sitting is a prerequisite for most functional there are several measures of work disability, they have not been
activities and a determinant of recovery from stroke. A primary adequately evaluated. PARTICIPANTS: Three pairs of reviewers
goal of physical therapy during the early phases of rehabilitation evaluated the articles. METHODS: MEDLINE, CINAHL (Cumulative
is to facilitate static and dynamic sitting balance. Accurate clinical Index to Nursing and Allied Health Literature), EMBASE, AMED
assessment of sitting is required to develop appropriate treatment (Allied and Complementary Medicine), and PsycINFO between
program and evaluate functional outcomes. No widely accepted 1980 to March 2006 were searched for peer-reviewed studies that
outcome tool for assessing sitting balance exists. But often evaluated self-administered instruments that assessed work disability
therapists based treatment on sitting balance components of other for individuals with musculoskeletal injuries. Examples of key words
standardized outcome measures. The purpose of this study was were “work disability”, “worker role”, “return to work”, “instrument
to examine some evaluative properties of the sitting balance items validation”, “validity”, and “reliability”. The eligibility criteria were
of Berg Balance (BBS) and the Clinical Outcome Variables Scales articles that: (1) were peer-reviewed, (2) were published in English,
(COVS) among patients with stroke who are receiving rehabilitation. (3) involved an evaluative component of a work disability outcome
RELEVANCE: The BBS and the COVS have sitting balance items measure, and (4) were conducted with individuals who had sustained
which are commonly used in stroke rehabilitation. Information musculoskeletal injuries. References cited in the retrieved articles
gained from this study will provide further information on some also were screened for possible inclusion. ANALYSIS: The reviewers
measurement properties of BBS and COVS to assess sitting balance. independently evaluated the outcome measures for the following
PARTICIPANTS: Fifty-one stroke patients admitted for rehabilitation psychometric properties: (1) content validity, (2) construct validity,
in a Canadian rural health region between January 2003 and June (3) internal consistency, (4) test-retest reliability, (5) responsiveness,
2005. METHODS: A retrospective study of patients with stroke, with (6) time to administer, and (7) ease of scoring. A modified rating
complete admission and discharge BBS and COVS records, was form was used to assess the instruments. A scoring method was
conducted. Admission and discharge BBS and COVS assessments developed whereby a value was assigned for each psychometric
were components of standardized evaluative process for all patients property evaluated (e.g., “1” was given for a “+” (adequate
admitted for rehabilitation. ANALYSIS: Frequency distribution was methods/results); “0.5” for a “±” (doubtful methods/results); and
used to evaluate ceiling and floor effects of the sitting balance scores “0” for either a “−” (inadequate methods/results) or “?” (no data
(ordinal). Change was evaluated using Wilcoxon test to compare available)). The total possible score was 7. When discrepancies
admission and discharge sitting balance scores and responsiveness occurred between reviewers in the rating of the article, the reasons
assessed using effect sizes for the BBS and COVS. Sign test was for the discrepancies were identified and consensus between
used to compare the COVS sitting scores of patients with maximum reviewers was reached. If consensus could not be obtained, a third
score on the BBS sitting item. RESULTS: The mean age of the reviewer independently evaluated the article until agreement was
sample was 72 (SD = 11.3) years, 57% were males; 86% of the determined. RESULTS: Of the 767 articles that were identified, 12
strokes were due to infarction. The median length of stay was measures met the inclusion criteria. Most studies were found for
41days and 52% had strokes within 30 days of admission to the the Work Limitations Questionnaire (WLQ). None of the instruments
centre. The mean total BBS and COVS scores were 25.0 (SD demonstrated satisfactory results for all properties. Five instruments
15.9) and 56.6 (SD 15.8). There was significant ceiling effect only had data on content validity with the methodology being questionable
for the BBS sitting balance item with >90% of the patients having for two of the Instruments. Eleven studies reported on construct
validity, however, the methodology was doubtful for three of the Slovenian sportswomen participating in basketball, team handball
measures. Internal consistency was addressed for eight instruments. and volleyball are associated with higher amounts of training, greater
Test-retest reliability was reported for five instruments, with only one body height and a larger knee anterior laxity. The odds ratios and
instrument achieving an intra-class correlation coefficient greater than significant relationships are rather small and therefore, there are
0.7. Responsiveness was addressed for only two questionnaires. more important factors that need to be investigated. IMPLICATIONS:
Instruments with an administration time of less than 10 minutes As female participation in sports continues to grow and there is
included the Functional Abilities Confidence Scale (FACS) and the an increased knee injury rate reported among female athletes, it is
Stanford Presenteeism Scale (SPS). Scoring was considered easy crucial for clinicians and researches in the field of sports medicine to
for the WLQ and the SPS. Overall, the highest ratings (total scores of determine the risk factors for traumatic knee injury. With increasing
greater than 4 out of 7) were given to the FACS, the WLQ-25, and the knowledge of risk factors, more effective and appropriate prevention
Occupational Role Questionnaire. CONCLUSIONS: Further studies strategies might be offered to female athletes at risk. KEYWORDS:
should be conducted that evaluate the psychometric properties and injury prevention, female athletes, logistic regression;. FUNDING
clinical practicality of outcome measures for assessing work disability. ACKNOWLEDGEMENTS: Funded by Ministry of Science, Slovenia.
IMPLICATIONS: There is a need to continue to validate work CONTACT: [email protected] or [email protected]
disability outcome measures and to make them more meaningful for ETHICS COMMITTEE: Ethics committee approval has been gained
physical therapists. KEYWORDS: work disability, outcome measures, from the Committee for Medical Ethics at University of Ljubljana,
systematic review. FUNDING ACKNOWLEDGEMENTS: unfunded. Slovenia

TRAUMATIC KNEE INJURY – IS KNEE ANTERIOR LAXITY A PASSIVE VISCOELASTIC CHARACTERISTICS OF THE CALF
RISK FACTOR? MUSCLE-TENDON UNIT IN FORMER INTERNATIONAL FEMALE
Vauhnik R1,2 , Morrissey M1 , Rutherford O1 , Turk Z3 , Pilih I2,4 ; GYMNASTS
1 Division of Applied Biomedical Research, GKT School of
Maı̈setti O1,2 , Stutz I2 , Lecompte J1 , Portero P1,2 ; 1 Service de
Biomedical Sciences, King’s College London, UK; 2 Arthron – Rééducation Neuro-Orthopédique, INSERM UMR 731, Hôpital
Institute for Joint and Sports Injuries, Celje, Slovenia; 3 Department Rothschild, 33 boulevard de Picpus, 75571 Paris Cedex 12, France;
of Rehabilitation Sciences, General Hospital Maribor, Slovenia; 2 Département STAPS, Université Paris 12, 94000 Créteil, France
4 Department of Traumatology, General Hospital Maribor, Slovenia
PURPOSE: The purpose of this study was to examine the

PURPOSE: Traumatic knee injuries occur far more often in female
difference in passive viscoelastic characteristics of the calf muscle-
compared to male athletes. These findings are of particular impor-
tendon unit between former international female gymnasts and
tance as knee injuries are one of the most seriously disabling injuries
controls. RELEVANCE: Gymnasts usually start intensive training
in sports with short- and long-term disabilities being prevalent.
from early childhood. The impact of such strenuous training on the
Preventive measures begin with an investigation of possible risk
musculoskeletal system is not clear and needs to be investigated.
factors that may contribute to an athlete’s susceptibility to injury.
PARTICIPANTS: Six former international female gymnasts that have
The purpose of this study was to investigate if knee anterior laxity,
stopped intensive training for 5 to 17 years and 6 sedentary subjects
measured with an arthrometer, is a risk factor for traumatic knee injury
participated to the study. METHODS: An isokinetic dynamometer
in sportswomen. To allow a more rounded analysis, other, easily
measured variables such as anthropometry, lower leg characteristics, was used to passively stretch the right calf muscle-tendon unit from
sport exposure and menstrual cycle characteristics were also relaxed plantar flexion to the maximal angle of dorsiflexion (ROM)
evaluated as possible risk factors. RELEVANCE: Prevention has at 5º.s-1. The maximal passive resistive torque was measured and
become a focal point for researchers and clinicians. However, before average passive stiffness was calculated between 15 and 25º of dor-
meaningful prevention studies can be conducted, the risk factors siflexion and for the final 10% of ROM. The area under the moment-
for injury must be clearly established and defined. PARTICIPANTS: angle curve was calculated as the averaged absorbed passive-elastic
In the 2003/2004 preseason, 55 (70%) out of 79 women teams energy. In addition, the maximal voluntary torques of the plantar
in basketball, team handball and volleyball registered in Slovenia flexors and extensors were also measured. ANALYSIS: Unpaired
were tested. In Slovenia, women’s basketball is played in one Student test was performed to compare ROM, passive resistive
division, team handball is played in two divisions and volleyball is torque and passive elastic energy. For stiffness indexes comparison
played in three divisions. For each sport, testing occurred at all an ANOVA (group x stiffness indexes) was performed. RESULTS:
divisions. In total, 43 teams (54% of the total number of teams Despite similar maximal voluntary plantar flexion and dorsiflexion
targeted) finished the study. Sportswomen were aged between torques, former international gymnasts exhibited higher maximal
11 and 41 years (N = 585). Sportswomen were tested in the passive dorsiflexion ROM (+35%, P < 0.05), maximal passive resistive
preseason and followed for one season. METHODS: It was a cohort torque (+48%, P < 0.05) and passive-elastic energy (+63%, P < 0.01).
study and the data collection included: written informed consent, Furthermore, former gymnasts showed lower passive stiffness within
background questionnaire, anthropometric tests, leg dominance the 15-25º of dorsiflexion (−33%, P < 0.01) and higher for the last 10%
assessment, navicular drop test (measurement of foot pronation), of ROM (+41%, P < 0.05). CONCLUSIONS: Although speculative,
passive knee extension assessment and measurement of knee these results suggest that long term loading during childhood
anterior laxity with the KT arthrometer. ANALYSIS: Several sets of have modified passive properties of the calf muscle-tendon unit
data analysis were performed including logistic regression analysis of former international female gymnasts that persist several years
in order to build a model for predicting traumatic knee injury after the cessation of sport practice. IMPLICATIONS: Longitudinal
among sportswomen. RESULTS: Height and average hours of follow up would assist in determining whether or not passive
training per week were found to differ significantly (p < 0.05) between properties of plantar flexors is genetically determined and/or able
sportswomen who had an injury in the target season vs those who to be modified with further gymnastic training. KEYWORDS: former
did not. Logistic regression indicated that height and knee anterior female gymnasts, viscoelasticity, muscle-tendon unit. FUNDING
laxity are significant risk factors for traumatic knee injuries among ACKNOWLEDGEMENTS: This study was supported by the Institute
sportswomen. CONCLUSIONS: Traumatic knee injuries among of Myology – AFM, Paris, France. CONTACT: [email protected]
Research Report Poster Display paid personal support workers (PSWs) addressing the following
38-17 Tuesday 5 June 14:00 research questions: 1) How do ventilator-users and PSWs describe
VCEC Exhibit Hall B & C and evaluate their relationships? 2) What are the relevant social and
EFFECT OF TAPING ON KNEE ROTATIONAL KINEMATICS material conditions that are brought to bear on the relationship?
DURING SINGLE LEG SQUAT AND DROP LANDING RELEVANCE: Technical advancement has facilitated community
living for “severely” disabled persons including ventilator-users. Many
Kawabata M1 , Kagaya Y1 , Shiba Y2 , Nishizono H1 ; 1 National
require several hours per day of assistance that is provided by
Institute of Fitness and Sports; 2 Kitasato University, School of
PSWs who work under difficult conditions with low pay and minimal
Allied Health Sciences
training. The frequent intimate contact between ventilator-users
PURPOSE: The purpose of this study is to examine quantitatively of and PSWs has the potential to have considerable effects on the
the restricting taping on a knee rotational kinematics during dynamic well-being of each. Physiotherapists and other health providers
movement with a three-dimensional rigid body model. RELEVANCE: who work with these individuals, often over the course of many
Taping is ordinary used to relieve pain and to improve joint looseness. years, need to have adequate information regarding non-professional
The effect of taping tends to be judged subjectively, and there are care arrangements in order to maximize care effectiveness and
few studies on the influence of taping for a knee joint objectively. build successful teams. In addition, information about ventilator-
PARTICIPANTS: The subjects were 15 normal women (age 21.6±0.9 user/PSW relationships, including barriers and facilitators to success,
years, height 157.0±4.3cm, body mass 50.7±6.6kg). METHODS: has relevance for educational programs for PSWs and persons
Subjects performed the single leg squat and the single leg drop with disabilities. PARTICIPANTS: 10 ventilator-users and 10 of
landing with inside spiral taping, outside spiral taping and without their PSW’s in supported housing environments located in Toronto,
taping. A 3D motion detection system (OPTOTRAK; Northern Digital) Canada METHODS: One-on-one qualitative interviews with all
was used for measuring the knee rotational angle. The taping was participants. ANALYSIS: The data was analyzed using a flexible
carried out equally by the same expert with 50mm width elasticity coding system consistent with the research purposes and grounded
tape (ELASTIKON; Johnson & Johnson). We defined the relative in a critical social science approach. RESULTS: The accounts
rotational angle as 0 degrees in both limbs standing. ANALYSIS: revealed that PSWs and ventilator-users were generally highly
Paired t-test comparisons were made to examine the rotational adaptable, finding ways to make relationships work despite significant
angle without taping and with the taping during squat and landing. variability in interpersonal and official (management) expectations.
RESULTS: As for the squat of starting position, the leg was located Both groups struggled with defining the relationship that was often
in 0.47±2.5 degrees external rotation without taping. The outside perceived as different from either a “friendship” or “professional”
spiral taping guided the leg to 15.9±3.5 degrees external rotation, relationship. In addition, considerable variability existed amongst
and the inside spiral taping guided it to 12.4±3.8 degrees internal participants on what it means to “‘direct care” and how it affected the
rotation. As for the maximum rotational shift during squat, the leg was success of relationships. Participants “worked” their relationships by
located in 2.6±2.3 degrees external rotation without taping. With the alternately drawing from and resisting the policies and philosophies of
outside spiral taping, the leg was located in 5.1±2.3 degrees external management and unions in order to support their individual styles and
rotation, and with the inside spiral taping, it was located in 0.3±2.1 commitments. CONCLUSIONS: The considerable variability in how
degrees internal rotation. The rotational angle with each taping was PSWs and ventilator- users interpret their relationships and “work
significantly shifted as compared to without taping (p < 0.05). As for the system” suggests that “independent living” and what it means
the pre-landing, the leg was located in 6.9±3.4 degrees external to “direct care” are not univers IMPLICATIONS: The study informs
rotation without taping. With the outside spiral taping, the leg was the practice of physiotherapists and other health professionals by
located in 19.1±4.3 degrees external rotation, and with the inside providing insight into the most significant health care relationship
spiral taping, it was located in 7.6±5.2 degrees internal rotation. in the lives of persons who require daily supportive care and the
As for the post-landing, the leg was located in 2.3±5.7 degrees implications for health care within an “independent living” model.
internal rotation without taping. With the outside spiral taping, the KEYWORDS: Disability, personal support workers, home mechanical
leg was located in 4.5±6.7 degrees external rotation, and with ventilation. FUNDING ACKNOWLEDGEMENTS: The study was
the inside spiral taping, it was located in 7.3±6.4 degrees internal supported by a grant from the Ontario Lung Association. CONTACT:
rotation. In pre- and post-landing, the leg of rotational angle with the [email protected]
taping shifted statistically better than that without taping (p < 0.01). ETHICS COMMITTEE: University of Toronto Research Ethics Board
CONCLUSIONS: These results showed that the leg rotational angle
with the outside spiral taping was always located to external rotation
as compared to without taping. On the other hand, the leg rotational Research Report Poster Display
angle with the inside spiral taping was always located to internal 02-07 Tuesday 5 June 15:30
rotation. That is, the spiral taping affected the static and the dynamic VCEC Exhibit Hall B & C
alignment. IMPLICATIONS: We considered that the conventional INTERVAL VERSUS CONTINUOUS EXERCISE FOR PATIENTS
experiential evaluations or treatments were showed objectively. WITH SEVERE COPD
KEYWORDS: Taping, knee rotation, rigid body model. FUNDING
ACKNOWLEDGEMENTS: The spiral taping affected the static and Puhan M1 , Büsching G2 , Schünemann H3,5 , vanOort E2 , Zaugg C4 ,
the dynamic alignment. CONTACT: [email protected] Frey M2 ; 1 Horten Centre, University of Zurich, Switzerland; 2 Klinik
ETHICS COMMITTEE: We do not have an ethics system. We Barmelweid, Barmelweid, Switzerland; 3 Department of Clinical
obtained subject’s approval. Epidemiology and Biostatistics, McMaster University, Hamilton,
Ontario, Canada & Dept. of Medicine, University at Buffalo, NY,
USA; 4 Experimental Cardiology Research Group, Dept. Research,
University of Basel, Switzerland; 5 Clinical Research Development
02-03 Tuesday 5 June 15:30 and Information Translation (INFORMA) Unit, Department of
VCEC Exhibit Hall B & C Epidemiology, Italian National Cancer Institute Regina Elena, Rome,
A CRITICAL EXPLORATION OF THE RELATIONSHIP BETWEEN Italy
PERSONAL SUPPORT WORKERS AND VENTILATOR-USERS
PURPOSE: Guidelines recommend continuous exercise at high
Gibson B, DeMatteo D, Brooks D; Department of Physical Therapy,
intensity to reduce peripheral muscle dysfunction in patients with
University of Toronto, Toronto, Canada
Chronic Obstructive Pulmonary Disease (COPD), but patients may
PURPOSE: This study examined the relationship between persons tolerate equally effective alternatives better. RELEVANCE: The
dependent on home mechanical ventilation (ventilator-users) and aim of our trial was to assess whether interval exercise is not
less effective than high intensity continuous exercise, but tolerated Research Report Poster Display
better by patients with severe COPD. PARTICIPANTS: 98 patients 02-11 Tuesday 5 June 15:30
with severe COPD. Publicly funded inpatient rehabilitation. COPD VCEC Exhibit Hall B & C
as defined by FEV1/FVC < 70% predicted, FEV1 < 50% predicted NEUROMUSCULAR ELECTRICAL STIMULATION TO
after bronchodilation corresponding to Global Initiative for Chronic THE LOWER EXTREMITY AFTER CARDIAC SURGERY:
Obstructive Lung Disease (GOLD) stage III-IV and German as first A RANDOMIZED CONTROLLED TRIAL
or daily language. Exclusion criteria included cardiovascular, mus-
Kamiya M1 , Yamada S2 , Yagi R1 , Nakagawa M1 , Ohno O1 ,
culoskelettal or neurological disorders that inhibit physical exercise
Watanabe T1 ; 1 Toyohashi Municipal Hospital; 2 Nagoya University
or the performance of exercise tests, as described previously. We
also excluded patients who had a diagnosis of cancer (excluding PURPOSE: The purpose of this study was to investigate the muscle
skin cancers) within the last two years and were undergoing current strengthening effect of neuromuscular electrical stimulation (ES) to
treatment. METHODS: Randomized, blinded (outcome assessment) the lower extremity (L/E) muscles in patients after cardiac surgery.
non-inferiority trial. 12-15 supervised interval exercise or high RELEVANCE: In the acute phase of rehabilitation of the patients
intensity continuous exercise sessions followed by home exercise. after cardiac surgery, they occasionally complain of fatigue in the
All patients followed an inpatient respiratory rehabilitation for three L/E or unstable walking, although they have no trouble in the chest.
weeks followed by individually prescribed home-based exercise. Then we considered that a muscle strengthening exercise (M.S.E)
Apart from the exercise program, the rehabilitation program was might be effective for these symptoms. However, methods of a
identical for both groups and included breathing therapy, relaxation M.S.E for these patients have not been reported. PARTICIPANTS: 19
therapy, guided walking tours and patient education. Primary patients who had undergone cardiac surgery at Toyohashi municipal
outcomes were health-related quality of life using the Chronic hospital (8 females and 11 males; mean age of 63.1±8.6 y/o; 12
Respiratory Questionnaire (CRQ, summary scores from 1 [most CABG surgery, 6 valve replacement, 1 left atrial myxoma extraction)
severe impairment] to 7 by domain) after five weeks and adherence were included in this study. METHODS: We studied the patients
to protocols. Secondary outcomes included exercise tests such in a single-blind, randomized controlled trial. The patients were
as Six-minute walking distance (SMWD). ANALYSIS: We used assigned either to the control group (standard cardiac rehabilitation
the confidence interval approach as recommended for equivalence program)or to the ES group (standard cardiac rehabilitation program
and non-inferiority trials. We established non-inferiority of interval plus ES). As to the ES protocol, a biphasic symmetric pulsatile
exercise if the point estimates and their 95% confidence intervals for current, 200 msec pulse width, and a 20-pps frequency were used.
differences between change scores of the continuous and interval The amplitude was increased to the maximum value tolerated by
exercise group was smaller than the a priori determined boundary each of the patients. The muscle contraction/relaxation time ratio
of clinical equivalence, which we set around the minimal important was 1/1. The treatment time was 60 minutes/day, and performed 5
difference (0.5 for CRQ31, 45 meters for SMWD39 and 8 for days a week. In the ES group, quadriceps (Q) and gastrocnemius
FT40). We used both intention-to-treat and per-protocol analysis. (G) muscles of both legs were stimulated. The maximum isometric
We analysed exercise tolerance by comparing the number of breaks muscle forces were evaluated pre and post the hospital cardiac
between groups using the Mann-Whitney U-test and the proportion rehabilitation program by using a hand held dynamometer. Vital
of patients achieving target exercise using the chi square test. signs such as electrocardiogram (ECG), heart rate (HR), and blood
RESULTS: Both groups experienced large improvements in HRQL pressure (BP) were monitored during ES and analyzed. This study
(increase of CRQ scores of 1.00 [0.98 SD] for interval and 1.02 design was approved by the Toyohashi municipal hospital ethics
[1.05 SD] for continuous exercise group). Adjusted between-group committee, and written informed consent was obtained from the
differences (−0.05 [95% CI −0.42-0.32] for CRQ total scores and patients. ANALYSIS: Values are expressed as mean±SD. Normally
3.4 meters [95% CI −21.7–28.6] for six-minute walking distance) distributed paired data were compared using a paired t-test. A value
were within the a priori defined boundaries of non-inferiority (0.5 of p < 0.05 was considered statistically significant. RESULTS: In the
for CRQ and 45 meters for six-minute walking distance). 47.9% of ES group, small increases were observed for the maximum Q force,
patients with interval exercise were able to adhere to the protocol but the values did not reach statistical significance from 4.2±0.3 to
versus 24.0% with continuous exercise (difference 23.9%, 95% CI 4.4±0.2[N/Kg]. The maximum G force increased significantly from
5.0-42.8%, P = 0.014). The median number of unintended breaks 4.0±0.4 to 5.5±0.4[N/Kg]. On the other hand, in the control group,
1 minute during supervised rehabilitation was 2 (interquartile a significant decrease was seen in both the maximum Q force from
range 0-16) for the interval exercise and 11 (2-26) for the 4.0±0.2 to 3.4±0.3[N/Kg] and G force from 4.2±0.4 to 3.5±0.4[N/Kg]
continuous exercise group (P = 0.023). CONCLUSIONS: Interval is (p < 0.05). There were no remarkable changes in the vital signs of the
not less effective than continuous exercise, but tolerated better. patients during ES. CONCLUSIONS: This study showed that ES to
Clinicians and patients can choose either of the two exercise the L/E muscles in combination with a standard cardiac rehabilitation
modalities to initiate physical exercise. IMPLICATIONS: For physical program was feasible and might be effective in speeding recovery
therapy practice KEYWORDS: COPD, interval exercise, non- of the muscle forces in the short term. As to the side effects of
inferiority trial,. FUNDING ACKNOWLEDGEMENTS: Astra/Zeneca ES to the cardiac function, it was conceivable that an excessive
Switzerland (unrestricted grant), BoehringerIngelheim Switzerland load was not imposed on the heart during ES. IMPLICATIONS:
(unrestricted grant) and Klinik Barmelweid. The funding sources ES to the L/E muscles might be beneficial and safe in the
provided unrestricted grants and did not influence the planning, acute phase of rehabilitation in the patients after cardiac surgery.
conduct and analyses of the trial or the preparation of the manuscript. KEYWORDS: cardiac surgery, neuromuscular electrical stimulation,
CONTACT: [email protected] cardiac rehabilitation. FUNDING ACKNOWLEDGEMENTS: The
ETHICS COMMITTEE: The ethics committee of the Kantonsspital work was unfunded. CONTACT: [email protected]
Aarau (Aargau, Switzerland) approved the study protocol. ETHICS COMMITTEE: This study design was approved by the
Toyohashi municipal hospital ethics committee.
CLINICAL EDUCATOR AND STUDENT EXPERIENCES OF EFFECTS OF HEAT STRESS ON MUSCLE FIBERS DAMAGE IN
PAIRED AND NON-PAIRED CLINICAL PLACEMENTS RELOADING AFTER IMMOBILIZED RAT SOLEUS MUSCLE
O’Connor A, Sainsbury D, Coote S; Department of Physiotherapy, Banno Y1 , Okita M1 , Inoue T2 , Suzuki S2 ; 1 Faculty of Care and
School of Health Sciences, University of Limerick, Limerick, Ireland Rehabilitaion, Seijoh University, Tokai, Japan; 2 Program in Physical
and Occupational Therapy Graduate School of Health Sciences
PURPOSE: Paired clinical placements have been strongly en- Nagoya University, Nagoya, Japan
couraged by educational institutions in Ireland recently due to
PURPOSE: The purpose of this study was to determine whether
a shortage of student placements. Evidence for the success
heat stress is preventive for muscle fiber injury induced by reloading
of paired placements in the Irish system is limited due to the
after immobilized rat soleus muscle. RELEVANCE: One of the
relatively recent introduction of this model. The purpose of this main programs of physical therapy is thermotherapy, but its efficacy
study was to investigate differences perceived by students and is still not clear. This study provides new information on the
clinical educators between paired and non-paired placements using effects of thermotherapy on muscle tissue. PARTICIPANTS: Twenty
satisfaction questionnaires completed at the end of placement. male Wistar rats, aged 8-week-old, were used. Rats were divided
RELEVANCE: Reported advantages in current literature relating to randomly into the control (C, n=5), control with heat stress (CH,
paired placements include reduced staff and resources required n=5), immobilized followed by normal recovery (IR, n=5), and
for supervison of students, and decreased supervision time for immobilized followed by heat stress before reloading (IH, n=5)
clinical educators due to fewer superficial questions from students groups. METHODS: The experimental protocol was approved by
as these are resolved through peer learning sessions. The value of the Ethics Review Committee for Animal Experimentation at our
shared learning experiences have been reported by students who institution. Bilateral ankles of each rat in the IR and IH group were
have experienced paired placements. The results of this study will fixed in full planter flexion with a plaster cast for 4 weeks. Immediately
provide more insight about clinical placement models as well as after the 4 weeks immobilized, reloading was allowed to the rats in
increasing the existing database of knowledge. PARTICIPANTS: 222 the IR group. The rats in the CH and IH group were first exposed to
completed student feedback questionnaires (131 paired and 91 non- heat stress (41ºC for 60 min) in an incubator under anesthesia 2 days
paired) and 133 completed clinical educator feedback questionnaires before the reloading. ANALYSIS: In all groups, both soleus muscles
(42 from paired model, 91 from non-paired model) were included were extracted and weighed. Frozen sections of these muscles
for analysis. METHODS: The satisfaction questionnaires were were stained with hematoxylin-eosin, the number of necrotic muscle
essentially designed by the University Clinical Placement Co- fibers was counted, and muscle fiber diameters were measured.
ordinator as satisfaction questionnaires relating to several aspects of Moreover, Hsp70 contents in muscle tissue were measured by using
the Western blot method. RESULTS: The number of necrotic muscle
the clinical placement. This questionnaire was routinely administered
fibers was significantly increased in IR compared with C and CH
to all student and clinical educators at the end of placement
groups. In IH group, however, the number of necrotic fibers was
regardless of which placement model was used and then returned to
less than IR group. The mean muscle fiber diameter in IH group
the university for analysis. Each statement on the questionnaire was
decreased significantly compared with C, CH, and IR groups. HSP70
scored from zero to ten, where zero represented disagreement with levels were significantly greater in CH and IH groups compared
the statement and ten represented agreement with the statement. with C and IR groups. CONCLUSIONS: These finding suggest that
Statements chosen for analysis related to personal enjoyment of heat stress prior to reloading induces expression of HSP70 and
the placement for both student and clinical educator, whether the leads to protective effect against soleus muscle injury induced by
placement provided a beneficial learning experience for the clinical reloading after immobilization. IMPLICATIONS: The results of the
educator and topics regarding supervision provision and time devoted present study may be provided new information on the effects of
to problem solving for the students. ANALYSIS: The independent thermotherapy on muscle injury. KEYWORDS: Reloading, Muscle
sample T-test was used to determine any differences between fibers injury, Heat stress. FUNDING ACKNOWLEDGEMENTS: This
paired and non-paired placements from the selected responses of research was supported in part a grant-in-aid for Scientific Research
the clinical educator questionnaire and the student questionnaire. from the Ministry of Education, Science, Sports and Culture of Japan
RESULTS: Analysis of student and clinical educator feedback (grant no. 16700409). CONTACT: [email protected]
showed no significant differences between paired and non-paired ETHICS COMMITTEE: The experimental protocol was approved by
clinical placement model experiences. Furthermore there was no the Ethics Review Committee for Animal Experimentation at Seijoh
significant difference between paired and non-paired experiences University.
in outpatient settings (adult and paediatrics) and no difference
between paired and unpaired in a mixed inpatient/ outpatient setting. Research Report Poster Display
CONCLUSIONS: More collaborative research is needed in this area
of clinical education to determine which teaching model is superior. VCEC Exhibit Hall B & C
A comprehensive questionnaire including all pertinent educational
issues relating to clinical placements would assist this process. INFLUENCE OF PULSE DURATION IN SENSORIAL
DISCOMFORT DURING THE NEUROMUSCULAR ELECTRICAL
Results of this study may have been influenced by some paired
STIMULATION
placement sites that conducted placements as a 1:1 model although
theoretically offering a 2:1 placement. In other words, students Murazawa M1 , Rodrigues T1 , Liebano R1,2 ; 1 Physical Therapy
continued to work independently of each other and did not experience Department, Universidade Cidade de São Paulo, Brazil; 2 Plastic
the shared learning opportunities of a paired placement model. Surgery Division, Surgery Department, Universidade Federal de
IMPLICATIONS: The results found have highlighted the need for São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
more research related to clinical education models and also that, for PURPOSE: The aim of this study was to evaluate the sensorial
analysis of these models to be valid, then both clinicians and students discomfort during the Neuromuscular Electrical Stimulation (NMES)
must follow the guidelines of that model. KEYWORDS: Clinical with different pulse durations through of the NMES in the peak
placement, Physiotherapy education,teaching models. FUNDING torque of the quadriceps muscle. RELEVANCE: Check the relation
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] of pulse duration and the sensorial discomfort of NMES to optimize
the parameters utilized in this type of stimulation. PARTICIPANTS: trend to increase in all groups CONCLUSIONS: All groups showed
Twenty healthy women were included as volunteers with age significant gains in flexibility after the four-week program; the group
between 18 and 22 years old, without any history of neuromuscular who did the stretch exercises three times a week showed statistically
disease, cardiovascular disease or knee disorders participated in significant greater improvement in flexibility than the group who did
the study. METHODS: The maximum voluntary isometric contraction the exercises once a week; and showed a trend to obtain greater
(MVIC) test of the quadriceps femoris muscle was performed in all flexibility gain when compared to the group who did the stretching
volunteers at an angle of 60 degrees of knee flexion in an isokinetic 5 times a week; during maximum isometric contraction after the
computerized dynamometer. After that, each one was subjected to stretching program there was a trend to increased EMG activity
NMES in three different pulse durations (400, 700 and 1000ms) in all groups. IMPLICATIONS: Global stretching exercises may be
in order to reach 40% of the peak torque of a MVIC then the added in the physical therapy treatments, especially to improve
subjects were asked to express their perceived discomfort on a Visual the range of motion and flexibility. KEYWORDS: static stretching,
Analog Scale (VAS) 10 cm. ANALYSIS: To determine which pulse electromyography, flexibility. FUNDING ACKNOWLEDGEMENTS:
duration were more comfort, the score of sensorial discomfort were FAPESP. CONTACT: [email protected]
subjected to a repeated measures Analysis of Variance (ANOVA) ETHICS COMMITTEE: Comitê de Ética para Análise de Projetos de
followed by Tukey-Kramer Multiple Comparisons Test RESULTS: The Pesquisa (CAPPesq, Ethics Committee for the Analysis of Research
sensorial discomfort with the different pulse duration of 400, 700 Projects)
and 1000ms were respectively in average of 4.92, 5.62 and 6.22
on VAS. The results showed that 400 X 700ms (P > 0.05 N.S), 400
X 1000ms (P < 0.001), 700ms X 1000 (P < 0.05). CONCLUSIONS:
The pulse of 1000ms presents higher index of discomfort compared 09-19 Tuesday 5 June 15:30
with 400 and 700ms. There was no significant statistic difference VCEC Exhibit Hall B & C
between 400 and 700ms. IMPLICATIONS: When the comfort is the ESTIMATION AND SEPARATION OF JOINT TORQUE USING
main factor to be considered it is suggested to use lower pulse SURFACE ELECTROMYOGRAMS
duration. KEYWORDS: NMES, Peak torque, Quadriceps muscle. Tsurusaki T1 , Nishimura H2 , Shitani Y3 , Kajiki M4 ; 1 Graduate
FUNDING ACKNOWLEDGEMENTS: Universidade Cidade de São School of Health Sciences, Nagasaki University; 2 NagasakiYurino
Paulo (UNICID). CONTACT: [email protected] Hospital; 3 Nagasaki KITA Hospital; 4 Osaka Rehabilitation Hospital
ETHICS COMMITTEE: It was approved by Universidade Cidade de
São Paulo ethics committee PURPOSE: Joint torque (JTQ) can be evaluated by summation of
the torques that are generated from several muscles (MTQ). In a
simpler model, joint torque becomes a subtraction of agonist and
Research Report Poster Display antagonist muscle generative torque. The purpose of this study was
09-15 Tuesday 5 June 15:30 to estimate JTQ and MTQ from surface electromyograms (SEMG).
VCEC Exhibit Hall B & C RELEVANCE: Muscle strength assessment is critical to the outcome
EFFECT OF THE NUMBER OF WEEKLY REPETITIONS OF of physical therapy. However, the measured power is JTQ and
STATIC STRETCHING ONTO ISCHIOTIBIAL AND TRICEPS not MTQ. The results of the present study will enable muscle
SURAE ELECTROMYOGRAPHY AND FLEXIBILITY strength assessment under conditions of uncontrolled behavior by
Marques A, Cabral C, Vasconcelos A, Sacco I; School of Medicine estimating JTQ and MTQ from SEMG. PARTICIPANTS: Five healthy
of the University of São Paulo, São Paulo, Brazil males (average age 22.8 y, S.D., 3.0 y) provided written, informed
consent to participate in the study. We studied the elbow joint of
PURPOSE: To compare the effect of the number of weekly repetitions the dominant arm of all the participants. METHODS: The volunteers
of a static segment stretch program on electromyography activity performed (1) maximum voluntary contractions (MVCs), (2) isometric
and flexibility of shortened ischiotibials and triceps surae muscles. contraction of the elbow joint to flexion/extension to a target (20%,
RELEVANCE: Stretching exercises are always applied in the physical 40%, 60% and 80% MVC) and (3) isometric contraction of the elbow
rehabilitation to achieve the best results, but there are few studies joint to flexion/extension with extensor/flexor contraction. All tasks
to compare static segment stretch program. Though duration and were executed with the spine and shoulder joint abducted 90º, the
number of daily repetitions of stretching have been extensively elbow joint flexed 90º and the forearm fully supinated. Fourteen
studied, weekly frequencies have not; also, electromyography (EMG) SEMGs from superficial muscles of the upper extremity and JTQ
activity has seldom if ever been measured during stretching were recorded in a personal computer (sampled at 1 kHz) using
PARTICIPANTS: Thirty one healthy subjects (18-30 years old), with the BIO-amp system (NF Corporation, JAPAN). ANALYSIS: Data
shortened ischiotibials and triceps surae, were randomly distributed were analyzed off-line using MATLAB with the Wavelet toolbox (The
into three groups: Group1 (G1) performed the stretch exercises once MathWorks Inc., Natick, MA, USA). Parameters of SEMG signals are
a week, Group 3 (G3) three times a week, and Group 5 (G5), five based on scalograms (the square of the discrete wavelet transform)
times a week. given by the University of São Paulo. METHODS: estimated using the Daubechies 5 wavelet (DB5) at decomposition
Flexibility was assessed by the finger tip-to-floor test before and level 5. Prediction equations for JTQ estimation were calculated
after the stretching program. Electromyography data were collected by multi-regression analysis of data from each of tasks 2 and 3.
before and after the program during stretching and during maximum The dependent variable was JTQ and SEMG parameters were
isometric contraction (MIC). Before its realization, this study had the independent variables. One prediction equation was selected for
ethics approval given by the University of São Paulo. ANALYSIS: each task as follows: (a) statistical significance, (b) the SEMG from
All variables were analysed as to normality using Shapiro-Wilk’s the same muscle, (c) sign of coefficient and (d) one or more flexor
test. When data distribution was normal, variables between groups and extensor muscles. Thereafter, the correlation between the actual
were compared using one-way analysis of variance (ANOVA) with value of task 2/task 3 and the assessed value of task 3/task 2
post hoc Scheffé tests; and that of data pre and post-stretching was examined. RESULTS: We found that JTQ can be estimated
program, by the paired t-test. For non-parametric data, a Kruskal- from SEMG (p < 0.001), the actual and assessed values significantly
Wallis test (followed by a post hoc Mann-Whitney U test) was used correlated (R2 = 0.831) and prediction equations can be expressed by
to compare variables between the groups, and Wilcoxon’s for pre factors generated by flexor and extensor muscles. CONCLUSIONS:
and post-program data (a<0.05). RESULTS: Group 3 obtained larger To measure tension generated by muscle in vivo and to measure
flexibility gain than Group 1 (p = 0.018) and similar to that of Group muscular strength under uncontrolled behavior is difficult. Not only
5 (p = 0.3). EMG during stretching tended to decrease in Group can JTQ be estimated by SEMG, it can be separated into some
3 and Group 5 after the program. EMG during MIC showed a MTQs. Further study is required to establish this analysis method.
IMPLICATIONS: The SEMG is useful for physical therapy, and it Research Report Poster Display
also has a much broader range of applications such as muscle 11-03 Tuesday 5 June 15:30
strength assessment under conditions of uncontrolled behavior. VCEC Exhibit Hall B & C
KEYWORDS: Joint Torque, Surface Electromyograms, Prediction RELATIONSHIP BETWEEN A ROUTINE WALKING PROGRAM
Equation. FUNDING ACKNOWLEDGEMENTS: The funding source AND EYE HEALTH IN INDIVIDUALS WITH TYPE 2 DIABETES
of this study was the General Research Fund of Nagasaki University Stern D, Nof L; Nova Southeastern University, Ft. Lauderdale,
(Nagasaki, JAPAN). CONTACT: [email protected] FL, USA
PURPOSE: The purpose was to investigate whether there is a
Research Report Poster Display relationship between a walking program and eye health in individuals
09-23 Tuesday 5 June 15:30 with Diabetes Type 2. Diabetes is a multi-system disease, impacting
VCEC Exhibit Hall B & C all body systems including the eye and vision. No studies could be
CARDIAC AUTONOMIC FUNCTION AT REST AND PHYSICAL identified in the literature that examined this relationship. A routine
CAPACITY OF INDIVIDUALS WITH PROFESSIONAL ACTIVITY walking program was hypothesized as a prevention tool for contin-
OF LOW AND HIGH ENERGY EXPENSE uous deterioration of eye health in type 2 diabetes. RELEVANCE:
Paschoal M, Junqueira M, Trevizan P, Bloes M; Pontifı́cia Physical therapy guidance and monitoring as preventive and disease
Universidade Católica de Campinas management strategies for individuals with diabetes are consistent
with the APTA Guide to Physical Therapist Practice. PARTICIPANTS:
PURPOSE: Different professional activities are recognized for The 20 subjects were 40 years of age or older, had history of Type
demanding high and low energy expense to be performed, and 2 diabetes, were: English speaking and read at 20/60 or less in the
also to promote cardiac and metabolic changes with possible best corrected eye, willing to participate for 9 months, independent
health interferences. RELEVANCE: This study it evaluated if the ambulators with or without a device and had physician permission
normal activity of professional work could promote cardiac autonomic to participate. Exclusion criteria: oxygen dependency, history of MI,
adaptative changes that could be detected in rest condition by heart angina, intermittent claudication. METHODS: This pilot study used
rate variability (HRV) analysis, and during effort, by cardiorrespiratory a one group pre and post-test design. Walking tolerance levels and
effort tests. PARTICIPANTS: Healthy individuals (n=20) were studied: eye health were assessed at entry and at nine months. Participants
ten mailmen – M (5 men and 5 women, with mean age of 38.1 were instructed in walking programs based on a history and
+/− 4.8 years old), that walk about 3 to 4 hour per day, and 10 completion of the SF 36, Rate of Perceived Exertion (RPE),Timed
secretaries – S (5 men and 5 women, with mean age of 36.1+/− Up and Go (TUG), vital signs, BMI, lower extremity sensory
5.1 years old). All of them have worked for at least 5 years in the assessment and 6-minute walk test. Eye health was determined
same professional activity, and they haven’t performed any regular through history and opthalmic examination. Subjects were instructed
physical activity despite work in the last six months. METHODS: To in appropriate walking programs and used pedometers to track
study the cardiac autonomic contidions at rest, the cardiac beats performance and compliance throughout the 9 months. ANALYSIS:
were recorded (Polar Heart Rate Monitor S810) at morning, during Logistic regression analyses were conducted separately on change
10min after a regular night of sleep, and the HRV was analysed at of walking tolerance and eye health. To explore the strength and
time and frequency domains using the Polar Precision Performance direction of relationship between the two major outcomes (change
software. The Bruce’s modified protocol test (Inbrasport Super ATL of fitness level and change of eye health), Spearman correlational
treadmil) was applied to study the volunteer’s physical capacity analysis was used. A correlation coefficient r = 0.4 was considered
and performed from rest until 80% of HRmax. ANALYSIS: The statistical significant for this study. Wilcoxin Signed – Ranks test
Student T test was used with significance of p < 0.05. RESULTS: compared pre and post-test SF-36 scores to measure perceived
There was no difference among the two groups’ HRV analysis. sense of well-being. Paired t- tests compared TUG results, six-
Otherwise, all variables obtained during Bruce’s protocol showed minute walk test, and anthropometric measurements. Opthalmic
significative differences between the values of the groups. The results were recorded using the appropriate units of measure for
time to reach 80% of HRmax was 19:00min (M) and 15:03min each test. Diabetic retinopathy severity was graded according to
(S) with p = 0.006, also with a significative difference (p < 0.05) to a protocol similar to that used in the Early Treatment Diabetic
total distance from rest until 80%HRmax: 1365.0 and 895.0 meters, Retinopathy Study (ETDRS). For all analyses, significance was
respectively to M and S groups. The VO2 peak was also different determined at the p 0.05 level. Correlation analysis was used
(p < 0.05) between the groups, with 56.0 ml/O2/Kg/min for M and to compare the pre and posttest findings for exercise tolerance
45.5 ml/O2/Kg/min for S group. CONCLUSIONS: We can conclude and fitness tolerance and ophthalmic findings. RESULTS: Routine
that the adaptative differences in the cardiovascular system resultant walking was found to be effective in management of Type 2
of the professional activity could not be demonstrated when the diabetes. Based on self report, HgAIC levels were better controlled,
volunteers were in rest, however they could be easily shown when TUG speeds decreased, distance and speed on the 6 minute
they were submitted to an effort test. IMPLICATIONS: Precocious walk test increased, RPE decreased, individuals with a history
detention of reduction of the decurrent cardiorrespiratória functional of falls reported a decrease, and there was improvement in self
capacity of the professional activity, making possible that injunctions perceived quality of life, although not statistically significant. While
and therapeutical are carried through. KEYWORDS: effort test, heart participants improved in walking tolerance, ophthalmic results were
rate variability, physical activity. FUNDING ACKNOWLEDGEMENTS: inclusive. CONCLUSIONS: Further research with a larger population
The funding acknowledgements was support by CNPq. CONTACT: is recommended over a longer period of time. IMPLICATIONS:
[email protected] Physical Therapy is effective in the management of diabetes Type
ETHICS COMMITTEE: Ethics committee of Pontifı́cia Universidade 2. KEYWORDS: Diabetes; Physical therapy; Walking. FUNDING
Católica de Campinas.Protocol number:413/05 ACKNOWLEDGEMENTS: President’s Grant, Nova Southeastern
University, Ft. Lauderdale, FL. CONTACT: [email protected]
TEST-RETEST RELIABILITY OF THE STAR EXCURSION DETERMINATION OF SWAY AREA BY FOURIER ANALYSIS
BALANCE TEST IN A GERIATRIC POPULATION Sevsek F, Rugelj D, Bartol M; University of Ljubljana, University
Stockert B, Barakatt E; Department of Physical Therapy, California College of Health Studies, Ljubljana, Slovenia
State University, Sacramento, California, United States
PURPOSE: To establish the best method to calculate the sway
PURPOSE: The purpose of this study was to: 1) determine the area for impeded stability conditions. RELEVANCE: Measurement
test-retest reliability of the Star Excursion Balance (Star)Test in of the centre of pressure (COP) movement with a force platform
subjects>59 years old; 2) compare the findings to data collected is a standard procedure for assessment of postural stability during
on 20-39 yo subjects; and 3) determine the impact of subject rehabilitation. However, for given conditions, it is very important
height on test performance. RELEVANCE: The ability to maintain to select the most appropriate analysis of the trajectory – from
balance during activities of daily living is essential for mantaining measured data sway area, total trajectory length, velocity, principal
an independent lifestyle. The Star Test examines balance in single axes etc. are usually calculated. PARTICIPANTS: 25 healthy females
leg stance. The reliability and validity of the Star Test has not aged 21.4±1.7 years. METHODS: On force platform (Kistler 9286AA)
been established in a geriatric population. PARTICIPANTS: All each participant performed six tests: standing with feet together
subjects were community dwelling adults able to stand and walk on a hard and on a soft (compliant) surface, with open and
independently. Subjects were excluded if they had a condition or took closed eyes and watching projection of randomly moving objects
a medication known to impair balance. Subjects in the “Geriatric” on a screen. ANALYSIS: Data were analysed with a specially
group (n=42; 28 females, 14 males) were 60-92 years old (x=73.3) developed software (computer programmes written in Fortran, C
and ranged in height from 60-75 inches (x=65.7). Subjects in the and PHP). After optional smoothing, the outline of the data points
“Young” group (n=25; 16 females, 9 males) were 23-38 years old of each measurement was determined. It was expressed in polar
(x=26.3) and ranged in height from 61-76 inches (x=67.0). The data coordinates to which Fourier series was fitted by solving (using
on the Young Group were collected in a previous study. METHODS: LU decomposition) the linear system obtained from the normal
Informed consent was obtained from all subjects. They were placed equations. From the resulting Fourier coefficients the sway area, its
in the center of the Star Grid and stood on one lower extremity shape and principal axes were determined. All other parameters,
(LE). Subjects reached as far as possible in 5 specific directions including the area obtained by the principal component analysis,
with the opposite LE. Both LEs were tested (10 movements; 3 trials were determined by well established procedures. T-test was used to
each). Reach was quantified by measuring the furthest excursion of compare the results of different experimental conditions. RESULTS:
the great toe. At least 1 week separated the first and second test The area of the calculated sway trajectories statistically significantly
sessions. ANALYSIS: Data were analyzed using SPSS v14.0. The 3 (p < 0.001) increased when closing the eyes while standing on a
trials for each movement were converted to a mean for each subject. hard surface. Compliant surface and visual disturbances resulted
Test-retest reliability was estimated with an Intraclass Correlation in additional increase in all cases, whereas the influence of the
Coefficient (ICC) calculated for each movement and the test overall. former was much larger. Similar dependence was also recorded
A t-test was used to compare mean reach between the Young and in the length of COP trajectory. Paired t-test showed no significant
Geriatric groups. The relationship between subject height, reach changes in principal directions. CONCLUSIONS: Our results show
and normalized reach (reach expressed as a percentage of subject that the sway area, as calculated from the Fourier coefficients
height) was examined using a Pearson product-moment coefficient of of its outline, discriminates well different stability conditions. The
correlation. RESULTS: Test-retest reliability estimates (ICCs) ranged procedure seems to be best in cases where a small number of large
from 0.91-0.95. Reach and normalized reach were significantly lower COP movements are important. IMPLICATIONS: When stability is
in the Geriatric group for each movement (p < 0.001). Subject height disturbed by external or internal factors, the Fourier analysis of the
was correlated to reach for all movements (p < 0.05). However, outline of measured COP data shows good discriminative power
subject height was not correlated with normalized reach for any and gives additional information. KEYWORDS: force platform, sway
movement. CONCLUSIONS: The Star Test has excellent test- area, Fourier analysis. FUNDING ACKNOWLEDGEMENTS: ARRS
retest reliability in a geriatric population. Reach and normalized contract J3-6423-0382-06. CONTACT: [email protected]
reach in the Geriatric group were significantly less than in the ETHICS COMMITTEE: State commitee for medical ethics of Slovenia
Young group. While reach was significantly correlated to subject
height, normalized reach was not correlated to subject height,
i.e. subject height did not predict test performance when the Research Report Poster Display
data were normalized to subject height. IMPLICATIONS: The Star 12-23 Tuesday 5 June 15:30
Excursion Balance Test has excellent test-retest reliability for use VCEC Exhibit Hall B & C
as a clinical instrument. Subject height does not predict test MUSCLE RECRUITMENT PATTERNS IN RESPONSE TO
performance when data are normalized to subject height. These BALANCE CHALLENGE: A COMPARATIVE STUDY
findings may allow for the development of performance standards
Hrka-Nikolic B1 , Anderson G; 1 Departments of Kinesiology and
for the Star Test, regardless of subject height or age. The validity
Physical Education, University College of the Fraser Valley,
of the Star Test has not been established. KEYWORDS: dynamic
Abbotsfod BC, Canada
balance, Star Excursion Balance Test; geriatric; screening. FUNDING
ACKNOWLEDGEMENTS: none. CONTACT: [email protected] PURPOSE: Prescription of exercise performed on unstable surfaces
ETHICS COMMITTEE: Commmittee for the Protection of Human is common practice in the rehabilitation of many musculoskeletal
Subjects; California State University, Sacrmento, CA., US. injuries, although the training variables and the muscle response to
such environments are not well understood. This study examined
the influence of training state, support surface stability, base of
support and vision on the muscular response and recruitment
pattern of muscles in response to exercise performed on stable
and unstable surfaces. RELEVANCE: While common practice, little
evidence supports the use of unstable surfaces, limited vision
and or manipulation of base of support as training variables to
consider when designing a progressive rehabilitation program for
lower body injury. PARTICIPANTS: 15 highly trained and 15 untrained of the direction of passive movement (TDDPM) has been proposed
individuals held static balanced positions for five seconds in four for research purposes in experimental environments (McCloskey,
conditions (two-foot stance/eyes open; one-foot stance/eyes open; 1978). RELEVANCE: However, both approaches lack a precise,
two-foot stance/eyes closed; one-foot stance/eyes closed) without reliable and sensitive tool for the quantification of proprioception.
aid, on three different stability surfaces (floor, BOSU dome, and In addition, at the lower limb, the tests usually performed in non
BOSU platform). METHODS: Muscle electrical activity (EMG) was weight bearing condition, should also be performed during weight
recorded using surface electromyography as measured using a Grass bearing to be representative of a more functional position such as
Model 10A evoked potential system. EMG recordings were obtained standing. The objectives were (1) to evaluate the test-retest reliability
from each of the soleus, biceps femoris, erector spinae, internal of the TDDPM of the knee, with and without weight bearing, using
oblique and rectus abdominis muscles. ANALYSIS: Descriptive an apparatus especially designed by our research team and (2) to
statistics and graphical representations were used to compare compare these measurements during slow movements in both flexion
the muscle response to each condition for each of the highly and extension at different starting angles. PARTICIPANTS: Fifteen
trained and untrained subjects because of the large numbers of healthy young subjects (mean±SD: 26±4years) were evaluated at
contrasts. For exploratory purposes, uncorrected, simple T-tests 0.3º/s in two sessions (2 to 4 days interval) in two conditions (sitting
were used to examine differences between trained and untrained and standing). METHODS: The subjects had to press a button as
subjects. RESULTS: EMG activity increased across both groups soon as they felt the direction of the movement of the knee. The joint
in response to increased instability when moving from the floor, excursion between the initiation of motion and subject perception
to BOSU dome, to BOSU platform, and in response to reduced was expressed in degrees. The starting angles for assessment of
base of support (moving from two feet to one foot stance). TDDPM were 15º, 30º and 45º of knee flexion sitting and 15º and
Reduction in base of support increased core muscle activation in 30º of knee flexion standing. Each movement was evaluated 4 times
the untrained, while increasing the lower body stabilizing muscles in a counterbalanced random order for the direction of movement and
in the trained subjects. Visual input was only a factor on unstable starting angles for a total of 24 trials in sitting and 16 trials standing
surfaces with increased muscle activity in the untrained when moving for each session. ANALYSIS: Test-retest reliability between the two
to 2 feet, eyes closed on the BOSU dome, while the trained sessions was determined by calculating the intraclass correlation
subjects increased muscle activity only after reducing the base of coefficients (ICC). A three-way ANOVA (knee angle, direction of
support to one foot with eyes closed. CONCLUSIONS: Evidence movement and side) was used for each condition, followed by
of co-activation of core stabilizing and prime mover muscles were Tukey’s Post-hoc test. RESULTS: Similar and reliable measurements
evident in the untrained population demonstrating inefficient muscle were found for the two sessions, whether the condition was without
coordination and motor control. Highly trained individuals responded (ICC=0.78±0.16) or with (ICC=0.78±0.12) weight bearing. Moreover,
with evidence of a bottom up pattern utilizing an ankle strategy the TDDPM was similar in both legs. In sitting, the TDDPM towards
with high soleus and biceps femoris activity, suggesting a proper extension was smaller (p < 0.05) for the starting position at 15º
neurological stimulus and muscle response. Untrained individuals (0.50º±0.20) compared to the 45º starting position (0.84º±0.62). In
demonstrated increased core muscle activation and a top-down standing, the TDDPM towards extension was also smaller (p < 0.05)
strategy that is less effective. Balance training should include all for the starting position at 15º (1.00º±0.64) compared to the
combinations of conditions starting with a stable surface with a wide 30º starting position (1.28º±0.57). Inversely, when the knee was
base of support and with full visual feedback. Progress in balance displaced towards flexion in standing, the TDDPM was smaller
training should include narrowing of the base of support initially (p < 0.05) at 30º (0.76º±0.27) compared to 15º starting position
with eyes open and then with eyes closed, progressing to two feet, (0.91º±0.50). CONCLUSIONS: The TDDPM measured with this
eyes open on an unstable surface, such as the dome side of a new apparatus is reliable and sensitive to the starting angle of
BOSU ball. IMPLICATIONS: Ethical approval was obtained from the the movement for both sitting and standing conditions. Indeed, the
Research Ethics Committee of the University College of the Fraser TDDPM towards extension was smaller when the starting position
Valley. KEYWORDS: Progressive overload, vision, base of support, of the knee was at the maximum extension tested. In a similar way,
instability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: the TDDPM towards flexion was smaller when the starting position of
[email protected] the knee was at the maximum flexion tested. IMPLICATIONS: This
ETHICS COMMITTEE: Ethical approval was obtained from the reveals that the proprioceptive sensitivity at slow speed is optimal
Research Ethics Committee of the University College of the Fraser when the joint and muscular structures are under tension during
Valley, BC, Canada. a passive movement. KEYWORDS: knee, kinesthesia, lower limb
proprioception, weight bearing and non weight bearing condition,
passive movement. FUNDING ACKNOWLEDGEMENTS: This study
was supported by MENTOR – Programme de formation des IRSC
14-03 Tuesday 5 June 15:30 sur les troubles de la mobilité et de la posture. CONTACT:
VCEC Exhibit Hall B & C [email protected]
RELIABILITY AND SENSITIVITY OF LOWER LIMB ETHICS COMMITTEE: CRIR
PROPRIOCEPTION MEASURES USING THE THRESHOLD OF
DETECTION OF MOVEMENT DIRECTION AT SLOW SPEED
Requiao L1−3,5 , de Andrade Melo S1,4 , Marineau D1 , Dumoulin A1 , 14-07 Tuesday 5 June 15:30
Goyette M1 , Fuentes A3,5 , De Guise J3,5,6 , Forget R1,4 ; 1 Centre VCEC Exhibit Hall B & C
de recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal
métropolitain, Institut de réadaptation de Montréal (IRM), Québec, OBJECTIVE EVALUATION OF FINE MOTOR DEXTERITY OF
Canada; 2 Universidade Tuiuti do Paraná, Faculdade de Fisioterapia, THE HAND IN NORMAL HUMAN PARTICIPANTS
Curitiba, Brazil; 3 Faculté de Médecine – Programme Sciences Hammond E1 , Stzurm T1 , Otto C2 , Shay B1 ; 1 Department of Physical
biomédicales – Université de Montréal; 4 Ecole de réadaptation, Therapy, University of Manitoba, Winnipeg, Canada; 2 Electrical
Faculté de Médecine – Université de Montréal; 5 Laboratoire Engineering Department, University of Manitoba, Winnipeg, Canada
de recherche en imagerie et orthopédie, CRCHUM pavillon
PURPOSE: To develop a reliable test protocol and valid objective
Notre-Dame – Canada; 6 École de Technologie Supérieure – Canada
measure that can accurately and precisely quantify finger/hand
PURPOSE: This study aims at improving the measurement of function during manipulation of any object, independent of geometric
proprioception. The detection of the direction of passive movement and surface properties. RELEVANCE: Providing effective and
is widely used in clinical settings. On the other hand, the threshold objective ways to document manual dexterity and hand function
is a critical part of evidence-based practice in Physical Therapy. electrogoniometers (Biometrics Ltd, Blackwood, Gwent, UK) were
Clinical measures of finger-hand functions measure time to perform used to assess joint ROM: ankle joint (type XM110A) knee flexion
movements but do not directly measure the accuracy of movements (type XM180) and hip flexion (type XM180). The testing procedure
or grade movement performance or skill level. These tests while was standardised including the testing sequence, limb position,
helpful cannot evaluate motor control beyond simple insertion tasks. participant instructions, stabilization, ambient room temperature and
PARTICIPANTS: Twenty right handed participants, aged 20-50 were time of day of repeat measurements. The electrogoniometers were
recruited. Participants were excluded if there was a history of attached following the manufacturer’s guidelines. ANALYSIS: At each
upper extremity pathology with residual deficits, recent injury to the attendance and for each limb movement, the mean value from
right arm, cognitive impairment or neurological impairment affecting three repetitions was used for statistical analysis. All data sets were
balance, vision or coordination. METHODS: The Minnesota Rate of checked for normality using the Kolmogorov-Smirnov normality test
Manipulation Test (MRMT), Purdue Pegboard, O’Connor Tweezer using SPSS (v10.1). The reliability of the results was calculated
Dexterity test and Nine Hole Peg test were administered to each using intraclass correction coefficients (ICC) to assess the between
subject without the use of the index finger to simulate an amputation. visit repeatability. The standard error of measurement (SEM) was
Motor performance was then quantified during manipulation of a set also calculated. RESULTS: Measurements of total ankle ROM (from
of test objects using a computerized visual guided tracking task. Five full plantar flexion to full dorsiflexion) revealed excellent levels of
objects, ranging in weight and size which required the use of 2 or test retest reliability (ICC 0.97, SEM 3º). However, a preliminary
3 fingers were selected for this study. Subjects performed the test pilot study revealed problems in assessing end of range knee
with and without the use of the index finger. A cursor set into motion flexion and hip flexion, where large measurement errors (>20º) were
on the computer screen cued participants to move the object in a observed. To accurately record end of range measurement of knee
predetermined direction with the amplitude and frequency selected to flexion it proved necessary to re-align the electrogoniometer when
match normal function. The cursor moved in a predictable sinusoidal the participants were in full flexion. Using this method excellent
trajectory for 12 cycles. The miniBird (Ascension Technology) levels of test retest reliability were produced for the full, active,
miniature motion tracking sensor was attached to each object to range of knee flexion (ICC 0.91, SEM 4º). For the hip flexion, the
measure and record the 3D linear and angular motion of each object measurement error could not be reduced below 20º and therefore
at 100Hz. An electro-goniometer (Biometrics Ltd.) was attached to this measurement was excluded. CONCLUSIONS: Excellent test
record wrist motion. To establish the test-retest reliability all tests retest reliability was found when using flexible electrogoniometers
were repeated one week later. ANALYSIS: A cross correlation to assess lower limb joint ROM. However, the measurements
analysis of the actual sinusoidal object movement and reference observed at both the knee and hip joints were not valid. Problems
cursor trajectory (10 cycles) was performed using MatLab 7.0 to were experienced in measuring full knee flexion and hip flexion,
obtain the peak r-value and phase for each object and test period. where the electrogoniometers consistently underestimated the actual
These values were used as the index of motor performance. Pearson ROM achieved. As the participant moved through the full ROM,
r correlation and paired t-tests were used to determine test-retest soft tissue distortions and skin movement caused one or both
reliability. Spearman rho correlation was used to evaluate concurrent of the electrogoniometer end-blocks to rotate out of alignment
validity between the clinical timed dexterity tests as well as the new with the underlying bones. This introduced substantial error, and
object manipulation task protocol. Results p < 0.05 are considered accurate measurements of full, active, knee flexion ROM were only
significant. RESULTS: The visual-guided object manipulation test achieved by re-aligning the electrogoniometer during full flexion.
protocol was found to be reproducible to quantify movement accuracy IMPLICATIONS: The results show that flexible electrogoniometers
at both time periods. Low concurrent validity was found between all of offer a reliable and accurate measurement of dynamic, full ROM
the tests r = 0.22-0.44. CONCLUSIONS: Evaluation with the motion only for the ankle joint. The effect of skin and soft tissue distortion
sensor is a more accurate and precise tool for the measurement around the hip and knee joints at full flexion introduced substantial
of fine motor manipulation than the current commonly used clinical errors rendering this measurement technique invalid for dynamic
tests. IMPLICATIONS: An objective outcome measure that quantifies full range movements. The need to re-align the electrogoniometer
performance of the hand to manipulate virtually any object is not at the end of full range knee flexion means it has no advantage
currently available. Development of this tool will prove invaluable to over the simple universal goniometer, and is not a feasible tool for
hand therapists not only as an assessment tool, but also as an measuring dynamic large range movements of the hip and knee.
outcome measurement for treatment and research. KEYWORDS: KEYWORDS: Electrogoniometer, range of motion (ROM), lower limb.
Hand Function, Motion Analysis, Fine motor manipulation. FUNDING FUNDING ACKNOWLEDGEMENTS: E.Bryant was supported with a
ACKNOWLEDGEMENTS: unfunded. studentship from the Engineering and Physical Sciences Research
ETHICS COMMITTEE: Health Research Ethics Board, University of Council (EPSRC). CONTACT: [email protected]
Manitoba ETHICS COMMITTEE: University of Brighton Research Ethics
Committee
RELIABILITY OF MEASURING ACTIVE LOWER LIMB JOINT VCEC Exhibit Hall B & C
RANGE OF MOTION USING FLEXIBLE ELECTROGONIOMETERS EFFECT OF TRAINING THE UPPER LIMBS FOR PARTIAL
Bryant E1 ,Trew M1 ,Bruce A2 ; 1 Clinical
Research Centre for Health WEIGHT BEARING GAIT WITH CRUTCHES
Professions, University of Brighton, Eastbourne, UK; 2 School of Shimatani K1 , Shimizu M1 , Miyamoto A2 ; 1 Prefectural University
Engineering, University of Brighton, Brighton, UK of Hiroshima, Mihara city, Japan; 2 Graduate School of Nihon
University, Tokorozawa city, Japan
PURPOSE: To assess the intra-rater reliability of using flexible
electrogoniometers to measure full, active, lower limb joint range PURPOSE: The purpose of this study was to try to enable a person
of motion. RELEVANCE: No previous studies have reported using to learn to perform lower limb partial weight bearing (1/3 body
electrogoniometers to measure the full active ROM of the hip, weight) through learning to bear 2/3 of the body weight on the upper
knee and ankle joints. PARTICIPANTS: Ten healthy participants limbs. RELEVANCE: The amount of time it takes to learn how to
had measurements of full, lower limb ROM assessed bilaterally on partially weight bear with crutches differs for each person. It has
three different attendances within a 10 day period. All participants been reported that constant reexamination of the methods used and
were aged between 29 and 59. METHODS: The relevant flexible frequent confirmation of the patient’s ability are necessary, which can
be very time consuming. Many of the studies report on the exercise of 25 s rest–15 s right hand grasping task while seeing a mirror
methods for the lower limbs used to begin partial and non-weight which reflected the right hand was repeated for 5 times. In addition,
bearing, but no reports on the use of the upper limbs were found. we obtained the answer to presence in motor illusion after NIRS
PARTICIPANTS: The subjects included 40 normal young adult men measurement. ANALYSIS: Local brain activation during MT was
and women, who were divided equally into an upper limb group considered significant when the elevation of oxy-Hb and total-Hb
(UG) and a lower limb group (LG). The average age of the UG was change was above 2SD against the baseline. RESULTS: Six of
25.5±3.7 years, and the average age of the LG was 26.2±3.3 years. subjects were caused motor illusion by MT. The concentration of
METHODS: We used bilateral crutches and 4 scales to measure oxy-Hb and total-Hb around the SMC significantly increased in
the weight applied to each crutch and leg. The UG performed 10 response to MT with right hand grasping and returned to baseline
trials learning to support 2/3 of their body weight on their hands, to after termination of the motor task. CONCLUSIONS: The present
become able to partially weight bear on one of the lower limbs. The study suggests that not all of the subjects can be caused motor
LG performed 10 trials to learn to support 1/3 of their body weight on illusion by MT. Moreover, these results demonstrate that MT with right
one of the lower limbs. Feedback on the amount of weight put on the hand grasping activates the ipsilateral SMC. IMPLICATIONS: For
crutches or leg (“knowledge of results”) was given on alternate trials this reason, MT with right hand movement may enhance functional
to facilitate the learning. ANALYSIS: The average constant error for motor recovery from affected left hand (injured right hemisphere; left
each group was analyzed with the Post Hoc Bonferroni test. Statistical hemiplegia) via the ipsilateral SMC activation. KEYWORDS: Mirror
significance was established at the p = 0.05 level. RESULTS: In the therapy, near-infrared spectroscopy, sensorimotor cortex. FUNDING
beginning, both groups showed the same rate of error, indicating ACKNOWLEDGEMENTS: None. CONTACT: [email protected]
that little learning occurred. However, at the end of the trials, the UG ETHICS COMMITTEE: The ethics committee of international
showed fewer errors than the LG, indicating that they were better able university of health and welfare
to learn the task well. The LG had more errors and learning was not
as effective. Also the UG were significantly better able to retain the
knowledge gained from the performance 5 minutes after and one day
after the trials ended. CONCLUSIONS: The use of training weight 15-23 Tuesday 5 June 15:30
bearing on the upper limbs to learn partial weight bearing is more VCEC Exhibit Hall B & C
effective than training weight bearing through the lower limbs. Also, FACTORS INVOLVED IN THE DEVELOPMENT OF
the retention of the learned knowledge is better when training is done OSTEOARTHRITIS FOLLOWING ANTERIOR CRUCIATE
through the upper limbs. We believe that the cause may be that the LIGAMENT RECONSTRUCTION
upper limbs have a larger area in the brain available for sensation Keays S1 , Bullock-Saxton J2 , Newcombe P, Bullock M, Keays A;
and function than do the lower limbs. Also, as noted in studies in 1 Nambour Selangor Hospital; 2 University of Queensland, Brisbane,
psychophysics, it is easier to make minute weight adjustments when Australia
the amount is larger, and in this study the upper limbs controlled 2/3 of
the weight, as compared to 1/3 for the lower limbs. IMPLICATIONS: PURPOSE: This study aimed to determine the factors involved in
If a person can learn to perform lower limb partial weight bearing the development of osteoarthritis (OA)of the knee following anterior
through learning automatically to bear weight on the upper limbs, cruciate ligament (ACL) reconstruction. RELEVANCE: OA is a very
it will be clinically significant. KEYWORDS: motor learning, partial common condition and the knee is the most frequently affected
weight bearing, upper limbs. FUNDING ACKNOWLEDGEMENTS: weight bearing joint. Any knowledge of predisposing factors for
Unfunded. CONTACT: [email protected] the development of OA following injury and surgery would lead to
improved preventive and therapeutic management. PARTICIPANTS:
Fifty six patients comprising 29 patellar tendon (PT) and 27
semitendinosus/gracilis (STG) ACL reconstructed subjects were
15-19 Tuesday 5 June 15:30 followed from pre-surgery to six years post surgery. Patients with
VCEC Exhibit Hall B & C pre-existing OA were excluded. METHODS: Assessment before and
SENSORIMOTOR CORTEX ACTIVATION DURING THE MIRROR after surgery included strength testing (Cybex 11 dynamometer)
THERAPY IN HEALTHY RIGHT-HANDED SUBJECTS: A STUDY and stability testing (KT1000 arthometer). Six-year assessment
OF NEAR-INFRARED SPECTROSCOPY (NIRS) also addressed injury-surgery and musculoskeletal factors that
may have contributed to the development of OA: Injury-surgery
Imai I1 , Shiomi T2,3 , Takeda K2,3 , Taniguchi T2 , Kato H2,3 ;
1 Department of Physical Therapy, Nasu Neurosurgical Center; factors included time delay between injury and surgery, age at
2 International University of Health and Welfare; 3 CREST, Japan the time of surgery, family history, meniscectomy,chondral/bony
injury, and type of graft used. Musculoskeletal factors included
Science and Technology Agency
quadriceps and hamstring strength and anteroposterior stability.
PURPOSE: Clinical studies show that functional motor recovery Tibiofemoral (TF)OA and patellofemoral (PF)OA were assessed by
after stroke can be beneficial by mirror therapy (MT). However, an independent radiologist. ANALYSIS: Discriminant analyses were
its underlying mechanism is uncertain. The purpose of present performed separately on the injury-surgery and musculoskeletal
study was to investigate whether MT can always cause motor factors in order to assess which were relevant in the development
illusion. Furthermore, we examined the MT-related concentration of OA. RESULTS: Forty eight percent of patients developed TF
change of oxygenated hemoglobin (oxy-Hb) and total hemoglobin OA and 36% developed PF OA. Analysis found a group of three
(total-Hb) in and around the primary sensorimotor cortex (SMC) injury-surgery variables that would reliably discriminate TF OA,
of both hemispheres during MT (right or left hand grasping) Chi-square(6,n=56)=22.6;p < 0.001. These included the presence of
by using near-infrared spectroscopy (NIRS). RELEVANCE: It is bony or chondral damage, meniscectomy, and use of the PT as
necessary for physical therapy to investigate the effects of MT a graft. Overall this would allow a 76.8% correct classification.
on the cerebral activation and to explain the role of recovery Older age at the time of surgery as well as meniscectomy and
from stroke. PARTICIPANTS: Eight right-handed healthy subjects the presence of chondral or bony damage were predictors of PF
(6 women and 2 men) were recruited for measurement by NIRS OA, Chi-square(6,n=56)=14.4,p = 0.013. These three factors again
during MT. The subjects were each informed of the purpose and allowing a 76.8% correct classification. In addition a lower quadriceps
the method of the study before the experiment began. METHODS: to hamstring strength ratio were found to be musculoskeletal
The MT-related changes in concentrations of oxy-Hb and deoxy- discriminator for TFOA. CONCLUSIONS: Five factors were found to
Hb were measured using NIRS (Hitachi ETG-4000) placing the be involved in the development of OA: The presence of chondral or
probes on the scalp overlying SMC in both hemispheres. A cycle bony injury, meniscectomy and reconstruction using the PT. Older
age at the time of surgery was predictive of PF OA. A lower When ANOVA revealed significant differences, further analysis was
quadriceps to hamstring strength ratio was also associated with performed using Tukey’s post hoc test for multiple comparisons.
OA. IMPLICATIONS: In order to reduce the incidence of OA post Differences between groups were considered statistically significant
ACL reconstruction, it is important to avoid undue delay in surgery when p < 0.05. RESULTS: Following cyclic stretch, the myotubes
which may result in further injury to menisci or chondral surfaces. showed a significant increase in 2-DG uptake. The stretch-stimulated
Physiotherapy has an important role to play in patient education and 2-DG uptake was unaffected by wortmannin, whereas the insulin
in restoring balance between quadriceps and hamstrings strength effect was completely inhibited by wortmannin. These results
both before and after surgery. Finally the use of STG tendons as demonstrate that at least part of the mechanism by which stretch
a graft seem to be associated with a lower risk of OA in the long and insulin stimulate glucose uptake is distinct. By contrast, the
term. KEYWORDS: knee reconstruction osteoarthritis. FUNDING pretreatment of cells with dantrolene completely inhibited stretch-
ACKNOWLEDGEMENTS: No funding was received. CONTACT: stimulated 2-DG uptake, suggesting that Ca2+ release from intra-
[email protected] cellular stores is required to induce the glucose transport response.
ETHICS COMMITTEE: University of Queensland CONCLUSIONS: In summary, our present results suggest that the
effects of cyclic mechanical stretch-stimulated glucose transport are
independent of the insulin-signaling pathway. By contrast, our results
demonstrate that the release of Ca2+ from intracellular stores plays
17-03 Tuesday 5 June 15:30 a pivotal role in eliciting cyclic stretch-stimulated glucose transport.
VCEC Exhibit Hall B & C IMPLICATIONS: Especially in cases involving obligate immobility
THE RELEASE OF CALCIUM FROM SARCOPLASMIC RETIC- due to illness or physical disability, passive stretching may be
ULUM IS ESSENTIAL FOR STRETCH-STIMULATED GLUCOSE a good alternative to exercise for improving glucose metabolism.
TRANSPORT IN CULTURED SKELETAL MUSCLE CELLS KEYWORDS: mechanical stretch, glucose uptake, intracellular Ca2+
Iwata M1 , Hayakawa K2 , Murakami T3 , Naruse K4 , Kawakami K1 , concentration. FUNDING ACKNOWLEDGEMENTS: This work was
Inoue-Miyazu M1 , Suzuki S1 ; 1 Program in Physical and supported in part by a grant from the Techno Link Science
Occupational Therapy, Nagoya University Graduate School of Foundation. CONTACT: [email protected]
Medicine, 1-1-20 Daikominami, Higashi-ku, Nagoya 461-8673, ETHICS COMMITTEE: Nagoya University Graduate School of
Japan; 2 ICORP/SORST Cell Mechanosensing, Japan Science Medicine
and Technology Agency, 65 Tsurumai-cho, Showa-ku, Nagoya
466-8550, Japan; 3 Department of Nutrition, Faculty of Wellness, Research Report Poster Display
Chukyo Women’s University, 55 Nadakayama Yokone-cho, Ohbu 17-07 Tuesday 5 June 15:30
474-8651, Japan; 4 Department of Cardiovascular Physiology, VCEC Exhibit Hall B & C
Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, ORAL ADMINISTRATION OF GERANYLGERANYLACETONE
Japan INDUCE EXPRESSION OF HEAT SHOCK PROTEIN 70 IN MICE
SOLEUS MUSCLE
PURPOSE: It is now generally accepted that physical exercise
Okita M1 , Banno Y1 , Hibino I2 , Inoue T3 , Suzuki S3 ; 1 Faculty
or skeletal muscle contraction activates cell surface expression
of Care and Rehabilitation, Seijoh University, Tokai, Japan;
of glucose transporter 4 in skeletal muscle cells, and that this 2 Department of Physical Therapy, Japan College of Medical
expression induces glucose uptake and subsequent events, including
Care and Welfare, Nagoya, Japan; 3 Program in Physical and
glycogen metabolism. When a muscle contracts, it not only receives
Occupational Therapy Graduate School of Health Sciences Nagoya
electrical stimulation but it is also subjected to mechanical stimuli
University, Nagoya, Japan
such as stretch or deformation loaded to its own cells and tissues.
Interestingly, passive stretching per se has been reported to increase PURPOSE: It is known that heat or several other types of
glucose uptake in skeletal muscle without force-producing contraction stresses induce expression of heat shock protein 70 (HSP70) in
and in cultured muscle cells. However, the signal transduction myocytes. HSP70 plays an important role in chaperoning nascent
pathway leading to glucose transport following mechanical stretch peptides during translation, and it has been assumed that the
in skeletal muscle remained to be elucidated. In the current study, elevation of cellular HSP70 levels can serve as a countermeasure
we sought to determine whether the signaling mechanism leading to attenuate the disuse-induced muscular atrophy. On the other
to cyclic mechanical stretch-stimulated glucose transport is similar hand, geranylgeranylacetone (GGA), known as teprenone, is widely
to, or distinct from, the signaling mechanisms leading to insulin- used as an anti-ulcer drug. Recent information suggests that GGA
stimulated glucose transport in cultured muscle cells. RELEVANCE: increases HSP70 expression in various tissues (e.g. stomach and
Skeletal muscle is the main tissue involved in glucose disposal in liver). Little is known, however, whether GGA administration induced
vivo, and this function is enormously regulated by physical exercise expression of HSP70 in skeletal muscles. The purposes of the
and insulin. Most interestingly, in insulin-resistant diseases such present study were to evaluate the induction of HSP70 expression in
as Type 2 diabetes, the effects of contraction on glucose uptake mice soleus muscle by GGA administration. RELEVANCE: If GGA
are unchanged. Thus, efforts have been made to understand the administration has such effects on muscle cells, it may be able to
molecular mechanisms involved in contraction-stimulated glucose use for the treatment of disuse muscle atrophy. This study provides
transport. PARTICIPANTS: A subclone of the mouse myogenic new information on the effects of GGA administration on muscle
(myoblastic) cell line, C2C12 was used in this study. METHODS: cells in mice. PARTICIPANTS: Twenty-eight male ddy mice, 8 weeks
We first determined whether glucose uptake increased in response old, were used, and divided randomly into the control (n=8), heat
to uniaxial cyclic stretch in 7-day-old myotube cells cultured from stress (Heat, n=8), and GGA administration (GGA, n=12) groups.
mouse myogenic (myoblastic) cell line C2C12. Furthermore, to METHODS: The experimental protocol was approved by the Ethics
determine whether stretch and insulin stimulate glucose uptake via Review Committee for Animal Experimentation at our institution.
different signaling mechanisms, C2C12 myotubes were stretched Heat group was exposed to heat stress (41 degrees for 60 min)
or insulin treated for 30 min in the absence or presence of the in an incubator without anesthesia. Mice in the GGA group were
phosphatidylinositol 3-kinase inhibitor, wortmannin, or sarcoplasmic divided into three subgroups (GGA concentrations 600, 900, or 1200
reticulum (SR) Ca2+ release inhibitor, dantrolene, after which 2- mg/kg), saline solution of GGA was orally administered. Western
deoxy-D-glucose (2-DG) uptake was measured. ANALYSIS: Results blot analysis using soleus muscle homogenates obtained from all
are expressed as the mean ± standard deviation. Statistical analysis groups determined that HSP70 expression at 24hrs after treatment.
was undertaken using one-way analysis of variance (ANOVA). ANALYSIS: Results were analyzed by one-way analysis of variance
(ANOVA). If significance was obtained (p < 0.05) by ANOVA, pair the present study provide new evidences on the histopathological
wise comparisons were made by Fisher’s PLSD method. RESULTS: findings of the joint contracture. KEYWORDS: joint contracture, ROM
HSP70 content was significantly greater in Heat than control groups. exercise, Pathology. FUNDING ACKNOWLEDGEMENTS: None.
Similarly, at GGA groups in 600 and 900 mg/kg, HSP70 content CONTACT: [email protected]
was significantly increased than control group. HSP70 content in ETHICS COMMITTEE: Guideline for the care and use of laboratory
the 1200 mg/kg of GGA group, however, was significantly decreased animals in Kanazawa University including ethical codes.
than control group. CONCLUSIONS: The results of the present study
indicate that oral administration of GGA at concentration of 600 or
900 mg/kg induce expression of HSP70 in muscle cells. GGA at
concentration of 1200 mg/kg, however, inhibit expression of HSP70. 18-15 Tuesday 5 June 15:30
High concentration GGA has the possibility to give it a bad influence VCEC Exhibit Hall B & C
to the myocyte. IMPLICATIONS: Orally administered GGA can be DISTRESS AND HEALTH BELIEFS IN PEOPLE WITH CHRONIC
used as the treatment of disuse muscle atrophy like heat stress. LOW BACK PAIN FOLLOWING DIFFERENT KINDS OF
KEYWORDS: Geranylgeranylacetone (GGA), Heat shock protein PHYSIOTHERAPY
70 (HSP70), Skeletal muscle. FUNDING ACKNOWLEDGEMENTS: Critchley D1 , Dore C2 , Noonan S3 , Jones R4 , Hurley M1 ;
This study was supported in part by a Grant-in-Aid for Scientific 1 Academic Department of Physiotherapy, King’s College London,
Research from the Ministry of Education, Science, Sports and Culture London, UK; 2 Clinical Trials Unit, Medical Research Council,
of Japan (Grant no. 18500428). CONTACT: [email protected] London, UK; 3 3Department of Physiotherapy, Guy’s and St Thomas’
ETHICS COMMITTEE: The experimental protocol was approved by Hospitals, London, UK; 4 School of Medicine, King’s College
the Ethics Review Committee for Animal Experimentation at Seijoh London, London, UK
University.
PURPOSE: To compare distress and health beliefs in people
with chronic low-back pain (cLBP) following usual individual
Research Report Poster Display physiotherapy, spinal stabilisation classes, or physiotherapist-led
17-11 Tuesday 5 June 15:30 outpatient pain management. RELEVANCE: Psychological factors
VCEC Exhibit Hall B & C (distress, health beliefs) play an important role in chronic pain
HISTPATHOLOGICAL EFFECTS OF THE RANGE OF MOTION disability. Physiotherapist-led pain management using a cognitive-
EXERCISE ON JOINT CONTRACTURE. AN EXPERIMENTAL behavioural approach combining education with paced exercises
STUDY USING RATS is advocated as reducing distress and unhelpful beliefs (Fear-
avoidance, Catastrophising, Praying/hoping) and encouraging helpful
Matsuzaki T1 , Hoso M1 , Takemura K2 , Tachino K1 ; 1 Division of
coping strategies. Other forms of physiotherapy may have inadvertent
Rehabilitation Science, Department of Health Science, Graduate
effects on psychological factors. PARTICIPANTS: 212 people with
School of Medical Science, Kanazawa University; 2 Yamanaka-spa
non-specific cLBP. Participants were 44 (range 18-76) years old,
Medical Center
136 (64%) female with a 7.4 (range 0.25-52) years history
PURPOSE: The Range Of Motion (ROM) exercise is thought to be of LBP. METHODS: Participants were randomised to individual
effective in the treatment of the joint contracture, though its medical physiotherapy (n=71), spinal stabilisation (n=72) or outpatient pain
evidence is obscure. We investigated the histopathological findings management (n=69). Outcomes measured were distress [General
of treated and non-treated rat’s joint components after two-week Health Questionnaire (GHQ-28), including Anxiety and Depres-
knee joint immobilization. RELEVANCE: For physical therapists, it sion sub-scales], Fear-avoidance [Tampa Scale of Kinesiophobia
is important to demonstrate the efficacy of ROM exercise against (TSK)], and pain coping strategies [Coping Strategies Questionnaire
contracture, especially with medical evidences. PARTICIPANTS: (CSQ)] including Catastrophising and Praying/hoping. ANALYSIS:
Referring to the precedent reports, sixteen adults, nine-week-old Outcomes were compared with ANCOVA with baseline as covariate.
male Wistar rats (body weight 240-280g) were used for this study. RESULTS: Values are mean(SD) at baseline, 6, 12, 18 months
METHODS: The rats were randomly divided into four groups; respectively. GHQ-28 (Distress) Individual physiotherapy: 7.46(6.96),
normal group (n=4), contracture group (n=4), treatment group (n=4), 3.93(5.52), 3.23 (4.88), 2.93(4.26). Spinal stabilisation: 8.80(6.84),
and non-treatment group (n=4). Normal group rats were raised in 3.98(5.71), 3.84(5.58), 4.71(5.58). Pain management: 6.30(5.19),
separates cages for 2 weeks. Contracture group rat’s right hind limb 4.84(6.07), 4.53(5.48), 4.45(5.88). Reduction from baseline distress
was immobilized by plaster cast for 2 weeks. Treatment group rats was significant in all arms (P < 0.001); differences between arms
were treated with ROM exercise after 2 weeks immobilization of were non-significant. Anxiety and Depression subscales results
the right hind limb. Non-treatment group rats were left free for f2 were similar. TSK (Fear-avoidance) Individual physiotherapy:
weeks after 2 week immobilization of the right hind limb. ANALYSIS: 39.89(7.97), 36.51(7.72), 33.40(10.21), 35.55(8.60). Spinal stabil-
Tissue specimens from each group were stained with hematoxylin isation: 40.13(8.15), 35.69(6.83), 35.55(9.18), 34.66,(8.15). Pain
and eosin, and examined under a light microscope. RESULTS: The management: 38.65(7.66), 31.02(7.82), 31.63(8.13), 31.46(8.46).
2-week immobilization caused a limitation of extension about 30 Fear-avoidance reduced significantly at all follow-ups in all arms
degrees. After that, the ROM limitation of about 10 degrees was left (P < 0.001). Pain management participants exhibited least Fear-
when both the non-treatment group and the treatment group finished avoidance at all follow-ups; differences between arms were significant
the experiment, though recovery was seen early after the fixation at 6 months (P = 0.001), not significant at 12 (P = 0.2) or 18
was released. Compared with the normal group, the atrophy of the months (P = 0.14). CSQ (Catastrophising) Individual physiotherapy:
synovial intimal cells, the fibrosis of the subsynovial layer, the dilation 11.24(7.66), 8.49(6.81), 7.52(6.56), 7.73(7.16). Spinal stabilisation:
and the congestion of the small blood vessels were recognized 9.92(8.35), 7.27(8.59), 8.18(7.19), 7.20(7.86). Pain management:
histologically. These changes showed a tendency to be recovered 9.31(7.05), 6.18 (5.19), 6.27 (5.81), 5.70 (5.91), Catastrophising
with the treatment group to the condition close to the normal group. reduced in all arms for all follow-up points (P = 0.0001); there
The recovery tendency observed in the treatment group was not seen were no significant differences between arms, but Catastrophis-
with the non-treatment group. Inflammatory cell infiltration into the ing tended to occur least in pain management participants
synovial tissue was not recognized in each group. CONCLUSIONS: It (P = 0.206 at 6/12). CSQ (Praying/hoping) Individual physiotherapy:
was demonstrated that the ROM exercise is effective in the treatment 17.20(9.26), 12.00(8.18), 12.69(8.58), 13.02(8.29). Spinal stabili-
of the joint contracture. Further histopathological investigation and sation: 17.38(9.77), 16.06(10.64), 17.76(9.83), 15.39(10.12). Pain
elucidation of the evidence based effective treatments against management: 15.88(11.13), 13.75(11.62), 12.86(9.88), 10.88(9.85).
the joint contracture is necessary. IMPLICATIONS: The results of Praying/hoping decreased in all arms at all follow-up points
(P = 0.0001), remaining greatest in the Spinal Stabilisation arm, ANALYSIS: 1) To determine the number of RCTs that have compared
significantly at 6 (P = 0.029) and 12 months (P = 0.013) but not at 18 the efficacy of different forms of SMT or acupuncture for low back
months (P = 0.141). Helpful coping strategies showed inconsistent, pain and have used an expertise-based RCT design; 2) To extract the
non-significant, changes. CONCLUSIONS: Considerable distress parameters around the characteristics of these trials. RESULTS: Our
and unhelpful health beliefs were found before intervention. All three electronic search yielded 3592 references, and after screening, 265
arms showed reductions in distress and unhelpful beliefs but changes articles were identified for full-text review. An additional 31 articles
in helpful coping strategies were inconsistent. Physiotherapist-led were identified from the grey literature. One hundred and seventy-
pain management was most effective in reducing unhelpful beliefs but seven RCTs of acupuncture or spinal manipulation for low back pain
no more effective at reducing distress or encouraging positive coping were identified, with 18 exploring the effect of competing techniques;
strategies than other interventions. Spinal stabilisation was least however, none of these trials used an expertise-based design.
effective in reducing unhelpful beliefs. Differences, if any, between CONCLUSIONS: Use of expertise-based RCT design to evaluate
interventions reduced in the longer-term. IMPLICATIONS: These acupuncture and spinal manipulation for low back pain is non-
results support guidelines advocating physiotherapists acknowledge existent. IMPLICATIONS: Expertise-based RCTs offer advantages
and address the marked psychological factors commonly found in over conventional RCTs when exploring the effect of competing
people with cLBP. Further research is needed to find the most techniques in either SMT of acupuncture for low back pain; however,
effective strategies for physiotherapists to reduce cLBP-associated trialists are not currently making use of this design. KEYWORDS:
distress and promote helpful coping strategies. KEYWORDS: acupuncture, spinal manipulation, low back pain, expertise-based
low back pain, psychology. FUNDING ACKNOWLEDGEMENTS: randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
This research was funded by the Arthritis Research Campaign. BCJ holds a Duncan L. Gordon Research Fellowship. JWB is funded
CONTACT: [email protected] by a Canadian Institutes of Health Research Fellowship Award. PJD
ETHICS COMMITTEE: Guy’s and St thomas’ Local Research Ethics is holds a Canadian Institute of Health Research New Investigator
Committee Award. CONTACT: [email protected]

THE USE OF EXPERTISE-BASED RANDOMIZED CONTROLLED INTEGRATED PROPRIOCEPTIVE TRAINING REDUCED THE
TRIALS TO ASSESS SPINAL MANIPULATION AND SELF-REPORTED NECK DISABILITY IN PATIENTS WITH HIGH
ACUPUNCTURE FOR LOW BACK PAIN: A SYSTEMATIC REVIEW FREQUENCY OF NECK PAIN
Johnston B1 , da Costa B2 , Busse J3 , Akl E4 , Mills E3 , Lee H1 , Wang S2 , Wang J3 ; 1 1. Institute of Occupational Medicine
Devereaux P3 ; 1 1) Complementary and Alternative Research and Industrial Hygiene, College of Public Health, National Taiwan
and Education (CARE) Program, University of Alberta, Edmonton, University, Taipei, Taiwan; 2 2. School and Graduate Institute of
Alberta, Canada; 2 2) Department of Physical Therapy, Faculty Physical Therapy, College of Medicine, National Taiwan University,
of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Taipei, Taiwan; 3 3. Department of Internal Medicine, National
Canada; 3 3) Department of Clinical Epidemiology and Biostatistics, Taiwan University Hospital, Taipei, Taiwan
McMaster University, Hamilton, Ontario, Canada; 4 4) Department
of Medicine, State University of New York, Buffalo, New York, USA PURPOSE: To determine the effectiveness of a proprioceptive
training program on the perceived disability for subjects with
PURPOSE: The use of randomized controlled trials (RCTs) has different frequency of neck pain, as compared with a control group.
become the ‘gold standard’ for evaluating the efficacy of clinical RELEVANCE: This study invesitgated the association between
interventions. Patients are typically randomized according to in- neck proprioception and neck disability.Its results could be helpful
tervention; however, when treatment is influenced by the skill-set in the identification of target population for future proprioceptive
of the provider it is advisable to randomize patients to therapists training. PARTICIPANTS: Eighty-six subjects with current neck
skilled in the procedures under evaluation. This is known as an pain were recruited from the bank employees and divided into
expertise-based RCT. RELEVANCE: Because it takes training and 6-week proprioceptive training group and control group. In the
experience to develop expertise in different acupuncture and spinal follow-up assessment, there were 39 subjects of training group
manipulation (SMT) techniques, RCTs comparing different forms of and 33 subjects of control group completed the study. METHODS:
these complementary and alternative therapies would benefit from an The intervention integrated the proprioceptive training and deep
expertise-based randomization scheme. Randomization of patients neck muscle training.Outcome measurements included neck pain
to clinicians with defined expertise in intervention A or B will also frequency, head repositioning errors, and neck disability index.
reduce the potential for differential expertise-bias, and may be more ANALYSIS: A general linear model was used to investigate the
ethical if the intervention has been proven superior to placebo or interaction between pain frequency and neck proprioception on
sham for the study population under investigation. PARTICIPANTS: the determination of NDI. After the intervention, change in head
Patients with low back pain from previously conducted RCTs. repositioning errors and neck disability was assessed by paired t
METHODS: We conducted a comprehensive search of six relevant test for subjects with different pain frequency. RESULTS: There
electronic databases (i.e. MEDLINE, CENTRAL, EMBASE, AMED, exist a significant interaction between pain frequency and neck
PEDro, ICL) from inception to December 2005, and a grey literature proprioception on the measure of NDI (p < 0.01). A positive correlation
search (i.e. reference lists, and contact with authors, experts in between head repositioning errors and NDI was found in subjects
the field, and relevant governing organizations). Search terms with weekly and daily pain, but not in those with monthly pain.
included extensive controlled vocabulary and keyword searches After six-week proprioceptive training, all the subjects demonstrated a
for (acupuncture OR spinal manipulation) AND (low back pain) significant improvement in head repositioning task while a significant
AND (randomized controlled trials). Two reviewers independently decrease of NDI was only found in subjects with weekly and
screened titles/abstracts and titles of identified citations by applying daily pain (p < 0.05). CONCLUSIONS: The association between
pre-specified eligibility criteria. We retrieved the full text of all neck proprioception and neck disability became evident in the
titles/abstracts that appeared to report an RCT of either SMT or patients with high neck pain frequency.Proprioceptive training was
acupuncture for low back pain. Two reviewers then independently effective in reducing the neck disability for subjects with higher pain
screened full text articles for RCTs using an expertise-based design frequency. IMPLICATIONS: Pain frequency should be included in the
for allocating patients to competing forms of SMT or acupuncture. assessment of neck pain perception, particularly for those studies
interested to investigate the role of neck proprioception during the prescribed by physical therapists are necessary for patients with
development of neck pain. These results also indicate that following vertebral fracture to improve motor function and prevent fall.
6-weeks of neck proprioceptive training, people with high frequency KEYWORDS: Osteoporosis, Previous vertebral fracture, Physical
of neck pain can get improvement in their disability level. By contrast, function. FUNDING ACKNOWLEDGEMENTS: This study was no
for those with infrequent neck pain, the same exercise may not funded. CONTACT: [email protected]
have substantial effect. KEYWORDS: Proprioception, neck disability,
pain frequency. FUNDING ACKNOWLEDGEMENTS: This study was
supported by grants from the Institute of Occupational Safety and
Health, Council of Labor Affairs, Taiwan (IOSH 90-H331 and IOSH Research Report Poster Display
91-H122). CONTACT: [email protected] 20-15 Tuesday 5 June 15:30
ETHICS COMMITTEE: Institutional Human Study and Ethics Review VCEC Exhibit Hall B & C
Board of college of Publich Health in National Taiwan Unversity
RELIABILITY TESTING OF THE PATELLOFEMORAL JOINT
REACTION FORCE (PFJRF) MEASUREMENT DURING
Research Report Poster Display DOUBLE-LEGGED SQUATTING: A PILOT STUDY
Mostamand J, Bader D, Hudson Z; Queen Mary University of London
THE RELATION BETWEEN PREVIOUS VERTEBRAL FRACTURE PURPOSE: Reliability of patellofemoral joint reaction force (PFJRF)
AND PHYSICAL FUNCTION IN PATIENTS WITH OSTEOPOROSIS measurement during a range of activities for different patient groups
has not yet been reported. Such information is critical in future
Kamide N1 , Sumida S2 , Watanabe T3 , Imura T3 , Shiba Y1 ,
Sato H1 , Maeda Y4 ; 1 Kitasato University, School of Allied Health research on patients with patellofemoral pain syndrome (PFPS). As
Sciences; 2 Kitasato University East Hospital, Department of an example,these patients might experience pain due to alterations
rehabilitation; 3 Kitasato University East Hospital, Department of in PFJRF during a wide range of physical activities.The present
orthopedic; 4 Kanto Rehabilitation College pilot study was designed to examine the reliability of PFJRF mea-
surements during double-legged squatting. RELEVANCE: PFJRF,as
PURPOSE: It has been reported that previous vertebral fracture an important outcome measure may explain the mechanism of
in patients with osteoporosis lowers quality of life (QOL) and producing pain during different activities in patients with PFPS.This
raises mortality (Kado, et al.1999 & Lips, et al.2005). But, the study identifies the reliability of the PFJRF measurements before
relation between previous vertebral fracture and physical function performance of further studies. PARTICIPANTS: Five volunteers
has not yet been thoroughly investigated. Therefore, the purpose without any disorders in lower extremities and spinal column were
of this study was to investigate the relation between previous included in the pilot study. METHODS: A complete kinematic and
vertebral fracture and physical function in patients with osteoporosis. kinetic analysis of the right leg of each subject during three
RELEVANCE: To understand whether previous vertebral fracture sets of three repetitions were performed using a motion analysis
affect physical function is very important for physical therapists who system (SIMI Reality Motion Systems,Germany) and single force
treat osteoporotic patients, because occurrence rate of vertebral plate (Kistler Switzerland),respectively. Knee extensor moments were
fracture is higher than other osteoporotic fractures (ex. hip fracture, subsequently calculated using inverse dynamics (Winter,1990) and
humerus fracture, wrist fracture). PARTICIPANTS: Subjects were combined with a biomechanical model of the patellofemoral joint
thirty five out-patients who had undergone medication treatment (Salem and Powers 2001) to estimate PFJRF for each measurement.
for postmenopausal osteoporosis by orthopedists. Exclusion criteria
All data were analysed in the eccentric phase of double-legged
were as follows: severe pain, cancer, neuromuscular disease,
squatting at 30 degrees of the knee flexion. ANALYSIS: The
articular rheumatism, hyperthyroidism, history of fracture within one-
coefficient of variation (CV) was used to obtain the repeatability of
year, history of gastrectomy and history of taking steroid. METHODS:
the PFJRF measurements. The correlation coefficient (r) was used
Height, weight, BMI, bone mineral density (BMD) of heel, and fall
to find the intratester reliability of pair measurements. The standard
history were recorded as a character of subjects. Previous vertebral
error of measurements (SEM) was calculated for PFJRF to evaluate
fracture was assessed by radiographs of thoracic and lumber region,
the precision of these measurements. The least significant difference
which was recorded as diagnosis and treatment. Vertebral fracture
(LSD) was used to detect the minimum significant level of the PFJRF
was defined by criterion of the japanese society for bone and
mineral research. Lower limb muscle strength, grip strength, gait measurements. RESULTS: The coefficient of variations showed that
speed, Timed Up & Go test (TUGT), Tokyo Metropolitan Institute the repeatability of the PFJRF measurements was good (ranged
of Gerontology Index of Competence (TMIG-IC), and Modified Fall from 1.10% to 10.89%). The correlation coefficient revealed relatively
Efficacy Scale (MFES) were measured to evaluate the physical moderate to high significant intratester reliability (0.95 > r > 0.65,
function. ANALYSIS: Based on existence of previous vertebral P < 0.05) and poor to moderate significant intratester reliability
fracture, subjects was divided into two groups (group one: patients (0.67 > r > 0.38, P < 0.05) during second and first sets of 3 repetitions
with fracture, group two: patients without fracture). And, unpaired respectively. The extent of SEM values during the first and second
t-test, Mann-Whitney U test, and Fisher’s exact probability test sets of 3 repetitions of the tests (16.54-51.85 N) showed the high
were used for comparison of physical functions of two groups. reliability of the measurements. LSD values showed that there was
Statistical significance was set at 5%. RESULTS: Sixteen of thirty-five insufficient evidence to conclude that the obtained values are different
patients (45.7%) had vertebral fracture. When it was compared with during the 3 sets of 3 repetitions. CONCLUSIONS: The reliability data
patients without fracture, both maximum gait speed and effectance associated with this pilot study on normal subjects have indicated that
were lower in patients with fracture (p < 0.05). In addition, the PFJRF can be used to as a parameter to examine biomechanical
number who experienced fall in patients with fracture was higher changes in the patellofemoral joint in patients with varying degrees
than that in patients without fracture (p < 0.05). CONCLUSIONS: of PFPS. IMPLICATIONS: For physical therapy practice/Education.
It was suggested that osteoporotic vertebral fracture was related KEYWORDS: Patellofemoral pain syndrome, patellofemoral joint
to deterioration of gait speed and effectance, and higher fall- reaction force. FUNDING ACKNOWLEDGEMENTS: This study has
tendency. These factors are also reported that they are risk factors been funded by the Ministry of Health and Medical Education of
that cause deterioration of ADL, IADL, and raises frequency of the Islamic Republic of Iran and Queen Mary University of London.
hip fracture (Shinkai, et al. 2000 & Dargent-Molina, et al.1996). CONTACT: [email protected]
Therefore, vertebral fracture may disturb the functional independent ETHICS COMMITTEE: East London and The City Research Ethics
life in elderly. IMPLICATIONS: It is thought that the exercises Committee
COMPARISON OF THE PATELLAR MOBILITY IN FEMALE EFFECT OF TREADMILL AND BEAM-WALKING EXERCISE ON
ADULTS WITH AND WITHOUT PATELLOFEMORAL PAIN FUNCTIONAL RECOVERY AND EXPRESSION OF GDNF AFTER
Ota S1,2 , Nakashima T1 , Morisaka F1 , Yagi R1 , Oishi Y1 , Ida K3 , CEREBRAL INFARCTION IN RATS
Kawamura M2 ; 1 Toyohashi Municipal Hospital; 2 Nagoya University; Ohwatashi A1,2 , Ikeda S2 , Horinouchi K2 , Harada K2 , Kamikawa Y2 ,
3 Asahi Hospital
Yoshida A2 , Nomoto Y2 , Sakae K1 , Kawahira K2 ; 1 School of
PURPOSE: The purpose of this study was to compare the patellar Medical Sciences, Faculty of Medicine, Kagoshima University,
mobility of the subjects, using the Patellaofemoral Arthrometer (PFA), Kagoshima, Japan; 2 Department of Rehabilitation and Physical
with and without patellofemoral pain (PFP). RELEVANCE: One Medicine, Graduate School of Medical and Dental Sciences,
of the causes of PFP is tightness of the retinaculam. This has Kagoshima University, Kagoshima, Japan
been attributed to abnormal patellar mobility such as decreased
lateral and/or medial patellar mobility. Quantification of patellar PURPOSE: This study evaluated differences in the recovery of motor
mobility is important for providing health professionals with reliable function by different exercises and the relationship between functional
objective data for selection of the optimal treatment method, that recovery and the expression of GDNF (Glial cell line-derived
is, the evidence-based medicine. PARTICIPANTS: Forty four of the neurotrophic factor) was examined. RELEVANCE: There is limited
subjects, consisting of 44 females (68 knees) between the ages of evidence regarding the effects of rehabilitation on functional recovery
21 and 41, participated in this study. Twenty two participants, (34 on stroke patients. In particular, there are few studies focusing on
knees-PFP group) had a history of PFP. Each control subject (control differences in exercise. Therefore, we investigated the effects of
group: 22 females, 34 knees) was matched with each of the PFP treadmill and beam-walking exercise on functional recovery in a rat
subjects using parameters such as the measured side of the knees, experimental model of hemiplegia. PARTICIPANTS: In this study, a
age (±3 years), height (±5%) and weight (±10%). This research was total of 59 adult Wistar rats (231±11 g) were used. METHODS: This
approved by the Institutional Review Board of Toyohashi municipal
study involved the following two procedures. In the first experiment,
hospital and Nagoya university. METHODS: Patellar mobility on
34 adult Wistar rats (231±12 g) were used. These animals were
subjects with PFP and the control group was measured by the
divided into three groups: non-exercise (n = 11), treadmill exercise
modified reported PFA (in press). The maximal lateral and medial
displacement of the patella at knee flexion angles of 0 degrees (n = 12) and beam-walking exercise (n = 11). All rats underwent
was obtained by manual force pushing the patella laterally and surgical photochemical infarction at the age of 7 weeks. Rats in the
medially until it stopped. Patellar mobility index (PMI), is calculated treadmill exercise group were made to run on a treadmill for 20 min
with the formula: PMI = (patellar mobility/patellar width) × 100, to everyday for 14 days. In the beam-walking exercise group, beam-
normalize patellar mobility. Lateral patellar mobility, medial patellar walking exercises were performed for 20 min everyday for 14 days
mobility, total side patellar mobility (lateral mobility plus medial and non-exercise group were left to follow a natural course. In the
mobility), side patellar mobility balance ratio (log. lateral mobility/ second experiment, 25 adult Wistar rats (231±10 g) were used. At
log. medial mobility), the difference of lateral and medial patellar various time points (1 day, 3 days, 5 days and 7 days) after photo-
mobility (lateral mobility – medial mobility), and the same parameters chemical infarction, the brains were removed under deep anesthesia.
of the PMI were used in the final analysis. ANALYSIS: Differences The expression of GDNF was examined by immunohistochemical
of patellar mobility between the PFP and the control group were analyses. The Committee of Research Facilities for Laboratory
compared using paired t-tests and F-tests. Significant levels were Animal Sciences, Kagoshima University, approved the experimental
set at P < 0.05. RESULTS: Lateral patellar mobility, lateral PMI, procedures. ANALYSIS: Hindlimb function was evaluated with beam-
total side patellar mobility, and total PMI of the PFP group were
walking task using a narrow beam (122cm long x 2.5 cm wide).
significantly decreased. On the other hand, those deviations of the
Performance was rated on a seven-point scale. The number of
side patellar mobility balance of the PFP group were significantly
GDNF-like immunoreactive cells was counted. RESULTS: Functional
different from the balance of the control group (p < 0.01). Seven
knees with PFP showed decreased lateral (3 knees) or medial recovery in beam-walking exercise group occurred significantly earlier
patellar mobility (4 knees) based on 2 SD of the patellar mobility of than that in the other groups. Abundant expression of GDNF-
the control group (6.9 and 6.7 mm, respectively). CONCLUSIONS: like immunoreactive cells was observed at the early time points
Significant differences in decreased lateral patellar mobility and examined. CONCLUSIONS: In this study, beam-walking exercise
lateral PMI are shown, when patellar mobility is compared between showed the greatest enhancement of functional recovery in the rat
both of the groups. The raw data shows, however, 79% of the hemiplegic model. Immunohistochemical analysis of brain sections
participants with PFP have a normal range of patellar mobility. On showed abundant expressions of GDNF-like immunoreactive cells at
the other hand, 21% of the participants with PFP have deceased the early time points examined. IMPLICATIONS: The beam-walking
lateral (9%) and medial patellar mobility (12%). IMPLICATIONS: The exercise was the same as the task used for evaluation of functional
effect of the physical therapy intervention, based on these criteria, recovery. So this finding suggested that it might be more effective
is evident from these results, although a normal range of patellar to perform an exercise suitable for the purpose. There was limited
mobility could be shown more clearly through a large subject group. expression at 7 days. The functional recovery of paralysis was
KEYWORDS: Patellar mobility, Patellofemoral pain, Knee. FUNDING remarkable until 7 days, and thereafter improved gradually. Therefore,
ACKNOWLEDGEMENTS: The authors acknowledge the technical
it is considered that expression of GDNF protein is related in some
support of Matsumoto Prosthetics and Orthotics Manufacturing
manner with functional recovery of paralysis. KEYWORDS: cerebral
CO.LTD. CONTACT: [email protected]
ETHICS COMMITTEE: Toyohashi Municipal Hospital and Nagoya infarction, functional recovery, Glial cell line-derived neurotrophic fac-
University tor. FUNDING ACKNOWLEDGEMENTS: This study was supported
in part by Grant-in-Aid for Scientific Research (No. 18500410, 2006.),
the Ministry of Education, Science, Sports and Culture, Japan.
ETHICS COMMITTEE: The Committee of Research Facilities for
Laboratory Animal Sciences, Kagoshima University, approved the
experimental procedures.
Research Report Poster Display Fellowship from the University of Puget Sound, Tacoma, WA, USA.
22-03 Tuesday 5 June 15:30 CONTACT: [email protected]
VCEC Exhibit Hall B & C ETHICS COMMITTEE: Institutional Review Board, University of
VASOMOTOR INNERVATION PATTERNS BY PERIPHERAL Puget Sound, Tacoma, WA, USA
NERVES SUPPLYING THE UPPER AND LOWER EXTREMITIES
Allen R, Jefferson E, Bhangu V; University of Puget Sound, Research Report Poster Display
Tacoma, WA, USA 22-07 Tuesday 5 June 15:30
PURPOSE: The purpose was to map vasomotor innervation VCEC Exhibit Hall B & C
fields for peripheral nerves supplying the upper and lower ex- LOWER LIMB SENSORIMOTOR NETWORK: AN FMRI STUDY
tremities and compare these surface neurovascular patterns to
Kapreli E1,2 , Athanasopoulos S1 , Strimpakos N2 ,
somatosensory distributions. RELEVANCE: Knowledge of sensory
Papathanasiou M3 , Gliatis I4 , Van Hecke P5 , Gouliamos A3 ,
nerve distribution topography is essential to diagnosing peripheral
Peters R5 , Sunaert S5 ; 1 Department of Sports Medicine and
complaints with neurologic origins. Existing innervation maps present
Biology of Exercise, Sports Physiotherapy Laboratory, National &
only somatosensory fields. When complaints do not fit known
Kapodistrian University of Athens, Greece; 2 Department of
patterns, nonorganic etiology is sometimes erroneously suspected.
Physiotherapy, T.E.I of Lamia, Greece; 3 2nd Department of
Variations in sympathetic nerve activity to limb arterioles may
Radiology, Medical School, National & Kapodistrian University
result in symptoms of ischemic pain, numbness, or paresthesias
of Athens, Greece; 4 Department of Orthopedics and Traumatology,
following neurovascular rather than somatosensory distributions.
University Hospital of Patras, Rio-Patras, Greece; 5 Department
PARTICIPANTS: Participants included 31 female and 13 male
of Radiology, University Hospitals of K.U. Leuven, Belgium
volunteers, ages ranging from 27 to 64 years (x = 35.7), reporting
no history of amine-type anesthetic hypersensitivity, peripheral PURPOSE: The purpose of the current study was 1) to describe
neuropathy, vascular pathology or insufficiency, chronic limb pain, or the pattern of whole brain activity during motion of isolated joints
hypertension. Upper extremity mapping involved 32 participants and of the lower limb, 2) to examine the somatotopic organization
12 participated in mapping the lower extremity. METHODS: Nerves of lower limb joint representations in the primary sensorimotor
investigated were the median, radial, ulnar, musculocutaneous, cortex and the anterior lobe of the cerebellum, and 3) to quantify
lateral antebrachial cutaneous, axillary, femoral, lateral femoral the degree of overlap between these lower limb joint activations.
cutaneous, obturator, tibial, saphenous, deep and superficial fibulars, RELEVANCE: The better understanding of central nervous system
medial calcaneal, and medial and lateral plantars. The procedure function during lower limb motion could enhance rehabilitation,
involved blockade of each nerve via tissue infiltration of Carbocaine formatting new aspects and purposes. PARTICIPANTS: Eighteen,
hydrochloride to the nerve’s most proximal selective location, followed right-leg dominant volunteers (n = 18, males, aged 27±5 years)
by infrared digital thermographic imaging of the resultant region of participated in this study after giving written informed consent
superficial hyperemia. Neural blockade temporarily interrupted local in accordance with Helsinki Declaration. The study protocol was
sympathetic innervation to arteries supplied by the nerve, resulting approved by the Scientific Committee of Attikon University Hospital of
in vasodilation and hyperemia. Hyperemia regions represented the Athens, Greece. METHODS: The fMRI measurements were carried
vascular innervation field of the nerve. Manual muscle testing out on a 1.5 T MR scanner (Gyroscan ACS-NT; Phillips) using a
and Semmes Weinstein monofilaments were used to validate quadrate head coil. All subjects performed repetitive knee, ankle,
success and selectivity of each block. ANALYSIS: Pre-blockade and toes flexion/extension movements. In order to relate lower limb
thermographic stabilization images were digitally compared to post- joints activation to the well described patterns of finger movement,
blockade thermograms for changes in surface temperature. Areas serial finger-to-thumb opposition was assessed also. All movements
with increases of >3 degrees centigrade were assembled to represent were auditory paced at 72 beats/min (1.2 Hz). ANALYSIS: Statistical
the vasomotor innervation field for the blocked peripheral nerve. analysis was performed using SPM99 package implemented in
Innervation fields for the nerves under investigation were compiled Matlab. Statistical parametric mapping was used to analyze functional
to produce a map of vasomotor innervation patterns for each and anatomical data. The SPM activation maps of the different
extremity. RESULTS: In many cases, vasomotor innervation fields isolated joint movements were mapped on Caret 5.1 Atlas flat
corresponded to established somatosensory patterns, with several map. A statistical evaluation of somatotopy in contralateral SM1
clinically relevant differences revealed in both limbs. No evidence and ipsilateral cerebellum (anterior lobe) during right-sided and
was found for vasomotor innervation by the radial nerve distal left-sided movements was performed using one-way analysis of
to the wrist, with innervation to the hand supplied solely by the variance (ANOVA) and conditional on a significant main effect,
median and ulnar nerves. In the lower extremity, no hyperemia Tukey’s least square difference tests were calculated for post-hoc
was observed following lateral femoral cutaneous or obturator nerve identification of significantly different locations of individual joints
blockades, leaving the entire anteromedial to anterolateral thigh representations. The significant threshold adopted throughout was
innervated by the femoral nerve. Post-blockade hyperemia patterns p < 0.05. RESULTS: Isolated lower limbs movement activated a
of the deep fibular nerve indicated that it innervates arterioles of distributed sensorimotor network, including primary and nonprimary
the anterior leg and dorsum of the foot. CONCLUSIONS: Peripheral sensorimotor areas. Although a large overlap was evident in primary
nerves supplying the hand, anterior thigh and leg, and foot’s sensorimotor cortex (SM1) and cerebellum representations of the
dorsum display vasomotor innervation patterns notably different three lower limb joints, a somatotopic arrangement was recognizable
from somatosensory distributions. These findings are consistent with reference to center of mass coordinates of each individual joint
with the hypothesis that peripheral nerves innervate adjacent in the above areas. CONCLUSIONS: A somatotopic arrangement
principal arteries. IMPLICATIONS: Since vasomotor innervation was recognizable with reference to center- of-mass coordinates of
fields differ from those of somatosensation, neuropathies involving each individual joint in SM1 and cerebellum, although ankle and
sympathetic efferents may produce symptom patterns that do not toes presented a close neighboring position. The activated areas
match somatosensory distributions. Resulting symptoms should not differed for the different joints of upper and lower limbs, not only
lead therapists to suppose the pathology is nonorganic. Sample size considering the somatotopy but also the activation pattern of specific
and subject consistency now affords presentation of a vasomotor areas, implying the functional variation of the corresponding joints.
innervation map of the extremities for clinical use. KEYWORDS: Neu- IMPLICATIONS: Detection of active brain regions during movement
rovascular, vasomotor innervation, peripheral neuropathy. FUNDING of the lower limb joints is feasible with fMRI, encouraging future
ACKNOWLEDGEMENTS: Release time for the principal investigator studies especially on neurological patients. However, a carefully
to complete this study was funded by a John Lantz Senior Research optimized methodology protocol is required. KEYWORDS: primary
sensorimotor cortex; cerebellum; somatotopy; brain activation; fMRI; for patients with stroke at all levels of ability and throughout their
lower limb. FUNDING ACKNOWLEDGEMENTS: The current study recovery. It is reliable, valid, and sensitive to change. KEYWORDS:
was supported by Marie Curie Training Fellowship (QLK2-CT-2000- gait, stroke. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT:
60057). CONTACT: [email protected] [email protected]
ETHICS COMMITTEE: The study protocol was approved by the
Scientific Committee of Attikon University Hospital of Athens, Greece.
23-11 Tuesday 5 June 15:30 CONSTRAINT-INDUCED MOVEMENT THERAPY (CIMT):
VCEC Exhibit Hall B & C SHORT-AND LONG TERM OUTCOME OF AN INPATIENT
MEASURING WALKING ABILITY AFTER STROKE: A REHABILITATION PROGRAM
SYSTEMATIC REVIEW OF THE EVIDENCE Mey S, Jann B, Rutz-LaPitz L; Rheinburg-Klinik, Walzenhausen,
Fulk G1 , Mirelman A2 , Deutsch J2 ; 1 Clarkson University, Physical Switzerland
Therapy Department, Potsdam, NY, USA; 2 University of Medicine PURPOSE: CIMT is a well-established intervention for treatment of
and Dentistry New Jersey, School of Health Related Professions, the upper extremity in patients with hemiplegia. We looked at short
Newark, NJ, USA and long term changes on the Wolf Motor Function Test (WMFT)
PURPOSE: The purpose of this systematic review was to evaluate and the Motor Activity Log (MAL) that occurred when CIMT was
the validity and reliability of clinically based patient oriented outcome offered in an inpatient rehabilitation program. RELEVANCE: World-
measures for assessing walking ability after stroke. RELEVANCE: wide, the annual incidence of cerebro vascular accident (CVA) is
The recovery of walking ability is a primary goal for individuals with 700,000 persons. Of these, 30% die within one year and another 25%
stroke and the rehabilitation team. Approximately one third of all remain severely disabled. Disability is associated with high costs and
people who experience a stroke are not able to walk independently restricted quality of life. This study addresses the question if CIMT
or require assistance. There are a variety of outcome measures that can improve the use of upper extremity and result in more frequent
assess gait in people with stroke undergoing rehabilitation. In order use. PARTICIPANTS: 8 patients were recruited who met motor and
to determine the effectiveness of evidence based interventions and cognitive inclusion criteria, agreed to participate in a rehabilitation
to document change clinicians should use outcome measures with program at our center. METHODS: Participants were required to
established reliability and validity. PARTICIPANTS: N/A METHODS: wear a mitt for max. 90% of waking hours and to participate in at
Medline and CINHAL databases were searched in April 2006 least 6 hours therapy per day over a minimum of 8 days during 2
using the following MeSH terms and CINAHL headings: “stroke”, consecutive weeks. Objective functional assessment was performed
“cerebrovascular disorders”, “cerebrovascular accident”, “ischemic using the WMFT at the beginning, at the end of the program and
attack”, “hemiplegia”, “gait”, “gait analysis”, “ambulation”, “walking”, in a follow-up. The MAL was administered at the same time to
“locomotion”, “validity”, and “reliability”. Articles whose main purpose assess the subjective and objective quality and quantity of use of
was to explore reliability and validity were identified and reviewed. the affected arm. ANALYSIS: Statistical analysis was done using
The quality of the studies was rated using the Standards of SPSS version 11.5. The Wilcoxon-Test was used to compare pre-test,
Tests and Measurements in Physical Therapy Practice. ANALYSIS: post-test and follow-up data. RESULTS: Statistical analysis showed
N/A RESULTS: Thirty-four articles met inclusion criteria and were significant changes in 15 out of 17 items in the functional part of
grouped into 5 categories: independence, distance, speed, appear- WMFT and in 2 items in the timed section between the first and
ance, and composite. Independence was most frequently measured second test (95% CI). The MAL showed significant differences in
using the Functional Ambulation Categories (FAC). It demonstrated 13 out of 30 items between first and second test in both quality
fair reliability and was strongly related to other measures of of use (QOU) and amount of use (AOU). After 15 months (6 SD)
gait. Measures of distance demonstrated high test retest reliability 3 items from the WMFT functional ability and 9 QOU respective 5
(reliability coefficients ranged from 0.95 to 0.99) and were moderately AOU tasks from the MAL differed significantly from the original exam.
to strongly correlated with measures of body structure/function CONCLUSIONS: Objective outcomes indicate that CIMT, in selected
and level of activity. Speed, measured over a 10m walk, was the patients after stroke or severe brain damage, is a valuable addition to
most common method of measuring walking ability. It demonstrated the established therapy. Results show a small lasting effect.Further
strong reliability, (reliability coefficients ranged from 1.0 to 0.60) research is needed to address the questions as to whether 8 days of
and was strongly to moderately related to other measures of body CIMT are sufficient to cause lasting improvement or whether this
structure/function and level of activity. Gait speed was sensitive to could be achieved by either another session of CIMT at a later
change and was able to predict discharge destination and community date or an initial program of longer duration. IMPLICATIONS: At
walking ability. Observational gait analysis demonstrated moderate to this time reasonable evidence exists that patients with a hemiparesis
good intra and inter rater reliability (reliability coefficients ranged from can profit from a CIMT program. Rehabilitation specialists should
0.75 to 0.95) and was fairly to strongly correlated with measures consider that a short but intensive program can improve the patients
of body function/structure and level of activity. CONCLUSIONS: abilities. A clearly defined CIMT inpatient program is recommended.
Choosing an appropriate method of measuring walking ability after The question of cost effectiveness compared to benefit for the
stroke is important for clinicians and will be dependent on the patient is mentioned but not conclusively answered. KEYWORDS:
setting and level of recovery of the patient. Measures of gait Constraint-Induced Movement Therapy; stroke; physical therapy,
speed, distance walked, and level of independence have strong rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
psychometric properties and together provide a comprehensive not funded. Support was given by the Rheinburg-Klinik. CONTACT:
picture of walking ability that is clinically useful and important to the [email protected]
patient. Measures of level of independence may be more useful early
in recovery. Further research is needed in order to better support the
clinical utility of observational gait analysis. Composite measures that
include community based factors that affect walking are potentially
useful, but require more research into their psychometric properties.
IMPLICATIONS: It is important for clinicians to use measures of
walking ability that have strong psychometric properties and are
patient oriented. Gait speed measured over a 10m walk is appropriate
Research Report Poster Display used by physical therapists to treat shoulder subluxation in patients
23-19 Tuesday 5 June 15:30 after stroke. The aim of this study was to investigate the prevalence
VCEC Exhibit Hall B & C of and rationale for the methods used by physical therapists for
LOSS OF TRUNK REPOSITIONING SENSE AND ITS RELATION the prevention of subluxation within Thai hospitals. RELEVANCE:
TO POSTURAL FUNCTIONS IN PEOPLE POST STROKE Shoulder subluxation can hinder the recovery of upper arm function
and when it occurs, may be irreversible. Therefore, prevention of
Ryerson S1 , Byl N2 , Brown D3 , Wong R4 , Hidler J1,5 ; 1 National
shoulder subluxation is crucial for neurological rehabilitation. This
Rehabilitation Hospital, Center for Applied Biomechanics and
study will provide essential information of current practice of physical
Rehabilitation Research, Washington DC, USA; 2 University of
therapy on the prevention of subluxation of the shoulder in Thailand.
California San Francisco, San Francisco CA, USA; 3 Northwestern
PARTICIPANTS: Three hundred and fourteen hospitals across
University, Chicago IL, USA; 4 Marymount University, Arlington
Thailand were invited. These hospitals provided neurological physical
VA, USA; 5 Catholic University of America, Washington DC, USA
therapy services to stroke patients and were chosen to ensure all
PURPOSE: To determine whether trunk repositioning sense is major institutions treating stroke patients were surveyed. METHODS:
impaired and related to loss of postural control functions in people A self administered questionnaire was mailed to physical therapy
post stroke RELEVANCE: Good trunk control is essential for departments. A representative physical therapist from each hospital
functional activities. Deficits of trunk anticipatory postural control was asked about methods used to prevent subluxation, who perform
have been identified in people post stroke. One conceptual model them, the criteria for using, the criteria for discontinuing their use and
suggests that postural control requires an internal model for accurate when they were used. The institutional ethics committee approved the
orientation. Proprioceptive feedback provides part of the information procedures for the survey and consent was assumed by return of the
for internal modeling. Trunk repositioning sense is one aspect of questionnaire. ANALYSIS: The data was analysed descriptively to
proprioception. If trunk repositioning sense is impaired post stroke, it determine the percentage of respondents. RESULTS: Two hundred
may be an underlying contributing element of altered trunk postural and twenty-six questionnaires were returned, ie, a 72% response
control. Altered trunk postural control would adversely affect trunk- rate. 98% of the respondents used assisted exercise, 51% used
limb linked movement sequences and ultimately interfere with the electrical stimulation and 31% used shoulder sling for the prevention
performance of daily activities. PARTICIPANTS: 21 subjects with of subluxation. The most frequently prescribed assisted exercise
chronic stroke and 21 age/sex matched non-neurologically impaired was shoulder exercise (45% of those who prescribed exercise). The
subjects. METHODS: Trunk repositioning error was assessed in exercise was performed 30 minutes a day, 5 days/week. The most
sitting while subjects performed a forward flexion movement. Subjects frequently prescribed electrical stimulation was electrical stimulation
were instructed to move to a prespecified flexion position during that applied to supraspinatus muscle (38% of those who prescribed
which trunk position was recorded from a tracking marker placed electrical stimulation). The stimulation frequencies used were greater
on the skin over the spinous process of T1. An electromagnetic than 30 Hz and stimulation time of 20 minutes a day, 5 days/week.
movement analysis system, ‘Flock of Birds’, was used to track the The most frequently prescribed shoulder sling was Bobath sling
position of the trunk and to document errors. ANALYSIS: Mean (87% of those who prescribed slings). The sling was worn all
repositioning error in people post-stroke and non-neurologically day time. Inadequate muscle strength was the most frequently-
impaired people was compared using a two-tailed independent t-test. cited criterion used to prescribe assisted exercise and electrical
Spearman correlation coefficient analyses were used to determine stimulation (27% and 31% of those who prescribed) and continued
the strength of the relationship between absolute repositioning the use until full recovery of arm function was obtained. Shoulder
error and clincial measures of balance (Berg Balance Scale), subluxation was the most frequently-cited criterion used to prescribe
postural control (Postural Assessment Scale for Stroke), and stroke Bobath sling (31% of those who prescribed slings) and continued
severity (Fugl-Meyer). RESULTS: There were significant differences the use until subluxation was repositioned. CONCLUSIONS: Given
in absolute repositioning error between stroke and control groups in that assisted exercises are so commonly selected by Thai physical
both the sagittal(p = 0.0001)and transverse(p = 0.012)planes. There therapists as a method to prevent subluxation of the shoulder
was a significant correlation between sagittal plane absolute after stroke, it is unfortunate that there is so little evidence to
repositioning error and Berg Balance score (r = −0.487, p = 0.029) provide guidance for its use. IMPLICATIONS: Therefore, it is
transverse plane absolute repositioning error and Berg Balance score necessary for prescription of assisted exercise to become evidence-
(r = −0.484, p = 0.031; and transverse plane repositioning error and based. KEYWORDS: stroke, shoulder subluxation, questionnaires.
PASS score (r = −0.518, p = 0.019). CONCLUSIONS: This study is FUNDING ACKNOWLEDGEMENTS: This work was supported by
an important first step towards a more complete understanding a grant from the Faculty of Allied Health Sciences, Chulalongkorn
of the role of trunk repositioning sense in people with post University, Bangkok, Thailand. CONTACT: [email protected]
stroke hemiparesis. IMPLICATIONS: Trunk position sense, with an ETHICS COMMITTEE: Institute of Health Research Chulalongkorn
emphasis on sagittal and transverse plane movements should be University
integrated into intervention strategies to improve trunk control in sit-
ting for people post stroke. KEYWORDS: stroke, trunk repositioning
sense, postural control. FUNDING ACKNOWLEDGEMENTS: none. Research Report Poster Display
CONTACT: [email protected] 25-03 Tuesday 5 June 15:30
ETHICS COMMITTEE: MedStar Research Institute, National Reha- VCEC Exhibit Hall B & C
bilitation Hospital, Washington, DC TWO-POINT DISCRIMINATION AND RELATED FACTORS IN
PATIENTS WITH STROKE
Yi S1 , Moon J2 , Ahn S2 , Kim K2 ; 1 Dept. of Physical Therapy,
24-23 Tuesday 5 June 15:30 Andong Science College, Andong city; 2 Dept. of Physical Therapy,
VCEC Exhibit Hall B & C Andong General Hospital, Andong city, Republic of Korea
PREVENTION OF SUBLUXATION OF THE SHOULDER IN PA-
TIENTS AFTER STROKE: A THAI PHYSICAL THERAPY SURVEY PURPOSE: The purpose of this study was to investigate two-
point discrimination (TPD) and related factors in patients with
Foongchomcheay A, Chamonchant D, Atichatmanee U;
stroke. RELEVANCE: Two-point discrimination is one of the sensory
Department of Physical Therapy, Faculty of Allied Health Sciences,
discriminative modalities, which provides information on the subject’s
Chulalongkorn University, Bangkok, Thailand
spatial acuity. This study provides that physical therapists establish
PURPOSE: Supportive devices such as slings, wheelchair/chair the treatment plan for physical therapy in these patients with
attachments and orthoses as well as electrical stimulation have been stroke. PARTICIPANTS: The sample consisted of 40 stroke patients
who had received physical therapy at the physical therapy unit The results of this study will help inform clinical practice of
of Andong General Hospital in Andong city between January and effective interventions using virtual reality technology for recovery
August 2006 studied. METHODS: Physical therapists measured of arm movements in patients with hemiparesis. PARTICIPANTS:
TPD for patients with stroke. TPD was measured from the tips of Subjects aged 19–80 yrs who had a stroke <3 yrs previously and
the thumb, index, middle, ring, and little finger of each hand with mild-to-severe motor impairment participated. METHODS: Clinical
the TPD esthesiometer. The examiner performing the test asked evaluations of arm impairment (spasticity – Composite Spasticity
patients to say “one” if they felt it as one point and “two” if they Index, motor impairment – Fugl-Meyer Scale; Reaching Performance
felt it as two. The research was designed to be a cross-sectional Scale) and function (Box and Blocks Test, Wolf Motor Function Test,
measured study. ANALYSIS: SAS statistical software was used for Motor Activity Log) as well as kinematic analysis of a pointing task
the analysis. The characteristics of the study sample were described (Optotrak, 120Hz, 6 markers) was done before and immediately
by mean and standard deviation (SD) for continuous variables and after practice. Subjects practiced varied pointing movements (72
by frequency and percentage for categorical variables. The Student’s trials/session) daily over 10 days during 2wks, in either a PE or a
t-test and analysis of variance (ANOVA) were used to compare VE. The task was to point as quickly and accurately as possible to 6
TPD in variables. A Pearson’s correlation analysis was conducted targets (12 trials/target, randomized) placed in different workspace
for relationship among values of 5 fingers. Multiple regression areas in front of the patient. In PE, the targets consisted of 6
analysis was performed to determine the factors associated with x 6 cm squares placed at 2 heights at a distance just beyond
TPD. RESULTS: A total of 40 stroke patients were measured, the subject’s arm’s length. In VE, target size and location were
their average age ± SD was 63.4±10.7 years (range: 34-82 identical to PE, but viewed in a fully immersive and interactive
yr). The mean TPD for 5 fingers tips was 8.00±4.31mm (thumb visual scene via a head-mounted display. Participants received
8.13±4.95mm, index 7.68±4.32mm, middle 7.80±4.21mm, ring feedback about movement outcomes (knowledge of results) and how
8.08±4.47mm, and little finger 8.33±4.17mm, respectively), while they performed the task (knowledge of performance) ANALYSIS:
one for unaffected side was 5.23±1.72mm (thumb 5.13±1.40mm, Three motor performance outcomes (error, trajectory smoothness,
index 5.08±2.08mm, middle 5.20±2.04mm, ring 5.08±1.65mm, and peak arm velocity) and five behavioral movement pattern measures
little finger 5.65±2.19mm, respectively). There was a statistically (elbow extension, shoulder horizontal adduction and flexion, trunk
significant difference in weight (p < 0.05), 10.50±5.58mm for 60–69kg displacement, trunk rotation) were compared. Two-way ANOVAs with
in the mean TPD for 5 fingers was highest, 8.49±4.62mm for over repeated measures and factors: group (experimental vs control) and
70kg, and 6.17±1.96mm for less than 60kg. Value of Stroke patients time (pre vs post) were used for each measure. Minimal significance
with diabetes (10.12±4.71) was statistically higher than patients was set at p < 0.05 RESULTS: After training, movements made by
without (7.09±3.86) in diabetes mellitus (p < 0.05). Factors related subjects in both groups improved. Results suggest that participants
to TPD by multiple regressions were age (beta=0.18, p < 0.05) and who trained in the VE had better performance in terms of movement
length of stay (beta=0.06, p < 0.05). CONCLUSIONS: In conclusion, accuracy (less errors) and increased velocity. They also had improved
age and length of stay were significantly associated with TPD. We movement pattern measures in terms of increased elbow extension,
recommend that further research should measure TPD by using shoulder horizontal adduction and shoulder flexion ranges after
larger sample sizes and more sensitive measurement instruments. training in the VE. Participants expressed satisfaction with and
IMPLICATIONS: The results of this study provided physical therapists increased motivation when training in the VE. CONCLUSIONS:
with information to establish the treatment plan for physical therapy Training in virtual environments may offer a motivating and chal-
in the stroke patients. KEYWORDS: Stroke, Two-Point Discrimination lenging environment for rehabilitation interventions. IMPLICATIONS:
(TPD), Related factors. FUNDING ACKNOWLEDGEMENTS: We Repetative motor retraining performed in a VE with feedback may be
thank Byeong-yeol Chun, MD, PhD, for statistical support with a means of maximising arm motor recovery in patients with stroke.
variable analyses. CONTACT: [email protected] KEYWORDS: Stroke, Arm motor recovery, Exercise. FUNDING
ETHICS COMMITTEE: Ethics approval was obtained by the hospital ACKNOWLEDGEMENTS: We acknowledge Canadian Institutes of
ethics review board. Health Research (CIHR), Canadian Foundation for Innovation (CFI)
and Physiotherapy Foundation of Canada (PFC) for their support.
ETHICS COMMITTEE: Centre For Interdisciplinary Research in
25-07 Tuesday 5 June 15:30 Rehabilitation in Greater Montreal(CRIR), Montreal, Canada.
REPETITIVE TRAINING OF ARM POINTING MOVEMENTS IN
PATIENTS WITH HEMIPARESIS IN VIRTUAL VS PHYSICAL
ENVIRONMENTS 26-11 Tuesday 5 June 15:30
Subramanian S1,2 ,Knaut L1,3 ,
Henderson A1,4 ,
Levin M1,2 ;
1 Jewish Rehabilitation Hospital site of Centre For Interdisciplinary HAMSTRING LENGTH, LUMBAR SPINAL RANGE OF MOTION,
PELVIC TILT, PELVIC MOBILITY AND LOW BACK PAIN AMONG
Research in Rehabilitation, Montreal, Canada; 2 School of Physical
RACIALLY DIVERSE EMPLOYEES
and Occupational Therapy, McGill University, Montreal, Canada;
3 School of Rehabilitation, University of Montreal, Montreal, Canada;
Kraemer T; A.T. Still University, Arizona School of Health Sciences
4 Department of Neurology and Neurosurgery, McGill University,
PURPOSE: The purpose of this study was to investigate the
Montreal
relationship of various physical factors (hamstring length, spinal
PURPOSE: Only about 50% of patients with initial arm paresis post AROM, pelvic tilt, and pelvic mobility) that result in self-reported low
stroke recover arm function. Virtual reality training environments back pain in racially diverse employees in a physically demanding
(VEs) are promising new tools to improve functional recovery level job within a university setting. It was hypothesized that decreased
in chronic stroke patients. Elements essential to maximize motor hamstring flexibility and pelvic mobility are contributing factors to low
learning, such as repetitive and varied task practice, performance back pain. RELEVANCE: Back pain is one of the most common
feedback and motivation, can be optimized in VEs.There is musculoskeletal problems, accounting for 25% of all disabling injuries
preliminary evidence from several small case studies that virtual in the United States. Previous research on lumbopelvic dysfunction
reality in combination with real world therapy may improve functional has focused on a variety of physiological and anatomical parameters
and motor outcomes. However evidence is insufficient on whether the and found that lumbopelvic imbalances produce increased anterior
effects of training in a VE differ from training in physical environments tilt of the pelvis and exaggerated lumbar lordosis. PARTICIPANTS: A
(PEs).This study aimed to answer this question. RELEVANCE: convenient sample consisting of 30 racially diverse male employees
who had been employed by a major research University physical plant asked to be interviewed about experiences of participating in the
(maintenance, grounds,vehicle repair, custodial) for at least 3 months dance-project. METHODS: Data was gathered through semistruc-
were recruited to participate in this study. METHODS: This was a tured interviews audiotaped and verbatim transcribed. A qualitative
quasi-experimental, correlational design. Upon independently com- narrative design was used. ANALYSIS: The data was analysed
pleting the informed consent and a general demographic/screening according to a qualitative narraive design involving the following
questionnaire, physical measurements including anthropometrics, steps: initial reading, identification of significant events, storyline
straight leg raise, lumbar spine AROM, pelvic tilt position, and pelvic reconstruction, story/theory juxtaposition, reconstructing narratives.
mobility utilizing osteopathic spring techniques were obtained via RESULTS: Results showed that it was a challenge to participate
blinded testers at each station. ANALYSIS: Data analysis included in the work-shops and in the performance. To do movements that
descriptive analysis and Spearman Correlation using SPSS Version arouse from a memory made the body-mind connection obvious
14.0. RESULTS: Descriptive stats are as follows: BMI (X = 29.0; for participants in a way they were not previously aware of and a
df = 6.3); T12-L1 spinal inclination angle (X = 75.4; df = 14.5); new understanding of the meaning of bodily movements emerged.
L5-S2 spinal inclination angle (X = 42.2; df = 14.0); pelvic tilt The communicative resources of bodily movements emerged during
inclination angle (X = 0.07; df = 0.027); SLR-R (X = 64.1; df the process. Even though it was not found difficult to perform
= 14.3); SLR-L (X = 67.6; df = 17.1); osteopathic pelvic spring: the movements per se, the challenge consisted in remembering
57% hypomobile posterior rotation anterior ilium; 64% hypomobile the sequencing unless there was a clear underlying narrative.
inferior stress anterior ilium; 60% hypomobile superior stress to Participants also reported satisfaction with having done something
ischial tuberosity; 57% hypomobile inferior stress to posterior ilium. not expected from than challenging society’s view of what elderly
Spearman Correlation significant (p < 0.05) for SA-1:SLR-R (.44); persons should do. CONCLUSIONS: By expressing memories
SA-1:SLR-L (.41). CONCLUSIONS: Although the findings indicate through bodily movements these participants formed consiusness of
that each variable contributes to lumbopelvic dysfunction and the connection between body-mind. The cartesian dualism separating
resulting report of low back pain, the exact role of each remains body and mind was strongly questioned after the dance experience.
unclear. Reliable interpretation on the source and role of lumbar IMPLICATIONS: By transferring the experiences of the project
lordosis, hamstring tightness, and pelvic immobility is only possible Movements as the Memory of the Body to rehabilitation settings
if additional information on lumbar ROM, pelvic tilt, abdominal new ways of working with elderly to promote mobility and health
strength, and pelvic mobility (rotation, slide (slip), side bending, can be invented. KEYWORDS: Body-mind, dance, elderly, memory,
and spring) is available. Future research should focus on the role rehabilitation. FUNDING ACKNOWLEDGEMENTS: The work was
and contribution of pelvic mobility combined with neurophysiological unfunded. CONTACT: [email protected]
recruitment in completing lumbopelvic movements, lengthening the
hamstrings, and recruiting the abdominal muscles to reduce low
back pain. IMPLICATIONS: In the US alone, a 1% reduction
in the overall prevalence of low back pain and lumbopelvic 27-23 Tuesday 5 June 15:30
dysfunction could considerably reduce worker morbidity and save VCEC Exhibit Hall B & C
billions of dollars. By correctly identifying the contributing factors THE LONG-TERM EFFECTS ON HEALTH-RELATED QUALITY OF
to lumbopelvic dysfunction, physical therapists can determine an LIFE IN OLDER PEOPLE IN RELATION TO COMPREHENSIVE
accurate differential diagnosis, establish a clincially sound and logical GERIATRIC TRAINING
plan of care, utilize effective treatment intervention strategies, and Inaba Y1 , Obuchi S2 , Arai T1,2 , Satake K3 , Sato H4 , Futami T1 ;
provide cost effective quality care thereby enhancing a client’s quality 1 Graduate school of Medical Science, Kitasato University;
of life and reducing worker compensation costs and societal medical 2 Preventive Care, Tokyo Metropolitan Institute of Gerontology;
expenditures. KEYWORDS: Pelvic mobility, Osteopathic Spring 3 Sapporo Health Promotion Center; 4 School of Allied Science,
Techniques, Low back pain. FUNDING ACKNOWLEDGEMENTS: Kitasato University
This research was funded by the Institute on Black Life. CONTACT:
[email protected] PURPOSE: Interventional research to improve older people’s disuse
ETHICS COMMITTEE: The Institutional Review Board (IRB) at the have increased, and physical and mental improvements have been
University of South Florida approved this study. shown in high-intensity resistance training programs. However, there
has hardly been any research into long-term changes in Health-
Related Quality of Life (HRQOL) after intervention. Moreover, it is
Research Report Poster Display not clear whether the changes in HRQOL after intervention are
26-15 Tuesday 5 June 15:30 maintained. The purpose of the present study was to investigate
VCEC Exhibit Hall B & C 1) the persistence rate of resistance training with weight training
ELDERLY PERSONS PARTICIPATING IN DANCE-WORKSHOP machines (machines) on subjects after the intervention, and 2) the
PROMOTED SENSE OF BODY-MIND CONNECTION long-term changes of HRQOL between a training maintenance group
(one or more days per week after intervention) (TR) and a detraining
Thornberg K1 , Josephsson S2 ; 1 Karolinska Institute, Dept of
group (DT) after the intervention in a progressive resistance and
neurobiology, caring sciences and society, division of physiotherapy,
balance training program named Comprehensive Geriatric Training
Stockholm, Sweden; 2 Karolinska Institute, Dept of neurobiology,
(CGT). RELEVANCE: Caring for the expanding elderly population
caring sciences and society, division of occupational therapy,
is an important challenge in Japan as well as in other countries.
Stockholm, Sweden
Maintenance of physical functioning and a high HRQOL has become
PURPOSE: The purpose of the study was to investigate how an important goal. Having knowledge of the long-term changes of
elderly amateurs experienced the participation in a dance-project. a subject’s HRQOL provides information about the psychological
RELEVANCE: To promote health in old age it is important to effects of the training and the importance of maintaining training
investigate activies that are peceived as meaningful for the partic- in the aged. PARTICIPANTS: The study included 167 community-
ipant. PARTICIPANTS: A choreographer advertised for participants dwelling persons aged 65 years and older (mean age, 74.0 ±4.9y).
in a project entitled “Movement as the Memory of the Body”. 145 The subjects were recruited through a public relations magazine
persons applied to the project and 17 were selected through an and through invitation by public health nurses. Informed consent
audition process, 6 men and 11 women, aged 66-89. They were was obtained from all persons prior to participation. METHODS: The
selected from three criterias: different characters, a varied range subjects’ SF-36 as HRQOL were measured before intervention (T1),
of ages and representation of both sexes. When workshops and after intervention (T2), and 1 year later (T3). We also interviewed
performance were finished a letter was sent in which they were the subjects about their maintenance of training from T2 to T3.
ANALYSIS: We used two-way ANOVA with repeated measures and Research Report Poster Display
Bonferroni’s multiple comparisons. RESULTS: One-hundred fifty- 29-11 Tuesday 5 June 15:30
three subjects out of 167 completed the CGT, and the HRQOL VCEC Exhibit Hall B & C
were measured in 135 subjects and all data collected. Of the 135 A THREE-MONTH, PILOT, HEALTH PROMOTION AND EXERCISE
subjects, 58 subjects (43.0%) were in the TR group and 77 (57.0%) PROGRAM IN CANCER SURVIVORS TO IMPROVE ENDURANCE
in the DT group. Physical Functioning, Bodily Pain, General Health, AND HEALTH-RELATED QUALITY OF LIFE
Vitality, and Mental Health subscale scores were changed over time Pfalzer L, Floros D, Hoppe J, Rexer P, Westover J, Cowdery J,
in both groups. Physical Functioning, Role Physical, General Health, Fry D, Kincaid C; University of Michigan-Flint, Flint, MI, USA
Vitality, and Mental Health were significantly improved in the TR group
compared to the DT group. In the TR group, the T2 score significantly PURPOSE: To describe the effects of a three-month health promotion
improved from T1 in Physical Functioning, Vitality and Mental Health. in cancer survivors on aerobic endurance, self-reported fatigue,
Moreover, the T3 scores significantly improved from the T1 scores physical function of health-related quality of life (HRQOL) and health
in Physical Functioning and Role Physical. In the DT group, the beliefs related to physical activity. Cancer-related fatigue (CRF), a
T2 scores were significantly higher than the T1 scores in Vitality frequent complaint, is reported in as many as 60-70% of survivors.
and Mental Health, while the T3 scores significantly decreased from Although the exact cause of CRF is unknown, decreased physical
the T2 scores in Physical Functioning, General Health, Vitality and activity is proposed as one contributing factor. Fatigue is reported
Mental Health. No subscale scores in T3 were significantly lower to negatively impact endurance and HRQOL in cancer survivors.
than in T1. CONCLUSIONS: The subjects improved and maintained Several studies have analyzed the effects of exercise on CRF in
HRQOL through CGT. Maintaining training led to the maintenance cancer survivors; however, none have investigated a combined, high
of a high HRQOL after one year. However, if training is not intensity resistive training protocol for fitness with an aerobic, home
maintained, the improvement in HRQOL gained by this program does walking program for health in cancer survivors. RELEVANCE: Effec-
not continue after one year. IMPLICATIONS: For physical therapy tive physical therapy health promotion programs to decrease CRF,
practice, these results suggest that for the elderly, doing training increase endurance and HRQOL are needed for cancer survivors.
and maintaining training is good not only for physical function, but PARTICIPANTS: For the purpose of this study, cancer survivors are
for HRQOL. KEYWORDS: HRQOL, Long-term effect, Community- persons that have completed all cancer treatments. Thirty-eight can-
dwelling older persons. FUNDING ACKNOWLEDGEMENTS: This cer survivors who ranged in age from 26 to 74 years (mean = 52) and
work was unfunded. CONTACT: [email protected] who had completed medical/surgical treatment for cancer, including
breast, colorectal, prostate, and brain, volunteered for the study. All
subjects were women except for two men each in the control and
Research Report Poster Display intervention groups, respectively. Twenty-five subjects were assigned
28-07 Tuesday 5 June 15:30 to the three-month health promotion intervention that was an on-line
VCEC Exhibit Hall B & C health education combined with supervised, high-intensity resistance
PHYSICAL ABILITY ESTIMATION INVOLVEMENT FOR training and an unsupervised, home walking program based on the
FALLINGS IN THE ELDERLY transtheoretical health belief model (TTM) that used constructs such
as motivation, self-efficacy and readiness to change physical activity.
Toshimichi S1 , Mishima S1 , Tanaka M1 , Tsushima E2 ; 1 Yamagata
The remaining thirteen subjects were assigned to the non-treatment
College Medical Arts & Sciences; 2 Hirosaki University
control group. METHODS: Outcome measures included six-minute
PURPOSE: In this report we examined the factors regarding falling walk test distance (6-MWT, meters(m)), Fatigue Severity Scale (FSS),
related to physical strength awareness in the elderly using the recog- and Short Form-36 version 2 Quality of Life questionnaire (SF-36 v2),
nized ‘functional reach test’ in clinic. RELEVANCE: This study offers and physical activity motivation, self-efficacy and stages of change
a new evaluation of falling in elderly people. PARTICIPANTS: The questionnaires developed for this study. Pre- and post-intervention
subjects were 88 healthy elderly who were able to continue the mea- testing was completed for both, intervention and control groups, by
surement and had no impediments in their daily living. METHODS: the same set of investigators who were blinded to the subject’s study
After declaring the estimate values for the ‘functional reach test’ ac- group. ANALYSIS: A two-way MANCOVA between groups*time(type
tual measurements were carried out. Errors were shown in individual IV full factorial model with simply contrast with p 0.05) of the
physical strength awareness arising from differences in predicted and outcome measures (6MWT, FSS, and SF-36v2) while covarying
actual measurement values. Three months later, subjects undertook for age and BMI. Secondary analyses included one-way ANOVAs
a survey regarding whether or not falling took place and were between groups on the outcome measures. RESULTS: The 6-MWT
examined on physical strength awareness in falling. ANALYSIS: Mul- distance before intervention for the intervention and control groups
tiple logistic regression analysis and the discriminant characteristic were 464±84 (mean, standard deviation) and 511±90, and after
analysis were used. A p value of <0.05 was considered to be sta- intervention 531±109 and 513±116, respectively. MANCOVA results
tistically significant. RESULTS: Of 88 subjects, 21 subjects (23.9%) were not significantly different for the two groups after intervention
experienced fallings during 3 months survey period. As a result of the (p = 0.11). Endurance (6-MWT distance) in the intervention group
multiple logistic regression analysis, the usual functional reach test was significantly improved as compared to the control group after
result and physical strength awareness error were both chosen as intervention on one-way ANOVA (p = 0.023, observed power 64%).
influences and factors in falling within the 3 month period(p < 0.05). However, the smaller effect size of the intervention on FSS and
The recurrence adoption when the two factors were included was HRQOL indicates a need for a larger study sample or more
best. Furthermore the discriminant characteristic analysis indicated sensitive questionnaires to detect change with intervention in the FSS
that amount of error from measured FRT could judge the possibility of and HRQOL. CONCLUSIONS: This pilot study demonstrates that
falling with the border of 8.5cm for the group which overestimate and cancer survivors improve endurance (6MWT) with an unsupervised,
−9.5cm for the group which underestimate. CONCLUSIONS: The home walking program as part of a three-month health promotion
result of this study suggested that physical ability estimation is one program. IMPLICATIONS: A three-health promotion program is an
of the significant factors in fallings in the elderly. Understanding the effective and safe method of treatment to improve endurance in
physical ability estimation is meaningful information to predict falling cancer survivors. KEYWORDS: cancer; exercise; wellness & health
in the elderly. IMPLICATIONS: primaly health care KEYWORDS: promotion. FUNDING ACKNOWLEDGEMENTS: This Project was
Physical ability estimation, Falling, Elderly people. FUNDING funded by Research Excellence funds at the University of Michigan-
ACKNOWLEDGEMENTS: N.A. CONTACT: [email protected] Flint from the State of Michigan. CONTACT: [email protected]
ETHICS COMMITTEE: Yamagata College of Medical Arts & ETHICS COMMITTEE: The University of Michigan-Flint’s Instituti-
Sciences tional Review Board approved this study.
ROLES OF PHYSICAL THERAPISTS AND OCCUPATIONAL APPLICABILITY OF USING FORMETRIC INSTRUMENT SYSTEM
THERAPISTS IN SCHOOLS FOR PHYSICALLY HANDICAPPED (FIS) TO ANALYZE POSTURE IN CHILDREN WITH CEREBRAL
CHILDREN: AN ATTITUDE SURVEY ON TEACHERS PALSY
Kudo S1 , Takahashi K2 , Naba M3 ; 1 Department of Physical Therapy Abdelazeim F1 , Radwan H2 ; 1 Cairo University, Cairo, Egypt;
2 Winston Salem State University, NC, US
at the Akita University Faculty of Allied Medical Sciences. Akita
city, Japan; 2 Department of Occupational Therapy at the Akita
PURPOSE: The purpose of this study was to establish the
University Faculty of Allied Medical Sciences, Akita city, Japan;
3 Akita Prefectural School for Disabled Children, Akita city, Japan applicability of using FIS in postural analysis of children with cerebral
palsy (CP). RELEVANCE: FIS is used to analyze back configurations
PURPOSE: To determine the effects of the first adoption of PT (2 and posture in adults with and without spinal problems. The FIS is
individuals) and OT (1 individual) at the Akita Prefectural School relatively easy to use, the anatomical landmarks, vertebral position,
for Disabled Children, and to identify factors facilitating future and rotation are automatically detected and there is no need for
manual placement of markers on the vertebrae. However, the FIS is
cooperation. RELEVANCE: Background: Physical therapists (PT)
not used by clinicians to evaluate children with CP. PARTICIPANTS:
and occupational therapists (OT), which have been established as
This study was conducted at Faculty of Physiotherapy, Cairo
medical professions in Japan, are legally not allowed to work at
University. Twenty children with spastic diplegic CP were selected
schools for disabled children. PT and OT who wish to work at
from the outpatient clinic according to preset criteria. The ages
schools for disabled children must first obtain a license for teaching
of the children recruited started developmentally from 10 months
at schools for disabled children, be recruited as teachers (not
according to Denver developmental screening test. They measured
as PT or OT) at schools for disabled children, and perform their from 1 to 1+ degree of spasticity according to Modified Ashworth
functions as teachers. However, due to the increasing severity of scale. They had no significant perceptual disorders. They were able
impairment among students at schools for physically handicapped to stand alone with heels on the ground (at least five seconds) and
children in recent years, the Akita Prefectural School for Disabled Average height is nearly one meter METHODS: The history of every
Children has adopted PT and OT on a part-time basis, starting in child was taken and a primary clinical assessment was done which
2006, and received teaching advice and guidance from PT and OT. included subject’s weight and height. Then each child was prepared
So Our research bears some relevance to the discussions under to ensure exposure of the back, to avoid any disturbance of the
way at WCPT. PARTICIPANTS: 53 teachers in Akita Prefectural image, and to achieve free standing posture as much as possible
School for Disabled Children. METHODS: An attitude questionnaire with both heels on the ground. The formetric software program was
survey was conducted on 53 teachers in Akita Prefectural School for set to be ready prior to the actual testing to perform the scanning
Disabled Children. ANALYSIS: Following simple tabulation, results procedure as soon as the proper position if the chilled achieved to
were analyzed using the chi square goodness of fit test, and eliminate any movement artifact. The scanning procedure lasted for
classified by the number of years of teaching experience. RESULTS: very short time (40 ms). The formetric instrument system was used
Responses were obtained from 49 (response rate, 92.5%) teachers. to evaluate the spinal geometry in terms of trunk imbalance, pelvic
1) The most commonly reported expectations for PT and OT were tilt, pelvic torsion, surface rotation, and lateral deviation based on
needs for positioning and dietary guidance. 2) The most commonly dimensional scanning. Full Back Shape three-dimensional analysis
perceived role of teachers was to nurture the children’s ability to was done, recorded, and printed out for each patient. ANALYSIS:
express themselves. 3) The most commonly reported challenge for The data of trunk imbalance, pelvic tilt, pelvic torsion, surface rotation,
schools for disabled children was improvements in “independent and lateral deviation were collected, tabulated and analyzed using
activities”, 4) In response to the question, “Have you actually seen descriptive techniques. RESULTS: The data collected showed that
the work performed by PT and OT?”, 40 (82%) teachers had seen the using FIS to assess the posture of children with spastic diplegic
work performed by PT and OT, and had also received guidance from CP can determine with accuracy the degree of postural deviation in
PT and OT. 5) However, 31 (63%) teachers perceived the cooperation this population. In this study the trunk imbalance, pelvic tilt, surface
between education and healthcare/welfare to be inadequate or rotation, and lateral deviation were 9.13±3.46, 6.25±2.45, 6.45±2.
somewhat inadequate. 6) In response to a question regarding the 22, and 4.64±1.24 respectively. CONCLUSIONS: The FIS can be
effectiveness of the PT and OT adopted in April, 43 (88%) teachers used to assess and effectively evaluate posture in children with
evaluated PT and OT as being effective. Thus, considering that 37 CP. IMPLICATIONS: Clinicians will be able to accurately evaluate
(75.5%) teachers commented positively on the effectiveness of PT and develop an effective plan of care for children with CP when
and OT adoption, the activities thus far can be thought to have they use such system. KEYWORDS: Cerebral palsy, Formetric
achieved some degree of success. CONCLUSIONS: The adoption of Instrument System, posture. FUNDING ACKNOWLEDGEMENTS:
N/A. CONTACT: [email protected]
PT and OT in schools for physically handicapped children was shown
ETHICS COMMITTEE: Cairo University Research Committee
to be effective from an educational standpoint, and the following
points were identified as future needs: 1) sharing of the workplace
with teachers, 2) rapid transmission of information to the necessary Research Report Poster Display
departments, and 3) establishment of a mechanism for cooperation 31-07 Tuesday 5 June 15:30
that enables a mutual and shared sense of accomplishment at work. VCEC Exhibit Hall B & C
IMPLICATIONS: This research make a large contribution to the
BODY WEIGHT SUPPORT TREADMILL TRAINING WITH
development of new working area for Japanese Physical therapist
FUNCTIONAL ELECTRICAL STIMULATION FOR A TODDLER
and the form of new cooperated system for the special education
WITH L4/5 SPINDA BIFIDA
in Japan. KEYWORDS: Disabled Children,An attitude questionnaire,
cooperation. FUNDING ACKNOWLEDGEMENTS: We obtained the Paleg G; Montomery County Infant and Toddler Program Rockville,
Maryland, US
school master acknowledgment signature to this survey and all
the expenses the this research were covered by my expenditures PURPOSE: Recent studies have demostrated the value of Body
on research and development. CONTACT: [email protected] Weight Support Treadmill Training in improving functional overground
u.ac.jp mobility for people with CVA, TBI and SCI and children with Down
ETHICS COMMITTEE: Our university has an ethics committee. Syndrome. Newer studies have incorporated functional electrical
stimulation and have seen a trend toward improved outcomes. Can responses relating to work setting and -area, years qualified and
a toddler with L4/5 spina bifida benefit from this intervention? This conditions most commonly treated where this was appropriate.
study is the first known case to attempt to answer this question. Responses to the open-ended questions were qualitatively processed
RELEVANCE: The incidence of spina bifida is estimated at 1-2 and analysed. RESULTS: Responses where received from 461
per 1000 population, with certain populations having significantly physiotherapists. 70% of respondents reported a need to legally
increased incidence based on genetic predilection. In the past, most administer and 58% reported a need to store certain medicines.
children with L4/5 involvement do not become indep ambulators. More than 60% of respondents were in favour of the expansion
This study seeks a method to improve outcomes for these children. of the scope of physiotherapy practice to include prescription of
PARTICIPANTS: This child was born with L4/5 spina bifida. She a limited range of medications after training and within certain
began BWS-TT at 12 mos and electrical stimulation was added at areas of specialization or clinical competence. CONCLUSIONS: SA
15 mos. At the beginning of the intervention she was unable to sit, physiotherapists have a need for legal administration and storage
stand, or walk but was able to roll and commando (belly) scoot. She practice. Physiotherapists are aware of the role in optimal client
had absent sensation below her navel and mild increased tone (right management and have recognized the need for pharmacology
grater than left) of her hamstrings and heelcords. METHODS: Body knowledge. A need for voluntary limited prescription rights was also
Weight Support Gait Therapy (BWS-GT) alone was provided 3x/week identified. IMPLICATIONS: Several recommendations for inclusion
for 10 minutes for 6 weeks. The same subject was then provided 6 of a basic pharmacology module as part of the undergraduate
weeks of BWSGT with Functional Electrical Stimulation to her hip curriculum have been made. The option to expand or update
and knee extensors 3x/week for 10 minutes per session. ANALYSIS: knowledge and skills via CPD activities and through specialization
During the initial 6 weeks, the child tolerated the treatment well was also recommended. Following a report submitted to the Profes-
and gained the ability to get on her knees. During the second sional Board for Physiotherapy, a task team has been established
6 weeks she gained the ability to sit, step with HKAFOs with to persue the desicion to expand the scope of PT practice to
assistance for weight shifting, and regained sensation to light touch, include prescription of medicines. Process and successes achieved
pressure, ice and deep touch over her entire lower body. See was to date will also be briefly reported. KEYWORDS: precription rights;
also able to produce a Poor minus contraction of her hamstrings PT status. FUNDING ACKNOWLEDGEMENTS: Harry Crossley
bilaterally and began to move her toes. RESULTS: Child improved Fund; HPCSA; Stellenbosch University, Faculty of Health Sciences.
from Asia A to Asia B, gained the ability to sit and was able to begin CONTACT: [email protected]
using HKAFO’s. CONCLUSIONS: This study shows that BWSGT ETHICS COMMITTEE: Research and Ethics Committee at Stellen-
when combined with functional electrical stimulation is a feasible bosch University, registration no. 2003/147/N
and potentially beneficial treatment strategy for young children
with spina bifida. IMPLICATIONS: This case study demonstartes
that a child with spina bifida can tolerate and may benefit from
this intervention. KEYWORDS: Body Weight Support Treadmill 36-23 Tuesday 5 June 15:30
Training Functional Electrical Stimulation; Spina Bifida. FUNDING VCEC Exhibit Hall B & C
ACKNOWLEDGEMENTS: Mobility Research donated the BWSGT VALIDATION OF A PREDICTIVE MODEL FOR LOCOMOTION IN
System, Treadmill and harness. CONTACT: [email protected] STROKE PATIENTS: INVESTIGATION USING THE FUNCTIONAL
ETHICS COMMITTEE: Ethics was not required as no invasive BALANCE SCALE
procedure was involved Sugimoto S1 , Maruya K2 , Saitoh H3 , Asano S4 ; 1 Health Science
University, Minamitsurugunn Yamanashi, Japan; 2 Musashidai
Research Report Poster Display Hospital, Hidaka Saitama, Japan; 3 Tukuba Memorial Hospital,
33-23 Tuesday 5 June 15:30 Tsukuba Ibaraki, Japan; 4 Tukuba Central Hospital, Ushiku Ibaraki,
VCEC Exhibit Hall B & C Japan
PHARMACOLOGY AND PRESCRIPTION: WIDENING THE PURPOSE: The Functional Balance Scale [FBS] is a balance test
SCOPE OF PHYSIOTHERAPY PRACTICE IN SOUTH AFRICA including not only sitting balance but also higher-level balance
activities such as standing on one leg and stepping. The FBS is
Unger M1 , Lochner R1 , Eales C2 ; 1 Stellenbosch University; 2 Health
composed of 14 sub-tasks, which are allotted from 0 to 4 points
Professions Council of South Africa
(0 indicating an inability to complete any aspect of the task) and
PURPOSE: To investigate current practice regarding administration, the total score is commonly used as the index of balance ability.
recommendation and storage of medication by SA PTs and to Recently, many researchers have reported that the FBS is useful in
determine their need for the right to prescribe. RELEVANCE: predicting locomotive levels in stroke patients and risks of falling in
Inclusion of prescription rights has huge implications regarding the elderly. We also previously investigated the relationship between
expansion of an already very full undergraduate curriculum and cost locomotive levels and the FBS scores in chronic stroke patients
of insurance premiums. However as firstline practitioners and with (Sugimoto et al, 2005). Our report emphasized that each sub-task
the increasing evidence for lack of EBP, the status of physiotherapy of the FBS predicted locomotive levels because the point which
has and is decreasing. Many previously considered PT techniques was needed to get a good locomotive level was different from
are being utilised by other medical and non-medical professionals one task to another. However, we couldn’t confirm the validity of
and technicians and clients are seeking a one-stop shop for all their the predictive model in the previous study. Additionally, five-graded
medical requirements. PARTICIPANTS: All 4408 physiotherapists measurements were too many to judge whether the activity of
registered with the HPCSA in Jan 2004 were included in the study. each sub-task was good or not. The purpose of this study was
Motivation: results of this survey had enormous implications for to simplify the sub-tasks of the FBS and to investigate the validity
changing current scope of PT practice. This offered an opportunity of a predictive model using the simplified sub-tasks for locomotion
for all to comment. METHODS: Descriptive analytical design. in stroke patients. RELEVANCE: This study is useful in order to
A self-administered questionnaire was developed in consultation clarify methods to easily predict locomotive levels in stroke patients.
with the HPCSA. The questionnaire had 3 sections collating PARTICIPANTS: Eighty two chronic stroke patients (34 women and
information regarding personal details and demographics; current 48 men, 69.5±11.3 years old), who could walk indoors by themselves
practice and knowledge of pharmacology; and attitudes towards consented to participate in this study. METHODS: The subjects
drug administration and prescription respectively. Checklists, yes/no were randomly divided into the predictive group and the verifiable
and open-ended questions for listing and explanation were used. group after consideration of two locomotive levels (indoors/ outdoors).
ANALYSIS: Quantitative data was analysed and correlated with After frequency distribution tables were made for locomotive levels
and 14 sub-tasks of the FBS, a threshold level to distinguish the significant relationship between stretch reflex threshold values on the
difference between the two locomotive levels was investigated in MRST and resistance to passive stretch as measured on the MAS.
each sub-task in the predictive group. ANALYSIS: The predictive The main factor in improving reliability was better training of clinicians
expression for locomotive levels was formulated by discriminant on the use of the device. The validity and the responsiveness
analysis method using the two-graded sub-tasks. The hitting ratio of the MRST need to be investigated. IMPLICATIONS: The
of the locomotive level in the verifiable group was calculated with new measurement tool provides continuous numerical data to
this predictive expression. RESULTS: The results of the discriminant objectively and reliably quantify spasticity. It is the first portable
analysis using the stepwise selection method indicated that “Turn to device that provides accurate measurement of spasticity for both
look behind” and “Turn 360 degrees” in the sub-tasks were the most the rehabilitation researcher and clinician. KEYWORDS: spasticity,
effective predictors of locomotive levels. In the above two tasks, if a stretch reflex, neurological. FUNDING ACKNOWLEDGEMENTS:
patient could turn to look behind from both sides and he could turn The study was supported by Univalor and OPPQ-REPAR. CONTACT:
360 degrees slowly and safely, then the patient could be predicted [email protected]
as being in good condition. The hitting ratio of locomotive levels was ETHICS COMMITTEE: Center for the interdisciplinary Research in
80.4% in the predictive group and 68.2% in the verifiable group. Rehabilitation of Montreal.
CONCLUSIONS: Our results suggest that this predictive model
using the simplified sub-tasks of the FBS is useful in the prognosis
of locomotive levels in chronic stroke patients. IMPLICATIONS:
Physical therapy practice KEYWORDS: stroke patients, locomotion, 37-07 Tuesday 5 June 15:30
Functional Balance Scale. FUNDING ACKNOWLEDGEMENTS: VCEC Exhibit Hall B & C
N.A. CONTACT: [email protected] HEALTH LOCUS OF CONTROL SCALE IN PATIENTS WITH
CHRONIC LOW BACK PAIN: PSYCHOMETRIC PROPERTIES OF
THE BRAZILIAN-PORTUGUESE VERSION
37-03 Tuesday 5 June 15:30 Oliveira V1 , Furiati T1 , Ferreira P2 , Ferreira M1 , Sakamoto A3 ;
1 Pontificia Universidade Catolica de Minas Gerais, Belo Horizonte,
Brazil; 2 Universidade Federal de Minas Gerais, Belo Horizonte,
A NEW CLINICAL SPASTICITY MEASURE BASED ON EVALU- Brazil; 3 Centro Universitario de Belo Horizonte, Belo Horizonte, Brazil
ATION OF STRETCH REFLEX THRESHOLD EXCITABILITY
PURPOSE: Low Back Pain (LBP) is a common cause of disability in
Calota A1 , Feldman A2,3 , Johnstone E3 , Levin M1,3 ; 1 School of
the Brazilian population, affecting mainly those who are economically
Physical and Occupational Therapy, McGill University, Montreal,
active. The aim of this study was to translate and adapt the
Canada; 2 Department of Physiology, Université de Montréal,
Multidimensional Health Locus of Control (MHLC) scale to Brazilian-
Montreal, Canada; 3 Jewish Rehabiliation Hospital, Laval, Canada
Portuguese, and to investigate its psychometric properties in
PURPOSE: Spasticity is a motor disorder characterised by a Brazilian patients suffering with chronic LBP. RELEVANCE: There
velocity-dependent increase in tonic stretch reflexes with exaggerated is evidence that psychosocial factors such as health locus of
tendon jerks, resulting from hyperexcitability of the stretch reflex, control affect prognosis in LBP. Although the MHLC questionnaire
as one component of the upper motor neuron syndrome. Common is widely used in LBP, the Brazilian-Portuguese version has not been
clinical measures of spasticity are the Ashworth, the modified validated. PARTICIPANTS: The sample consisted of 40 Brazilians
Ashworth (MAS) and the Tardieu Scales. The validity of these with non-specific chronic LBP, of both sexes, from various social-
measures has been questioned since they focus more on the economic backgrounds. Individuals with tumours, traumas, infections,
quantification of resistance to passive stretch rather than the velocity- inflammatory disorders and compromised nerve roots were excluded.
dependence of spasticity. The purpose of this study was to test METHODS: In the first phase, we translated and adapted the
the reliability (inter and intra-rater) of a new portable measure questionaire as specified by Beaton et al (2000). In the second
of spasticity based on threshold excitability of the tonic stretch phase, the translated and adapted questionnaire was applied on
reflex. RELEVANCE: Evidence-based neurological practice and the the sample in order to evaluate the psychometric properties of
development of physiotherapeutic interventions depend upon valid, reliability (n=20), concurrent validity and internal consistency (n=40).
responsive and reliable assessment tools. DESCRIPTION: Patients To evaluate concurrent validity, we used the Roland Morris (RM)
with diagnoses of multiple sclerosis, stroke, cerebral palsy, traumatic disability questionnaire. The research project was approved by the
brain injury and spinal cord injury presenting with spasticity in the Pontificia Universidade Católica ethics committee. ANALYSIS: We
biceps brachii and/or the gastrocnemius participated in this study. All used intra-class correlation coefficients (ICCs), Minimal detectable
patients signed a consent form approved by the Ethics committee of change scores (MDCs), and Standard Error of the measurement
the Center for Interdisciplinary Research in Rehabilitation. Spasticity (SEM) to analyse reliability, Pearson’s r for concurrent validity and
was evaluated by three independent evaluators using the portable Cronbach’s alpha for internal consistency. The statistical analyses
device (MRST) and the MAS on two different days, spaced over were done by a blinded statistician. RESULTS: ICC values for
one week. The MRST uses an eletromyographic amplifier and an reliability were of 0.75 for the external subscale (p < 0.01), 0.87 for
electrogoniometer to record stretch reflex thresholds in terms of the internal subscale (p < 0.01) and 0.90 for the chance subscale
joint angles for different velocities of stretch. Up to 20 values of (p < 0.01). The MDC values were 6.84, 6.77 and 5.59 for the
velocity-dependent stretch reflex thresholds are used by the device external, internal and chance subscales respectively. The SEM
to compute the tonic threshold which is then displayed on a small values were 2.96, 2.92 and 2.42 for the same subscales respectively.
computer screen. The degree of spasticity is expressed as the joint With regard to the concurrent validity, the external and chance
angle at which the threshold response occurs. The MAS is a 5 subscales correlated positively with disability (r = 0.58; p < 0.01 for
point scale ranking spasticity from mild to severe based on the external and r = 0.35; p < 0.05 for chance respectively) whilst the
evaluator’s impression of the amount of resistance to stretch of the internal subscale correlated negatively (r = −0.33; p < 0.05). The
passive muscle. EVALUATION: Intra- and inter-rater reliability for Alpha-Cronback value for the scale was 0.75 and when each
each measure (MRST, MAS) was determined with Kappa and inter- item was excluded it varied between 0.71-0.75. CONCLUSIONS:
class correlation analyses (minimal significancelevel p < 0.05). The The Brazilian-Portuguese version of the MHLC scale for individuals
relationship between MRST and MAS scores was determined with with non-specific chronic LBP in Brazil showed excellent reliability,
Pearson correlations. CONCLUSIONS: Preliminary results suggest no problematic items and good internal consistency. Individuals
that the intra- and inter-rater reliability of the MRST is moderate with higher scores for the internal subscale demonstrated lower
to high while the MAS is less reliable. There was a moderate but disability levels whilst those with higher scores on the external
and chance subscales showed greater disability. IMPLICATIONS: the shoulder and scapular dysfunction, injury prevention and sports
The Brazilian-portuguese version of the MHLC scale is a useful performance. IMPLICATIONS: The application of Kinesio taping
tool for clinicians to evaluate Brazilians suffering with LBP. Future resulted in positive changes in the scapular motion and could be
research should investigate whether physiotherapy interventions alter used as a treatment aid in managing baseball players with shoulder
the health locus of control of Brazilians suffering with chronic impingement problems. KEYWORDS: taping, scapular kinematics,
LBP and the impact of these changes on clinical outcomes shoulder impingement. FUNDING ACKNOWLEDGEMENTS: This
such as disability. KEYWORDS: Low back pain, health locus of study was partly sponsored by the National Science Council, Taipei
control, scales. FUNDING ACKNOWLEDGEMENTS: This work was City Hospital, and China Medical University, Taiwan. CONTACT:
unfunded. CONTACT: [email protected] [email protected]
ETHICS COMMITTEE: Pontificia Universidade Católica ethics ETHICS COMMITTEE: Institutional Review Board (IRB) National
committee Yang Ming University

THE EFFECTS OF KINESIO TAPING ON SCAPULAR THE EFFECTS OF SPORTS PHYSICAL THERAPY ON NATIONAL
KINEMATICS IN BASEBALL PLAYERS WITH SHOULDER COMPETITIVE SWIMMERS
IMPINGEMENT SYNDROME
Kimura T1 , Sakai Y2 , Uchida Y3 ; 1 Department of Physical Therapy,
Shih Y1,2 , Hsu Y1 , Chen W1,2 ; 1 Faculty and Institute of Physical School of Health Sciences, Shinshu University; 2 Department
Therapy, National Yang-Ming University, Taipei, Taiwan; 2 Research of Physical Therapy, College of Medical and Human Services in
and Education Department, Taipei City Hospital, Taiwan Toyama; 3 San·ai Hospital
PURPOSE: Scapular dysfunction often occurs with shoulder im- PURPOSE: The purpose of this study was to clarify the effects of
pingement. The resultant alternations in scapular kinematics may sports physical therapy on the athletes of the national Japanese
lead to further shoulder injury and pain. Although Kinesio taping swimming team. RELEVANCE: This study is useful for providing
techniques are commonly used in treating this type of dysfunction guidelines in the clinical decision making process for physical therapy
in the Asia Pacific region, no research has ever been conducted to intervention programs, by clarifying the effects of sports physical ther-
investigate the effects of Kinesio taping on the scapular kinematics. apy such as physical modalities and manual therapy on the athletes
This study aimed to assess the immediate effects of Kinesio taping on in the national swimming team. PARTICIPANTS: The subjects in this
scapular kinematics in baseball players with shoulder impingement. study were forty-two swimmers (17 female, 25 male; mean age ±
RELEVANCE: With the growing use of therapeutic taping in the SD, 21.3±2.7 years; range, 16-27 years) from the Japanese national
sports injury management, we would like to establish the therapeutic swimming team at an international swimming competition in 2006.
effect of Kinesio taping on the scapular dysfunction and to explore METHODS: Physical modalities consisting of therapeutic ultrasound
the mechanism of the treatment effect. The results of this study could and direct current stimulation, and manual therapy consisting of
provide an evidence-based clinical practice when treating athletes mobilization, massage, and stretching, were executed to improve
with shoulder pain. PARTICIPANTS: Twenty baseball players with the local muscle fatigue and muscle pain in swimmers during pre-
shoulder impingement were recruited from amateur baseball teams competition and competition phases. To determine the effects of
in the Taipei area, and were randomized into an experimental-first these interventions, a numeric rating scale (NRS) was analyzed
or a placebo-first group. Seventeen subjects finished the study. before and after all interventions. ANALYSIS: Mann-Whitney U test
METHODS: Subjects received both types of taping with at least three was used for analysis of the changes in NRS in the local muscle
days in between. The Kinesio tape was used in the experimental fatigue and muscle pain between pre and post-intervention periods.
session, and the 3M Micropore tape in the placebo session. The Statistical significance level was set at 0.05. RESULTS: During
tape was applied to wrap around the lower trapezius muscle. sixteen-day study period which included a pre-competition phase
The testing tasks included three trials of shoulder elevation in the (twelve days) and competition phase (four days), a total of eighty-
scapular plane (scaption) with a 2 kg load in the testing hand. two swimmers utilized the sports physical therapy service provided.
During scaption, the data of the 3-dimensional motion of the scapula The area of local muscle fatigue where the swimmers complained
were collected using Liberty electromagnetic tracking system before the most (in descending order) included the low back (20.6%),
and after taping application. ANALYSIS: The raw data of the 3- thigh (14.1%), shoulder, upper back and buttocks (11.3%), calf
dimensional scapular movement were transformed into anatomically (10.7%), neck (8.2%), upper arm (5.5%), and others (6.9%). The
bound coordinate systems according to the recommendations from area of muscle pain where the swimmers complained the most (in
ISB (International Society of Biomechanics). The six components descending order) included the low back (53.8%), neck (17.9%),
of scapular movement, upward/downward rotation, internal/external shoulder (7.7%), buttocks and thigh (5.1%), and others (10.3%). With
rotation, anterior/posterior tilt, superior/inferior displacement, me- regards to local muscle fatigue, the mean (±SD) values of NRS
dial/lateral displacement, and anterior/posterior displacement were pre and post-intervention were 5.5 (±1.5) and 2.2 (±0.9), and this
described in relation to the arm elevation angle. Analyses of was significantly different (p < 0.01). With regards to muscle pain, the
variance (ANOVA) with repeated measures were used to compare mean (±SD) values of NRS pre and post-intervention were 5.5 (±2.1)
the differences in the scapular kinematics between the two types of and 2.6 (±1.1), and this was also significantly different (p < 0.01).
taping. RESULTS: With increased arm elevation, the scapula rotated CONCLUSIONS: From the results of this study, it is believed that the
upward and internally, tilted posteriorly, and moves superiorly and comprehensive intervention to the local muscle fatigue and muscle
medially. Compared to the placebo taping, Kinesio taping significantly pain were important in improving the performance of the swimmers.
increased the scapular posterior tilt at 30º and 60º of scaption Since it was observed that intervention by physical modalities and
(p < 0.05). CONCLUSIONS: This is the first study conducted to manual therapy demonstrated significant effects for local muscle
examine the effect of Kinesio taping on the scapular kinematics fatigue and muscle pain, it is believed that these interventions should
in baseball players with shoulder impingement. The results of this be available for prevention and treatment of sports disorders such as
investigation proved that use of Kinesio taping improve the scapular low back pain in swimmers. However, since outcome evaluation in
movement in baseball players with shoulder impingement syndrome. this study was analyzed based on the interactive effects of physical
Further research should be carried out to promote the understanding modalities and manual therapy, it is thought that further studies are
of the taping mechanisms and its long-term treatment effect on needed to clarify the individual effects of sports physical therapy.
Platform Presentations, Wednesday 6 June S485
IMPLICATIONS: The results from this study can be used to guide may work to improve recovery rates following training. KEYWORDS:
clinicians in their decision making process for determining the most Exercise, Recovery, Volumetry. FUNDING ACKNOWLEDGEMENTS:
appropriate physical therapy treatment for competitive swimmers. None. CONTACT: [email protected]
KEYWORDS: Sports physical therapy, Physical modalities, Man- ETHICS COMMITTEE: Ethics and Biosafety Committee, University
ual therapy, Swimming. FUNDING ACKNOWLEDGEMENTS: Nil. of Sydney.
ETHICS COMMITTEE: Japan Swimming Federation
Platform Presentations, Wednesday
6 June
38-19 Tuesday 5 June 15:30 Research Report Platform Presentation
VCEC Exhibit Hall B & C 777 Wednesday 6 June 08:30
THE EFFECTS OF WEARING SPORTS TIGHTS DURING PP Crystal Pavilion A
TRAINING ON LOWER LEG VOLUME IN PROFESSIONAL PROFESSIONAL SOCIALIZATION BEGINS: PERSPECTIVES
RUGBY LEAGUE PLAYERS FROM FIRST YEAR PHYSIOTHERAPY STUDENTS
Morgan K1,2 , Alonso A1 , Adams R3 ; 1 Bulldogs National Rugby Solomon P, Miller P; McMaster University, School of Rehabilitation
League Club, Sydney, Australia; 2 Parramatta National Rugby Science, Hamilton, Canada
League Club, Sydney, Australia; 3 School of Physiotherapy,
University of Sydney, Sydney, Australia PURPOSE: The purpose of this study was to examine the formal and
informal influences on the professional socialization of physiotherapy
PURPOSE: Swelling, or an increase in limb volume, has been found students as they enter their educational programs. RELEVANCE:
to occur following high intensity exercise. Swelling has been linked to Professional socialization is the process through which individuals
muscle damage, which requires a recovery period before maximum acquire the knowledge, skills, values, attitudes and beliefs of the
function can be regained. Applying a compression garment is one profession. Little is known about this process in physiotherapists yet
possible method of limiting exercise-induced swelling or increased the impact of formal and informal curricula, and role modeling by
limb volume. The aim of the present study was to determine if in fact faculty and clinicians can have a profound impact on students’ career
lower leg volume is increased in professional rugby league players goals and aspirations. PARTICIPANTS: Eleven masters-entery level
following a training session, then to determine what effect sports physiotherapy students with a mean age of 24.4 years volunteered
tights might have on lower leg volume if worn during a similar training to participate. There were 8 women and 3 men. Students were
session. RELEVANCE: If the swelling that occurs following high in- enrolled in a 2 year Canadian program with a problem-based learning
tensity exercise is limited or even prevented then recovery times may curriculum. METHODS: In a qualitative, phenomenological design,
be improved following intense training sessions. PARTICIPANTS: the students participated in individual semi-structured face-to-face
Twenty four professional first-grade rugby league players volunteered interviews within the first 6 weeks of their program. The interviewer
to take part in the study. METHODS: The players were assigned to was not a faculty member and was not known to the students.The
one of three training groups; endurance, sprint and weight training. students answered questions about the roles of physiotherapists,
Lower leg volume up to the popliteal crease was measured before what it means to be a professional, societal views of the profession,
and after two separate training sessions using water displacement views on research and future job preferences. ANALYSIS: Interviews
volumetry. Thirteen players volunteered to wear sports tights during were audiotaped and transcribed verbatim. The insetigators reviewed
training during the second session. All subjects filled out a question- 2 transcripts together to develop a coding scheme, apply the
naire before and after each training session, rating their feelings of scheme to the data and identify themes. Subsequent transcripts were
leg fatigue on visual analogue scales. ANALYSIS: Statistical analysis reviewed independently, then together, with differences in assigned
was performed using SPSS for windows (v10.0). Descriptive statistics codes and themes reconciled. RESULTS: Within 6 weeks of their
were obtained, including the mean pre and post training lower leg physiotherapy program, the students had well-developed perceptions
volumes as well as standard error and standard deviation. Descriptive of the knowledge, skills and values of the profession. Six themes
data was then analysed using paired samples t tests to determine were identified (in brackets). Students perceived the role of the
if any significant change in volume had occurred. The same method physiotherapist to be “hands-on” with a focus on improving function
was used to analyse the self-reported data obtained from the visual (“A Functional Role”). They had difficulty describing the meaning
analogue scales. RESULTS: Mean lower leg volume increased signif- of professionalism although they did identify honesty and integrity
icantly by 30.31ml (p = 0.001) when subjects trained without sports as important (“Being Professional”). Students recognized the value
tights. The endurance group recorded the largest volume increase of research and were distressed about the paucity of research in
(31.15ml).When sports tights were worn lower leg volume was many areas (“Perceptions of Research”). They felt that there were
unchanged following training. The volume increases in the endurance conflicting societal views about the value of the profession to society
group coincided with significant increases (p < 0.05) in post training (“Conflicting Societal Views”). Students spoke of a wide range of
ratings of leg tiredness, swelling and muscle twitching. When subjects career possibilities, although they did not want to work in geriatrics
from the endurance group wore sports tights during training there or cardiorespiratory practice (“A World of Possibilities”). Student
were no significant changes to lower leg volume, or to feelings of leg identified their sincere desire to help others and their interest in
fatigue. As well, the group reported a significant increase in subjective working with people as motivation for entering the profession (“Al-
ratings of training performance following training with sports tights. truistic Motivation”). CONCLUSIONS: Results indicate that students
CONCLUSIONS: In this sample of professional rugby league players enter their educational programs with many preconceived ideas
lower leg volume was significantly increased following training. about the profession. IMPLICATIONS: The findings support early
Endurance training resulted in the largest volume increase followed education about the scope of the profession, professionalism and
by sprint training and weight training. Sports tights, when worn during career opportunities. As students tend to embrace values that are
training, worked to limit the observed lower leg volume increase. espoused by their educational programs it is important that faculty
These preliminary data suggest that the compression applied by instill professional values through formal curriculum and informal role
sports tights is sufficient to prevent an increase in fluid accumulation modelling. KEYWORDS: professionalism, education, professional
in working limbs, possibly by altering the hydrostatic pressure gradi- socialization. FUNDING ACKNOWLEDGEMENTS: This project was
ent. IMPLICATIONS: Sports tights work to limit the lower leg volume funded by an internal grant from the School of Rehabiliation Science
increases seen following training. If the lower leg volume increases at McMaster University.
presented here are indicative of muscular damage then sports tights ETHICS COMMITTEE: Research Ethics Board McMaster University
1153 Wednesday 6 June 08:30 1085 Wednesday 6 June 08:30
WHAT MAKES A CLINICAL PLACEMENT EXCELLENT? A INFLUENCE OF REDUCED PRACTICE ON THE RELIABILITY
SURVEY OF MANITOBAN PHYSIOTHERAPISTS OF THE STAR EXCURSION BALANCE TEST
Stevenson T1,2 , Garrett M2 , Fruehm C2,3 ; 1 St. Boniface General Lane J, Varley E; Queen Margaret University College, Edinburgh, UK
Hospital, Winnipeg, Canada; 2 School of Medical Rehabilitation,
PURPOSE: To determine whether reliability of the Star Excursion
University of Manitoba, Winnipeg, Canada; 3 Health Sciences
Balance Test (SEBT) is influenced by the type of practice undertaken.
Centre, Winnipeg, Canada
RELEVANCE: The SEBT is a method of assessing dynamic
PURPOSE: To examine the factors that registered physiotherapists balance particularly following musculoskeletal injury. Previous studies
(PTs) in Manitoba believe to be important in making entry-to- concluded that at least 6 trials of the test in all 8 directions (i.e.
practice (ETP) clinical placements excellent. RELEVANCE: The ETP 48 reaches) are required before reliable results are achieved. Such
Physical Therapy curriculum at the University of Manitoba (UofM) practice may limit the clinical usefulness of the test due to the time
has academic and clinical education (ClinEd) components. In 2004- required and the potential for patient fatigue. This study therefore
2005, the ClinEd component constituted 24% of the credit hours aimed to determine whether practice could be reduced without
negatively influencing the reliability of the SEBT. PARTICIPANTS:
and 40% of the contact hours. Student feedback has indicated
A convenience sample of 30 healthy volunteers (median age 24.5
consistently that ClinEd is valued highly as the major opportunity
years) was recruited by word of mouth, emails and posters, from
in the curriculum to apply and integrate material presented in the
a student population. METHODS: Ethical approval was provided by
academic component. As such, ongoing effort to optimize ClinEd
Queen Margaret University College. Participants were randomised
experiences is warranted. Our first step was to survey PTs regarding
to either: reduced trial practice, reduced direction practice or control.
their opinions of the factors that led to an excellent ClinEd experience.
The reduced trial practice group completed 3 practice trials in all 8
PARTICIPANTS: All PTs licensed to practice in Manitoba (n=562) directions. The reduced direction practice group undertook 6 practice
were surveyed. METHODS: A questionnaire requiring respondents trials in only the antero-medial, antero-lateral, postero-lateral and
to rate each of 37 statements that reflected factors thought to have postero-medial directions. The control group undertook no practice.
influence on the quality of ClinEd was developed. A final summary Both practice groups completed 24 reaches in total in order to
question asked respondents to identify the 3 factors believed to be control for differences between groups due to fatigue. Following
most important in making a clinical placement excellent. All potential practice, each participant rested for 5 minutes before undertaking
respondents were mailed a package containing a questionnaire, a 3 master trials in all directions. Reach distances by the dominant
cover letter, and a postage-paid return envelope. ANALYSIS: The leg were recorded (in cm), by a single researcher. ANALYSIS: Data
number of respondents who identified each of the statements in were normalised to leg length before analysis. Intra-class correlation
the summary question was determined. Subgroups were formed coefficients (2,1) and the standard error of measurement (SEM) were
on the basis of various characteristics of respondents thereby used to determine the reliability of the three master trials. A mean
permitting between-group comparisons using Chi Square Tests for of the three trials was also calculated and a one-way ANOVA was
Association. RESULTS: The overall response rate was 55% (n=305). used to test for differences between groups in each direction. The
The vast majority of respondents had obtained their ETP credentials alpha level was 0.05. RESULTS: ICC’s for the reduced trial group
from the UofM (n=250; 82%) an average of 15.7 years prior to were >0.82 in all directions. The mean SEM was 2.3cm. ICC’s for
this project (range: 0-40 years); 50% (n=152) had served as a the reduced direction group were >0.9 for all directions including
Clinical Instructor (CI) in the past year. The summary question those that had not been practiced. The mean SEM was 1.8cm.
was completed by 292 respondents (96% of respondents). The ICC’s for the control group were >0.7 except for the three medial
following 5 statements were identified most often: “The student’s directions (0.525-0.686). The mean SEM was 4.6cm. There were
initiative in taking responsibility for their own learning” (n=113, 39%); no significant differences between reach distance in any direction
“Availability of suitable clients during the placement” (n=104, 36%); between the three groups (p > 0.05). CONCLUSIONS: Reducing
“The CI provides constructive feedback” (n=69, 24%); “The CI enjoys the overall number of practice trials of the SEBT by either limiting
supervising students” (n=53, 18%); and, “The student’s enthusiasm the number or direction of the practice both results in acceptable
about working with the client population” (n=52, 18%). Respondents reliability. Both practice groups showed better reliability than the
who had supervised a student in the previous year (n=149) did not control group although acceptable reliability in 5 out of 8 directions
differ from those who had not (n=135) in the statements listed in was obtained without any practice at all. Results do not support
the summary question (c2 = 1.099, df=4, p = 0.894). Similarly, CIs previous work which suggests that practice of 6 trials in all 8
who reported supervising fewer than 5 students over their careers directions is necessary although the use of healthy participants
limits generalisations to a wider population and further work may
(n=95) seemed to prioritize the same statements as those CIs
include a patient group. Further work is also required to determine
who had supervised more than 20 students (n=62) (c2 = 4.817,
whether reducing both direction and amount of practice is possible.
df=4, p = 0.307). CONCLUSIONS: There was no clear consensus
IMPLICATIONS: Practice of the SEBT can be reduced to three full
among our respondents about what factors were associated with an
trials or eight reduced direction trials without negatively influencing
excellent clinical placement with only 2 statements being identified
reliability of the results. KEYWORDS: SEBT; practice; reliability.
by more than one third of the respondents. The consistency with
FUNDING ACKNOWLEDGEMENTS: No funding was received in
which specific statements were prioritized by different subgroups support of this work. CONTACT: [email protected]
was remarkable. One reason for this might be that our respondents’ ETHICS COMMITTEE: Subject Area of Physiotherapy Ethics Panel,
formative experiences for ClinEd were obtained while they are Queen Margaret University College
students. IMPLICATIONS: The results suggest aspects of clinical
placements that CIs, students and placement sites may consider as
they endeavour to improve ClinEd. KEYWORDS: Clinical Education,
Survey. FUNDING ACKNOWLEDGEMENTS: University of Manitoba
School of Medical Rehabilitation Endowment Fund. CONTACT:
[email protected]
ETHICS COMMITTEE: Health Research Ethics Board, Bannatyne
Campus Researcdh Ethics Office, Unviversity of Manitoba
EXERCISE IN THE REHABILITATION OF SUBSTANCE AMBULATORY ACTIVITY, QUALITY OF LIFE, AND COMMUNITY
MISUSERS: A QUALITATIVE STUDY OF SERVICE USERS AND MOBILITY OF STROKE SURVIVORS DURING THE TRANSITION
STAFF PERCEPTIONS AND EXPERIENCES FROM HOSPITAL TO HOME
Dawes J1,2 , Mutrie N1 ; 1 University of Strathclyde, Glasgow, United Manns T1 , May L1 , Chard G2 , Edney P2 ; 1 Department of Physical
Kingdom; 2 Greater Glasgow NHS, Glasgow, United Kingdom Therapy, University of Alberta; 2 Department of Occupational
Therapy, University of Alberta
PURPOSE: The purpose of this research was to establish the per-
ceived benefits of exercise in the rehabilitation of substance misusers. PURPOSE: To determine the course of changes in ambulatory
Additionally, barriers to attendance were explored. RELEVANCE: activity, quality of life, and community mobility in stroke survivors
Substance misuse is a growing health problem both in Scotland during the transition from hospital to home. RELEVANCE: The scope
and across the world. Current literature suggests that exercise is of practice of physical therapists is expanding to include a greater
offered in substance misuse rehabilitation facilities, despite limited emphasis on services in the community for community dwelling stroke
evidence supporting the efficacy of this approach. This study will survivors. PARTICIPANTS: Five participants have been enrolled to
be of particular interest to physical therapists working in the field of date. Participants were inpatients in a large rehabilitation hospital
substance misuse rehabilitation and to those working in a community where they were receiving treatment for a first stroke. In order to be
or hospital setting with people who suffer from addiction problems. included, participants were required to be ambulatory (able to walk at
PARTICIPANTS: Following the completion of a structured exercise least 10 m with or without assistance), and have a discharge location
programme, purposeful sampling was used to recruit information rich of their own home or an assisted living environment. METHODS:
cases for interview. Seven people, of an age range 28 years to Participants were seen at three different time periods, once in
43 years were recruited, including: three people who successfully the rehabilitation hospital (between 4-10 days prior to discharge –
completed the ten week exercise programme, one person who time 1), and twice after discharge (at 2 weeks [time 2] and 6
started but did not complete and one person who agreed to weeks post discharge [time 3]). Ambulatory activity was measured
at all three times periods using the step activity monitor (Cyma
participate, but did not attend. A staff member from the community
Corporation, Mountlake Terrace, WA). Health related quality of life
drugs team and a staff member who provided the exercise sessions
was measured using the stroke impact scale, at all three time
were also interviewed. The structured exercise programme involved
periods. The life space assessment was used to measure community
people suffering from substance misuse problems attending a
mobility during the two week and six week post discharge visits. An
local authority gym once per week and carrying out an exercise
individual interview was conducted with the participants six weeks
programme tailored to their physical activity needs by a trained fitness
post discharge to explore the phenomenom of the hospital to home
instructor. METHODS: In depth, semi-structured interviews were
transition. ANALYSIS: A repeated measures analysis of variance
used to collect data. The interview schedules were systematically
was used to determine if there were differences in the dependent
created by identification of themes from the research questions,
variables (ambulatory activity, quality of life, community mobility)
critically examined by technical experts and piloted. The interviews
across the three time periods. Inductive analysis using N-Vivo 7
were then carried out, recorded with a Dictaphone and transcribed
identified themes and categories of the participants’ perceptions of
verbatim. ANALYSIS: Analysis involved the researcher becoming
the transition from hospital to home. RESULTS: Participants were
deeply familiar with the data set to identify direct quotes as “raw 62 ±18 years old and 78 ±27 days post stroke. Ambulatory activity
data themes”. These were then compared and contrasted and those was not different between the 3 times periods (6706 steps/day at
with common threads were clustered to create a collection of first- time 1, 5700 steps/day at time 2, 6446 steps/day at time 3)(F=0.708,
order themes. This process was repeated until no further groupings p = 0.462). The score on the physical domain of the stroke impact
could be made. The remaining groups were labelled as “general scale increased from time 1 to time 3 (63 to 76) but was not
dimensions”. RESULTS: The results of the investigation were significantly different across time periods (F=5.490, p = 0.079). The
positive. The group was well received, physical and mental health participation, memory, communication, and emotional domains on the
benefits were identified and it was felt that exercise could assist in stroke impact scale did not change across the three time periods.
preventing relapse of substance misuse amongst participants. There Community mobility as measured by the life space questionnaire
was also the perception that the group facilitated social functioning increased from 37.9 to 44.7 from time 2 to time 3, and not significantly
of the participants and impacted on their physical activity habits. different (t=-1.890, p = 0.132). Inductive analysis uncovered themes
However, there was recognition that many barriers to attendance related to adjustment, unwanted dependence, new priorities, and
existed in the lives of participants and that significant support from need for services. CONCLUSIONS: There was no change in
the community drugs team staff was required to facilitate attendance. ambulatory activity and domains on the stroke impact scale during
CONCLUSIONS: This study provides preliminary evidence that the six week transition period. IMPLICATIONS: An understanding
exercise may be of value in the rehabilitation of substance misusers. of the course of changes for stroke survivors during the transition
Further research is required to establish in greater detail firstly, the period will assist physical therapists to provide appropriate services
mechanisms of how these benefits are achieved and secondly, to during that transition period. KEYWORDS: community reintegration,
investigate the types of exercise programmes that promote adher- ambulatory activity, transition. FUNDING ACKNOWLEDGEMENTS:
ence and provide benefit. IMPLICATIONS: This research suggests This study was funded by the Physiotherapy Foundation of Canada.
that physical therapists and other health care workers involved CONTACT: [email protected]
in the rehabilitation of people suffering from substance misuse ETHICS COMMITTEE: Health research ethics board (Health Panel) –
problems should consider the use of exercise for this client group and University of Alberta
evaluate the programmes they develop. KEYWORDS: drug abuse,
physical activity, addiction. FUNDING ACKNOWLEDGEMENTS:
Greater Glasgow NHS, Primary Care Division Bursary; Chartered
Society of Physiotherapy Charitable Trust; HSA Charitable Trust
Major Scholarship. CONTACT: [email protected]
ETHICS COMMITTEE: Faculty of Biomedical and Life Sciences,
University of Glasgow & Department of Sports, Culture & the Arts,
University of Strathclyde
Research Report Platform Presentation complaints of the arm, neck or shoulder (CANS). We evaluated
1218 Wednesday 6 June 08:30 whether conservative interventions have a significant impact on
VCEC Meeting Room 17 outcomes for work related CANS. RELEVANCE: The relevance of
THE CONTRIBUTION OF GLUTEUS MAXIMUS AND GLUTEUS this systematic review in contributing to the body of knowledge
MEDIUS TO FRONTAL PLANE STABILITY OF THE HIP: AN concerning the efficacy of interventions in non-specific work related
ANATOMICAL STUDY CANS lies mainly in the fact that it points out a clear lack of evidence
regarding the effectiveness of most often prescribed interventions.
Conneely M1 , O Sullivan K2 , Edmondston S3 ; 1 Private Practitioner,
Most important difficulties found here are: lack of a definition of
Co. Galway, Ireland; 2 University of Limerick, Ireland; 3 Curtin
‘work-relatedness’, the wide variety of interventions used to treat
University of Technology, Perth
people with possible CANS, and the overall poor methodological
PURPOSE: To evaluate if the functional roles of gluteus maximus quality. PARTICIPANTS: not applicable METHODS: A systematic
and gluteus medius in hip frontal plane stability, as proposed in the review. Only (randomised) trials studying conservative interventions,
literature, are supported by their underlying anatomy. RELEVANCE: for patients suffering from work related CANS will be included.
Gluteal muscle dysfunction has been implicated in a variety of pelvic Interventions may include exercises, relaxation, physical applications,
and lower limb disorders. Rehabilitation of gluteus medius, especially biofeedback, myofeedback and work place adjustments. Two authors
the posterior fibres of gluteus medius, is often advocated in the independently selected the trials, assessed methodological quality
rehabilitation of these disorders. It has been suggested, however, and extracted data. ANALYSIS: We pooled data or, in the event
that the proposed importance of gluteus medius in frontal plane of clinical heterogeneity or lack of data, we used a rating system
stability does not correlate with its small size. Furthermore, it has to assess levels of evidence. RESULTS: We included 26 studies
been proposed that the greater size of gluteus maximus, and its (in total 2376 patients), 23 studies included patients with chronic
attachment to the iliotibial band (ITB), indicates it may also contribute non-specific neck and shoulder complaints or non-specific upper
significantly to frontal plane stability. PARTICIPANTS: One adult male extremity disorders. Over 30 interventions were evaluated; seven
cadaver METHODS: All skin and subcutaneous tissue, including main subgroups of interventions could be determined, of which
the gluteal fascia, was removed. Gluteus maximus, gluteus medius the subgroup ‘exercises’ was the largest one. Overall, the quality
and their anatomical relations, particularly the ITB, were identified. of the studies appeared to be poor. CONCLUSIONS: There is
Gluteus maximus was dissected at its ITB insertion and reflected limited evidence for the effectiveness of exercises when compared
medially, to facilitate complete observation of gluteus medius and to massage; adding breaks during computer work; massage as
all anatomical connections. Gluteus medius was then dissected add-on treatment on manual therapy, manual therapy as add-on
in an antero-posterior direction across its mid-substance, exposing treatment on exercises; and some keyboards in people with carpal
all anatomical relations and gluteus minimus. ANALYSIS: Digital tunnel syndrome when compared to other keyboards or placebo. For
images were taken at each stage of the dissection process. The other interventions no clear effectiveness could be demonstrated.
angle of muscle fibre orientation for each part of both muscles IMPLICATIONS: Implications for practice. In conclusion, this review
was calculated, using the specimen midline as a reference. Muscle shows limited evidence for the efficacy of specific keyboards with
thickness (cm) was calculated, using calipers, for each part of an alternative force-displacement or geometry only for participants
both muscles. Surface area (cm2 ), of both muscles was calculated labelled with carpal tunnel syndrome. There is limited evidence
electronically using the digital images. RESULTS: Gluteus maximus for the efficacy of exercises when compared to massage; adding
was strongly connected to the iliotibial band, while the insertion of breaks during computer work; massage as an add-on treatment on
gluteus medius enveloped the greater trochanter. The surface area of manual therapy, and manual therapy as an add-on treatment on
gluteus maximus was significantly larger than that of gluteus medius. exercises in participants with non-specific work-related complaints.
Average muscle thickness was similar in both (1.3cm), with large The benefit of (expensive) ergonomic interventions in the workplace
intramuscular variations in thickness (1.1-1.6cm). There were also is not clearly demonstrated. Implications for research: 1. There is
major differences in muscle fibre orientation, both between gluteus a need for an agreed definition of what can be considered as a
maximus and medius, and also between the functional subdivisions of ’work-related disorder’. This way a clear patient population can be
each muscle. CONCLUSIONS: Fascial connections, and similarities selected for future studies. 2. Future research should examine clear
in muscle fibre orientation, between superior gluteus maximus and and well defined interventions not only in pragmatic trials comparing
posterior gluteus medius, support a suggested synergistic action in various conservative interventions with each other, but also in more
the control of frontal plane stability. IMPLICATIONS: The synergistic explanatory trials comparing the intervention with a no treatment
activation of gluteus maximus and gluteus medius, rather than control group. 3. Large, adequately powered trials are needed that
the isolated activation of one particular muscle, should be an focus on appropriate allocation concealment, blinding of at least
important consideration in the assessment and rehabilitation of hip outcome assessment and, if possible, patient and therapist and
frontal plane stability. Further research is needed to verify these an adequate data presentation and analysis. 4. The design and
findings in larger samples, and to relate any proposed rehabilitation reporting of future trials should conform to the CONSORT statement
strategies to improved outcomes. KEYWORDS: Anatomy, dissection, (Altman 2001). KEYWORDS: randomised clinical trial, systematic
physiotherapy, gluteal region. FUNDING ACKNOWLEDGEMENTS: review, upper extremity disorder, physiotherapy, ergonomics, work
None. CONTACT: [email protected] related. FUNDING ACKNOWLEDGEMENTS: This project is funded
ETHICS COMMITTEE: Curtin University Ethics committee by the Dutch Health Insurance Executive Board (CvZ). CONTACT:
[email protected]
EXERCISES ARE EFFECTIVE IN WORK RELATED COMPLAINTS
OF THE ARM, NECK OR SHOULDERS
Verhagen A, Karels C, Bierma-Zeinstra S, Feleus A, Koes B; Dept
General Practice, Erasmus MC, PO Box 2040, 3000 CA Rotterdam,
The Netherlands
PURPOSE: Interventions such as physiotherapy and ergonomic
adjustments play a major role in the treatment of most work-related
EXPERIENCES OF PATIENTS WITH CHRONIC LOW BACK PAIN THE INFLUENCE OF PROPRIOCEPTIVE NEUROMUSCULAR FA-
OF TREATMENT WITH SPINAL STABILIZATION EXERCISES CILITATION STABILIZATION TECHNIQUES ON STATIC BALANCE
Sokunbi O1 , Moore A1 , Watt P2 ; 1 Clinical Research Centre Rugelj D, Seničar V, Sevšek F; University of Ljubljana/University
for Health Professions, University of Brighton, Eastbourne, UK; College of Health Studies, Ljubljana, Slovenia
2 Department of Sport and Exercise Science, Chelsea School,
PURPOSE: The purpose of the study was to evaluate the effect
University of Brighton, UK of 4-week stabilization training with proprioceptive neuromuscular
facilitation (PNF) stabilization techniques on static balance in
PURPOSE: The aim of this study was to elicit valuable information of young healthy subjects. RELEVANCE: PNF is a well-established
the experiences of patients who participated in a spinal stabilisation therapeutic approach. The assumption underlying its techniques is
programme within a randomised controlled trial (RCT). This qualita- based on the hierarchical model of neural organization; however,
tive study was part of a large mixed methods study into the effects scientific evidence for its effectiveness is moderate. PARTICIPANTS:
of spinal stabilisation exercises on participants with chronic low back 20 young healthy female subjects aged from 16 to 23 years
pain. It was hoped that this study would expose the possible reasons participated in the study. The participants were assigned into a
for the treatment benefit demonstrated in the RCT incorporating treatment and a control group. METHODS: The outcome measures
spinal stabilisation exercises. RELEVANCE: The results of many used were: timed one leg stance with eyes opened (EO) and eyes
randomized clinical controlled trials (RCTs) on the efficacy of closed (EC), tandem stance on compliant surface with EO and
commonly utilized therapeutic interventions for chronic back disorder EC, one leg stance on the narrow (2cm) beam with EO and EC.
The center of pressure (CoP) excursions during one leg stance
indicate a clear trend in favour of spinal stabilizing exercises.
was measured with the Kistler 9286AA force plate. The sampling
However, there is limited evidence on the patients’ perception of this
frequency used was 50 Hz. The participants of the treatment group
treatment and their overall experience of the treatment programme. took part in a 4-week training program, 5 times a week, 10 minutes
PARTICIPANTS: Participants were selected (purposive sampling) per session. The subjects were standing on one leg and the therapist
from among those who participated in a randomised controlled trial performed stabilizing reversals. In the first and the second treatment
(RCT) on the use of stabilization exercises in the treatment of chronic week, stabilizing reversals on one leg lasted continuously 30 seconds
low back pain. Nine participants (male = 3, female = 6) took part in the and than legs changed. In the third and the fourth week of treatment,
study. Four people participated in the first focus group interview while the continuous stabilizing reversals on one leg increased to one
five participants participated in a second focus group. METHODS: minute. Stabilizing reversals were performed in the trunk, pelvic and
A semi-structured interview comprising of open ended questions knee region in all directions. ANALYSIS: Paired t-Test was used for
were used and audio recording was used to record participants’ the comparison of results within the group and t-Test for comparison
opinions during the interview process. ANALYSIS: Careful checking, of the results between the two groups. RESULTS: All the participants
reading and correction of the transcript from the interviews was in both groups reached the maximum score of 60 seconds in the
carried out and a thematic content analysis was conducted on initial and final measurements at one leg stance with EO and tandem
the data. RESULTS: The main themes that emerged from the stance on the compliant surface with EO. For the treatment group
data analysis included. 1)Participants perceptions of the causes the difference after practice was statistically significant for one leg
stance with EC (p < 0.01), tandem stance on the compliant surface
and aggravating factors for their low back disorders. 2)Physical
with EC (p < 0.02), stance on the narrow (2cm) beam with EO
dimensions of participants chronic low back disorder experience.
(p < 0.02), stance on the narrow (2cm) beam with EC (p < 0.004).
3)Emotional and psychological dimensions of participants low back
There was no statistically significant difference at any assessment
disorders experience. 4)Perceived treatment effects on pain and in the control group. Differences between the treatment and control
functional limitation. 5)The impact of treatment programme on group reached significant levels for one leg stance (p < 0.02), one leg
participants empowerment and self efficacy. 6)Impact of information stance on the narrow beam with EO (p = 0.002) and EC (p < 0.001).
on participants attitude to treatment. 7)Relationship with the therapist. The treatment protocol did not influence the CoP excursions and
8)Compliance with home exercise programme. 9)Suggestions for its length of path during one leg stance with EO and EC. There
improvement in future studies involving spinal stabilisation exercise was no difference before and after treatment and it did not differ
treatment. CONCLUSIONS: Participants appeared to be unequivocal between the two groups. CONCLUSIONS: The results support the
as regards their satisfaction with the treatment received during assumption that PNF techniques of stabilizing reversals improve
this randomized controlled trial. However, opinions on what were the subject’s efficacy of balance function as measured with clinical
the major therapeutic benefits of the treatment presentation varied outcome measures. However, there is no observed difference in the
from one participant to another. Participants’ explanation for the body steadiness. It remains to be discovered whether we can attribute
perceived improvements included major increases in confidence these changes to the increase of muscle strength or endurance, or
and formulation of self help strategies. They also reflected on if the process of motor learning plays the key role in improvement
their ability to exert batter control over their back pain, due to of balance efficacy. IMPLICATIONS: The results support use of
stabilization techniques as an effective tool for balance retraining.
increase empowerment and self efficacy based on more knowledge
KEYWORDS: PNF, stabilization techniques, balance. FUNDING
of the spine and how it works. IMPLICATIONS: Empowerment
ACKNOWLEDGEMENTS: none.
and self efficacy enabled by increased awareness of what is
ETHICS COMMITTEE: State medical ethic commettee of Slovenia
causing the pain and getting a self help strategy with the use of
stabilization exercise appeared to be more responsible for greater
control of chronic low back disorder with the use of this exer-
cises. KEYWORDS: Back pain, stabilisation exercise, participants’
experiences. FUNDING ACKNOWLEDGEMENTS: Funding was
provided by Association of Commonwealth Universities. CONTACT:
[email protected]
ETHICS COMMITTEE: University of Brighton Research Ethics
Committee
DO VESTIBULAR INPUTS INFLUENCE STANDING BALANCE EFFECTS OF TASK-SPECIFIC LOCOMOTOR AND STRENGTH
IN ADULTS WITH A LOWER LIMB AMPUTATION DUE TO TRAINING IN AMBULATORY STROKE SURVIVORS
VASCULAR DISEASE? A PRELIMINARY INVESTIGATION
Sullivan K1 , Brown D2 , Klassen T1 , Mulroy S3 , Ge T1 , Azen S1 ,
Hendrie J1,2 , Earl M1,2 ; 1 Capital District Health Authority, Halifax, Winstein C1 ; 1 University of Southern California, Los Angeles,
Canada; 2 Dalhousie University, Halifax, Nova Scotia, Canada California, USA; 2 Northwestern University, Chicago, Illinois,
PURPOSE: Amputation due to PVD is a major cost to health care USA; 3 Rancho Los Amigos National Rehabilitation Center, Downey,
in many countries. After prosthetic rehabilitation, individuals often California, USA
have difficulty returning to functional independence. Balance control
PURPOSE: A phase II, multi-site, single-blinded, randomized clinical
is a major factor of functional independence. One important facet of
balance control is the ability to interpret sensory inputs for balance trial (RCT) was conducted to determine the independent and
control. These are received from the visual, somatosensory and combined effects of task-specific and LE strength training on walking
vestibular systems. Little literature exists about sensory inputs for outcomes post-stroke. RELEVANCE: Impaired walking ability is a
balance control, and none on the vestibular components of balance hallmark residual deficit that contributes to post-stroke walking dis-
in relation to this population. This preliminary project evaluated ability. Impairment in lower extremity muscle strength is a significant
the vestibular control of balance in individuals with lower limb contributor to decreased walking speed after stroke. No studies
amputations by comparing the Clinical Test of Sensory Interaction have combined task-specific locomotor training in combination with
and Balance test 1 (CTSIB1 ) where all three inputs for balance lower extremity strength training programs designed to improve post-
were available with test 5 (CTSIB5 ) where only vestibular inputs stroke walking outcomes. PARTICIPANTS: Participants included
for balance were accurate. The hypothesis was that CTSIB1 time 80 individuals (mean age 61±12.4 years) who were ambulatory,
would be longer than CTSIB5 time. The influence of vestibular but walked slower than 1.0 m/sec and were at least 6 months
inputs for balance control on balance confidence and age was post unilateral stroke (stroke onset 25±16.2 months). METHODS:
also explored. RELEVANCE: According to the literature, in current Participants were stratified by initial comfortable walking speed
physiotherapy practice, while function and mobility are routinely (moderate>0.5 m/sec; severe 0.5 m/sec) and randomized to one
assessed, sensory aspects for balance and in particular vestibular of four exercise pairs: 1) body-weight supported treadmill training
inputs for balance control are not examined or treated in adults with (BWST) and locomotor-based strength training (resistive cycling task,
a lower limb amputation. It may be that if the ability to use vestibular LBST), 2) BWST and LE muscle-specific strength training (MSST),
inputs for balance control were known, treatment of balance control 3) BWST and upper extremity ergometry (SHAM), and 4) LBST and
may be ameliorated in this population. PARTICIPANTS: Ten in-
SHAM.Training occurred 4 times per week for 6 weeks (24 total
patients on the rehabilitation ward of a rehabilitation centre in
sessions). Exercise type in each exercise pair was alternated daily.
a Canadian city and within 2 weeks of discharge, volunteered.
Primary outcomes were comfortable and fast overground walking
They were medically stable men aged 48–83 years with a lower
speed, and distance walked in 6-minutes measured at baseline,
limb amputation due to Peripheral Vascular Disease and were
able to walk 6m independently with or without a walking aid. after 12 and 24 treatment sessions and at a 6-month follow-up.
METHODS: Participants performed the CTSIB test, and the Activity- ANALYSIS: Interactions between severity, treatment group, and time
specific Balance Confidence (ABC) questionnaire was completed. were assessed by using a repeated measures ANOVA model for each
ANALYSIS: CTSIB1 and CTSIB5 were analysed using the Wilcoxon of the primary outcome measures. RESULTS: The BWST/SHAM
signed ranks test. Pearson correlation coefficients were used to group had significantly greater increases in walking speed compared
explore the association between vestibular inputs for balance control to the LBST/SHAM group (pre-post change in comfortable velocity =
(CTSIB5 ) and balance confidence (ABC score) and age. Hypotheses 0.12 +/− 0.14 m/sec vs. 0.01 +/− 0.07 m/sec, p = .004), change in fast
were evaluated using a = 0.05. RESULTS: The CTSIB5 median score velocity = 0.09 +/− 0.14 m/sec vs. 0.01 +/− 0.09 m/sec, p = .03), but
of 6.0s was significantly shorter than CTSIB1 score of 30.0s. (W improvement in 6 min walk distance was comparable between the
= 45, p < 0.05). The average ABC score was 71.9% ±19.9. The two groups. All BWST groups made similar significant improvements
average age was 62yrs ±13. CTSIB5 scores correlated with ABC in walking speed and distance with training (p < 0.0001) that were
scores (r = 0.651, p < 0.05) and there was a trend towards correlation evident regardless of whether LE strength training (LBST, MSST)
with age (r = 0.813, p < 0.1). CONCLUSIONS: Results indicate was combined or not (SHAM). Walking improvements for the BWST
that towards the end of prosthetic rehabilitation, participants had groups were maintained at the 6-month follow-up. CONCLUSIONS:
difficulty using vestibular inputs for balance control. Impaired ability After stroke, task-specific training using body-weight support during
to use vestibular inputs appeared to be associated with decreased treadmill walking is more effective in improving walking speed than
balance confidence. IMPLICATIONS: Assessment and treatment of resisted cycling. Furthermore, a moderate intensity LE progressive
the vestibular inputs for balance control by physiotherapists may resistive training program alternated daily with task-specific treadmill
improve balance and therefore function in this population. The CTSIB
walking did not provide an added benefit to walking outcomes.
would be an affordable method of assessment of vestibular inputs
IMPLICATIONS: The findings provide strong evidence for the
for balance in this population and may be easily reproduced in
effectiveness of intense, task-specific training to improve walking
different clinical settings. KEYWORDS: amputation, vestibular inputs,
outcomes after stroke. Further work is necessary to determine how
balance. FUNDING ACKNOWLEDGEMENTS: Unfunded.
ETHICS COMMITTEE: Capital District Health Authority Research exercise programs that combine muscle strengthening protocols
Ethics Board approved the work. with task-specific training can be implemented to maximize function
and voluntary muscle torque capability in individuals post-stroke.
KEYWORDS: Clinical Trials, Exercise, Walking Recovery. FUNDING
ACKNOWLEDGEMENTS: This study was supported by a grant from
the Foundation for Physical Therapy to establish the Physical Therapy
Research Network (PTClinResNet): a clinical research network to
evaluate the efficacy of physical therapist practice.
ETHICS COMMITTEE: University of Southern California Institutional
Review Board
Research Report Platform Presentation the western world, disability pension (DP) has become an increasing
1389 Wednesday 6 June 08:50 economical and social concern, and low back pain (LBP) is one
VCEC Meeting Room 17 of the most common conditions leading to DP. Therefore, efforts of
PASSIVE MECHANICAL PROPERTIES OF HUMAN returning disability pensioners to work have become a key target for
GASTROCNEMIUS MUSCLE-TENDON UNITS, MUSCLE health policy in most western countries. PARTICIPANTS: Eighty-nine
FASCICLES AND TENDONS IN VIVO individuals (65% women) receiving DP due to back pain participated
in the study. Mean age was 49.0 years (SD=5.4) ranging from 36
Hoang P1 , Herbert R1 , Gandevia S2 ; 1 University of Sydney,
to 56 years. Eligible for the study were all individuals on DP due
Sydney, Australia; 2 Prince of Wales Medical Research Institute,
to back pain in the county of Hordaland, Norway (n=431), being
Sydney, Australia
under 56 years of age and having received full DP for more than
PURPOSE: To develop a method for measuring mechanical one year. The disability pensioners (n=431) were identified through
properties of muscle fascicles and tendons in resting humans the National Insurance Administration. METHODS: The participants
muscles in vivo, and to describe mechanical properties of resting were randomised into an intervention group (n=45) or a control
muscle fascicles and tendons of gastrocnemius in healthy adults. group (n=44) to evaluate the effect of a brief vocational-oriented
RELEVANCE: Measurement of mechanical properties of resting intervention. The intervention consisted of two group sessions of
muscle fascicles and tendons on humans in vivo makes it possible to information,lectures related to spinal problems, fear reduction and
investigate mechanisms of contracture in humans. PARTICIPANTS: a motivational course. After the group sessions the participants were
9 healthy adults. METHODS: The method described by Hoang et offered individual follow-up by a physician and a nurse including a
al (J Biomechanics 2005;38:1333-41) was used to measure length- medical examination and assessment of their work ability. Primary
tension properties of human gastrocnemius. The method involves outcome measures were return to work or having entered a return to
measurement of ankle torque-angle relations at 8 knee angles work process. Secondary outcome measures were life satisfaction,
under passive condition. These measures were combined with physical functioning, fear avoidance behaviour and expectancy.
ultrasonographic measures of muscle fascicle lengths to determine Prognostic factors for having entered a return to work process were
passive length-tension properties, slack lengths and strains of evaluated. ANALYSIS: Comparisons of change between intervention
the whole muscle-tendon unit, its muscle fascicles and tendons. and control groups were examined by t-test for independent samples.
ANALYSIS: Descriptive (means and SDs). RESULTS: Mean slack Relative Risk (RR) for having entered a return to work process was
lengths of the gastrocnemius fascicles, tendons and whole muscle- calculated. Logistic regression analysis was used to identify possible
tendon units were 3.4 +/− 0.6 cm, 39 +/− 1.7 cm and 42.4 predictors at baseline for having entered a process of returning to
+/− 1.5 cm respectively (mean +/− SD, n = 6, slack lengths work (dependent variable) after 1 year. RESULTS: The intervention
not calculable for 3 of 9 subjects). With combined changes of had no statistically significant effect on return to work or having
knee and ankle angles, the maximal change in length of the entered a return to work process at 1-year follow-up. Twice as many
gastrocnemius muscle-tendon unit was 6.7 +/− 2 cm, to which the in the intervention group (n=10, 22%) had entered a return to work
muscle fascicles and the tendon contributed almost equal length process compared to the controls (n=5, 11%). The number needed to
changes. Muscle fascicles and the tendon undergo strains of 93.2 treat was 9. Only minor differences in secondary outcome measures
+/− 41% and 8.8 +/− 5.9% respectively across the physiological were demonstrated. Positive expectancy, better physical performance
range of lengths. CONCLUSIONS: The muscle-tendon unit of and less pain were related to return to work. CONCLUSIONS:
gastrocnemius falls slack at close to its shortest physiological despite lack of statistically significant results, the effort of returning
length. The tendon is quite extensible even at low forces and can disability pensioners back to work by a brief vocational-oriented
contribute substantially to the total compliance of resting muscle- intervention may have practical relevance. The effect needs to
tendon units. IMPLICATIONS: It is now possible to investigate be further explored in larger samples of disability pensioners.
mechanisms of contracture in human muscles in vivo. KEYWORDS: IMPLICATIONS: The vocational intervention offered in this study
Muscle, tendon, contracture. FUNDING ACKNOWLEDGEMENTS: might still be cost-effective if carefully selecting participants most
Professor Gandevia is supported by the Australian National Health & likely to succeed. KEYWORDS: Randomized controlled trial, return
Medical Research Council. CONTACT: [email protected] to work, disability pensioners, low back pain, vocational-oriented
ETHICS COMMITTEE: University of Sydney, University of New South rehabilitation. FUNDING ACKNOWLEDGEMENTS: The authors
Wales thank the Norwegian Foundation for Health and Rehabilitation for
funding. CONTACT: [email protected]
ETHICS COMMITTEE: The study was approved by the Norwegian
Ethics Committee for Medical Research, Health Region west
MOTIVATING DISABILITY PENSIONERS WITH BACK PAIN TO
RETURN TO WORK- A RANDOMIZED CONTROLLED TRIAL 1819 Wednesday 6 June 08:50
Magnussen L1 , Strand L2 , Skouen J3 , Eriksen H4 ; 1 Department
of Physiotherapy, Faculty of Health and Social Sciences, Bergen RANDOMIZED TRIAL COMPARING GENERAL EXERCISE,
University College and Department of Education and Health MOTOR CONTROL EXERCISE AND SPINAL MANUAL THERAPY
Promotion, University of Bergen, Bergen, Norway; 2 Department of FOR CHRONIC LOW BACK PAIN
Public Health and Primary Health Care, Section for Physiotherapy Ferreira P1,2 , Ferreira M1,3 , Latimer J1 , Herbert R1 , Hodges P4 ,
Science, University of Bergen, Bergen, Norway; 3 Outpatient Spine Jennings M5 , Maher C1 , Refshauge K1 ; 1 School of Physiotherapy,
Clinic, Haukeland University Hospital, Bergen, Norway; 4 Unifob The University of Sydney, Sydney, Australia; 2 Departamento de
Health and Department of Education and Health Promotion, Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte,
University of Bergen, Bergen, Norway Brazil; 3 Departamento de Fisioterapia, Pontifı́cie Universidade
Católica de Minas Gerais, Belo Horizonte, Brazil; 4 Division of
PURPOSE: The purpose of the present study was to investigate the
Physiotherapy, The University of Queensland, Brisbane, Australia;
effect of a brief vocational-oriented intervention on return to work 5 Outpatient Physiotherapy department, Liverpool Hospital, Sydney,
or having entered a return to work process in disability pensioners
Australia
with back pain, and to examine whether physical performance, self-
assessed work ability, emotional distress, fear avoidance beliefs and PURPOSE: To compare the effects of general exercise, motor control
expectancy could predict return to work. RELEVANCE: Throughout exercise, and spinal manual therapy on disability and global perceived
effect of intervention in patients with chronic non-specific low back make up of students in the light of final award. PARTICIPANTS:
pain. RELEVANCE: Evidence-based clinical practice guidelines Two cohorts of students were randomly selected using a research
recommend exercise and spinal manual therapy for management randomizer. A total of 110 students were investigated, 31 males.
of chronic non-specific low back pain. PARTICIPANTS: 240 adults The age range was from 18-42 years with a median 23.5 years.
with non-specific low back pain of at least 3 months duration. METHODS: This was retrospective study. Data were collected from
METHODS: Setting: Three physical therapy clinics in Australian the national database for university entry and collated relating to
hospitals. Intervention: Each participant was allocated to either a age, gender and entrance profile. Examination performance data was
general exercise group, a motor control exercise group, or a spinal collected from 2001 to Sept 2005. ANALYSIS: Data was classifed
manual therapy group. The general exercise included strengthening into categories, chi square statistics were used to assess differences
and stretching exercises and light aerobic exercises. The motor in degree classification according to age, gender and entry profile.
control exercise involved retraining of specific trunk muscles using Significance taken as p 0.05. All academic marks were normally
ultrasound feedback of muscle contraction. Spinal manual therapy distributed therefore a Spearmans correlation coefficient was used
included joint mobilization and manipulation. Participants in all three to look at relationships between marks awarded whilst at university
groups were treated for 8 weeks. Measurements: The primary and whilst on clincal practice. RESULTS: Staistically significant
outcomes were patient-specific function (PSFS, 3 to 30 scale) and differences were observed (p < 0.05) for entrance qualification and
global perceived effect of treatment (GPE, −5 to 5 scale) measured age when compared with final award. A first class award was
at 8 weeks. These outcomes were also measured at 6 and 12 achieved only by those students aged over 21 (and <31) and only
months. Other secondary outcomes were pain intensity and disability by students who entered the course via A’levles(36.4%) or held
measured at 8 weeks, 6 months and 12 months. The study was previous degrees (30%). Those who accessed the course via other
approved by the University of Sydney Ethics Committee. ANALYSIS: qualifications access degrees (25%) or other route (8.2%) achieved
The primary measures of treatment effect were measures of function lower final awards (p 0.05). We observed statistically significant
and global perceived effect of therapy at 8 weeks. Data were analyzed relationship between results awarded in year 1 at University and
according to a protocol specified a priori. The statistician was blinded year 2 clinical(p = 0.05) (r = 0.319). Year 2 university results and year
to which group received each intervention. Analysis was by intention- 2 clinical results (p 0.01) (r = 0.648). Year 2 university results and
to-treat. The emphasis in the analysis was on estimation rather year 3 clinical (p 0.01) (r = 0.541). CONCLUSIONS: Older age and
than hypothesis testing. To maximise precision we used analysis of qualification on entry to Physiotherapy appear to be associatd with
covariance to adjust the between-group differences in each outcome degree classification. There is a good relationship between results
for baseline values of that outcome. RESULTS: Follow-up was 93% of university based work and clinical work suggesting that those
at 8 weeks and 88% at 6 and 12 months. The motor control exercise who do well academically are also those who do well clinically.
group had substantially better outcomes than the general exercise IMPLICATIONS: With the current trend in the UK of widening
group at 8 weeks (between-group difference in PSFS: 2.9, 95% CI: participation to encourage a more diverse background in the student
0.9 to 4.8; GPE: 1.7, 95% CI: 0.9 to 2.4), as did the spinal manual population we need to be aware that achievement on th BSc degree
therapy group (PSFS: 2.3, 95% CI: 0.4 to 4.2; GPE: 1.2, 95% CI: 0.4 may be influenced by other factors. Universities need to monitor these
to 2.0). The three groups had similar outcomes at 6 and 12 month factors and see if additonal support or resources need to be offered to
follow-ups. No adverse events were reported. CONCLUSIONS: students. Are the current delivery mechanisms of our degrees limiting
Motor control exercise and spinal manual therapy produce better the non-traditional students? KEYWORDS: Education. FUNDING
short-term function and perceptions of global effect than general ACKNOWLEDGEMENTS: None.
exercise, but not better medium or long-term effects, in patients
with chronic non-specific low back pain. IMPLICATIONS: Motor
control exercises and spinal manual therapy are likely to be more
appropriate than general exercises when a non-specific chronic LBP 1906 Wednesday 6 June 09:10
patient requires faster short-term improvement in symptoms. General PP Crystal Pavilion B & C
exercises are likely to be more suitable when there is a high patient RELIABILITY OF AN ASSESSMENT OF CONTINUING
to health professional ratio and when physical space is available. COMPETENCE THROUGH PEER REVIEW
Future research should analyze and compare the cost effect of these Miller P1 , Nayer M2 , Eva K1 ; 1 McMaster University, Hamilton,
interventions. KEYWORDS: Low back pain; randomized controlled Ontario, Canada; 2 College of Physiotherapists of Ontario, Toronto,
trial; exercises. FUNDING ACKNOWLEDGEMENTS: The study was Ontario, Canada
funded by The Arthritis fundation, Motor Authority Association and the
University of Sydney SESQUI grant. CONTACT: [email protected] PURPOSE: This study was undertaken to examine: 1. the relation-
ETHICS COMMITTEE: The University of Sydney Ethics Committee ship between demographics and registrants’ performance on the
Onsite Assessment, the primary component of the Competency
Assessment Program of the College of Physiotherapists of Ontario,
Research Report Platform Presentation Canada (CPO); 2. the relationship among the various components
1111 Wednesday 6 June 09:10 of the Onsite Assessment; and 3. the reliability of the Onsite
PP Crystal Pavilion A Assessment. RELEVANCE: A key mandate of a professional
AN EVALUATION OF FACTORS INLFUENCING UNDERGRAD- regulatory board is to ensure that practitioners provide competent
UATE BSC PHSYIOTHERAPY ACADEMIC PERFORMANCE care. The challenge is to develop a competency assessment program
that is reliable, valid, and feasible. CPO developed a competency
Horgan T; Kingston University/St George’s University of London
assessment program to evaluate its registrants in their workplace.
London. England
PARTICIPANTS: 106 registrants completed an Onsite Assessment,
PURPOSE: To consider the influence of gender, age, and entrance conducted by peer assessors. The mean age of the registrants
qualification on the academic award of undergraduate physiotherapy was 42 years (SD 9.5) and the mean years since graduation
students. To investigate relationships between university performance was 18 (SD 10.7). The majority had a professional bachelor’s
and performance whilst on assessed clincal practice. RELEVANCE: degree (73%). METHODS: An assessor visited the registrant in
Populations of students entering higher education and health care his/her workplace. In 53 instances, the registrant was examined by
professions are from diverse backgrounds and experiences. This two assessors simultaneously. The assessment included: Practice
diversity maybe assocaited with changes in the national curriculum Issues Evaluation, Record Keeping Evaluation, Billing Practices
in the UK and initiatives to widen participation to inclde non- Evaluation (if applicable), Portfolio Review (formative feedback only),
traditional applicants. It is important to consider changes in the and a Chart Stimulated Recall process (CSR) using six to eight
patient records. One mandatory component of the Portfolio was the were required to complete 2500 steps (impacts) at a self-selected
Professional Issues Self Assessment (PISA). The assessor provided running speed. The number of steps taken by participants was
Summary Report to the Quality Management (QM)Committee, which recorded using a pedometer and running speed was measured at
reviewed the Summary Report and made a final decision regarding regular intervals throughout the run. Tibial and femoral knee articular
the registrant’s overall performance. ANALYSIS: Pearson correla- cartilage volumes were measured for each MRI scan using computer
tion coefficients and regression analyses were used to examine imaging software (OSIRIS). Within the laboratory, three-dimensional
the relationships between demographic factors and performance. (3D) motion analysis was used to capture lower limb kinematics
Generalizability theory analyses were used to examine the inter- and a force platform provided information on 3D ground reaction
rater reliability of the various performance measures and the inter- forces during the right foot stance of the running gait. A simplified
case reliability of the CSR. RESULTS: 88% of registrants (n=93) muscle model of the knee incorporating the patella ligament and
completed the program successfully while 11% (n=12) required a biceps femoris tendon was used to estimate knee compression
remediation program with 1 registrant requiring reassessment. There and shear forces. ANALYSIS: To test for the main effects of
was no relationship between the final decision and age, years since activity (sitting versus running) a repeated measures ANOVA with
graduation, or educational program (p < 0.05 in all cases). Record Bonferroni correction was performed. Pearson correlation coefficients
keeping was found to be the most significant contributor to both and linear regression analysis were used to examine the relationship
the QM Committee’s final decision and the Summary Report (R2 = between knee cartilage volume changes and compression and
0.385 and 0.474 respectively). The inter-rater reliability ranged from shear forces at the knee. The significant level was set at 0.05.
0.74 (Summary Report, n=52) to 0.48 (PISA, n=53). The inter- RESULTS: Thirty minutes of relaxed sitting resulted in no significant
case reliability of the CSR was 0.65 which rose to 0.92 when change in femoral and tibial (medial and lateral) cartilage volumes.
ratings were averaged across 6 cases. The review of 3 medical A significant decrease in the volume of femoral (4.4%, p < 0.05)
records is sufficient to achieve acceptable reliability (ICC =.85) in and lateral tibial cartilage (6.7%, p < 0.05) was found following
the CSR component. CONCLUSIONS: The majority of registrants the 30 minute run. None of the biomechanical parameters (i.e.
assessed in the Program were considered to be providing competent joint compression and shear forces) was found to be significantly
care and adhering to professional standards of practice. Unlike related to changes in articular cartilage. CONCLUSIONS: Knee joint
similar studies with physicians, this sample did not find a decline in loading associated with recreational running was shown to lead to
competency associated with increasing age. The inter-rater reliability decreases in knee articular cartilage volumes, most noticeably in
of the various components ranged from fair to good. IMPLICATIONS: the femoral and lateral tibial aspects of the knee joint. Observed
These results indicate that it is possible to implement a reliable changes due to the cyclic loading of knee joint could not be
evaluation of clinical competency through an Onsite Assessment explained by the individualised joint compression and shear forces
using peer assessors. This study can inform the QM Committee measured by this study. IMPLICATIONS: Volumetric changes in knee
on the number of patient records to be reviewed during the articular cartilage may have an important role in maintaining healthy
assessment. These results can provide valuable information to knee cartilage. Further work is needed to investigate similar cyclic
similar agencies considering the assessment of competency of loading responses of knee cartilage in a group of OA patients.
physiotherapists. KEYWORDS: Peer Review, Quality Management, KEYWORDS: Knee articular cartilage, MRI, running. FUNDING
Continuing Competence. FUNDING ACKNOWLEDGEMENTS: This ACKNOWLEDGEMENTS: Arthritis New Zealand, The Decade of
work was supported from a Strategic Training Fellowship in Bone and Joint in New Zealand and Countrywomens Institute.
Rehabilitation Research from the CIHR Musculoskeletal and Arthritis CONTACT: [email protected]
Institute to PM. CONTACT: [email protected] ETHICS COMMITTEE: AUT University Ethics Committee
ETHICS COMMITTEE: McMaster University Research Ethics Board
Research Report Platform Presentation 2490 Wednesday 6 June 09:10
1562 Wednesday 6 June 09:10 VCEC Meeting Rooms 11-12
VCEC Meeting Rooms 1-3 MEASUREMENT OF PHYSICAL PERFORMANCE, QUALITY OF
CHANGES IN KNEE ARTICULAR CARTILAGE IN RESPONSE LIFE AND NUTRITIONAL STATUS OUTCOMES FOLLOWING
TO RUNNING AND ITS RELATIONSHIP TO BIOMECHANICAL IMPLEMENTATION OF AN EXERCISE PROGRAM FOR
LOADING HAEMODIALYSIS PATIENTS
Boocock M1 , McNair P1 , Cicuttini F2 , Stuart A3 , Sinclair T3 ; Heck C1 , Darling P2 , Kerby J3 , Lee-Yu N4 , Lee S5 , Frazer J6 ,
1 Physical Rehabilitation Research Centre, AUT University, Cook D7 , Hardy D8 , Yang C9 , Kareem J10 , Saunderson R11 ,
Auckland, New Zealand; 2 Monash University Medical School, Cochrane N12 ; 1 University Health Network, Toronto Canada;
Alfred Hospital, Prahran, Victoria, Australia; 3 The Radiology Group, 2 St. Michael’s Hospital, Toronto Canada; 3 St. Michael’s Hospital,
Auckland, New Zealand Toronto Canada; 4 St. Michael’s Hospital, Toronto Canada; 5 St.
Michael’s Hospital, Toronto Canada; 6 St. Michael’s Hospital, Toronto
Canada; 7 St. Michael’s Hospital, Toronto Canada; 8 St. Michael’s
relationship between knee joint loading and changes in the volume
Hospital, Toronto Canada; 9 St. Michael’s Hospital, Toronto Canada;
of knee articular cartilage following a 30 minute recreational run. 10 St. Michael’s Hospital, Toronto Canada; 11 St. Michael’s Hospital,
RELEVANCE: Osteoarthritis (OA) is a leading cause of morbidity and
Toronto Canada; 12 St. Michael’s Hospital, Toronto Canada
disability internationally, costing billions in health-care expenditure
and lost earnings. In addition to the economic costs, patients often PURPOSE: To evaluate physical performance, quality of life and
suffer considerable pain, loss of function, disability and impaired nutritional status of end stage renal disease (ESRD) patients on
quality of life. Understanding the mechanical characteristics of knee haemodialysis following implementation of an exercise program.
articular cartilage in response to activities of daily living may provide RELEVANCE: Patients with ESRD have high mortality, high morbidity
important insights into the aetiology of knee OA. PARTICIPANTS: and a low quality of life which has been shown to be related to mal-
Ten healthy male subjects with a mean age of 33.4 years (SD= nutrition and compromised physical functioning. Physical functioning
±2.3) and no medical history of a lower limb musculoskeletal is an important predictor of an individual’s ability to perform activities
condition. METHODS: Magnetic Resonance Imaging (MRI) (T1- of daily living, which in turn is important for participation in social,
weighted) scans of the right knee were taken in the sagittal plane vocational and recreational activities. PARTICIPANTS: The thirty
(1.5 mm slices) prior-to and directly following a: 1) 30 minute period nine subjects included met the following criteria: interested/motivated
of relaxed sitting; and 2) a 30 minute run. During the run participants to exercise, deemed medical stable and suitable for exercise,
received hemodialysis for at least 3 months and currently were not ability and arm function in persons within one year of stroke onset, are
physically active METHODS: Subjects were randomized to either an maintained 6 months later. RELEVANCE: Existing evidence supports
exercise or attention placebo (non-exercise control) group. Exercisers the efficacy of a task-oriented approach in improving walking ability
(n=21) were prescribed an individualized bicycle exercise program, and arm function. In previous publications, we showed that a walking
performed three times/week for up to 30 minutes during hemodialysis. intervention was effective in the short term while an upper extremity
Controls (n=18) were offered attention placebo up to 30 minutes, (UE) intervention was not. This study focuses on what happened
three times a week during hemodialysis. Data was collected at three after the intervention ended and subjects were left to their own
time periods: baseline, 6 weeks and 12 weeks after initiation of devices and were no longer followed by a therapist. PARTICIPANTS:
the intervention. Outcomes measured included physical performance Ninety-one individuals within one year of a first or recurrent stroke
[six minute walk tests (6MWT), timed-up-and-go (TUG)]; quality of agreed to participate and provided written, informed consent; 44
life [SF-36 Health Survey (SF36)and Illness Intrusiveness Rating subjects were randomized to the walking intervention and 47 to
Scale (IIRS)]; measures of nutritional status [estimated dry weight, the UE intervention. Both groups were similar in terms of their
Subjective Global Assessment score (SGA), lean body mass, dietary baseline characteristics. Follow-up was immediately after the 6-
energy and protein intake]; biochemical values from routine blood week intervention (previously published) and 6 months later, the
work, and functional measures [Human Activity Profile (HAP)and results to be presented here. METHODS: The walking intervention
functional autonomy (SMAF)]. ANALYSIS: Analyses were performed consisted of walking on different surfaces, on a treadmill. The UE
using difference from baseline and percent change from baseline. intervention involved practice of functional, unilateral and bilateral
The comparisons between the 2 groups for continuous variables tasks designed to improve gross and fine manual dexterity. Persons
was performed with Wilcoxon Rank Sum test; and the comparisons in both groups attended three times a week for 6 weeks. Evaluations
within each group compared with baseline was performed with were conducted by trained and blind evaluators at baseline, on
Wilcoxon Signed Rank test. Comparisons for categorical variables completion of the intervention and 6 months after the completion of
was performed with Pearson Chi Square test. For cases where the the intervention. The Six Minute Walk Test (6MWT) was the primary
number of observations was small Fisher’s exact test was used. outcome measure for the walking intervention. Secondary walking
RESULTS: Participants were primarily male (59%), aged 51.6±15.2 outcomes were the 5-m walk, the Timed ‘Up and Go’ (TUG) and
years, whose primary cause of renal failure was attributed to diabetes the Berg Balance Scale. The Box and Block Test (BBT) was the
(14%) and/or hypertension. (25.6%). The majority had been on HD primary outcome measure for the UE intervention. Secondary UE
45.8±50.72 months (range 3 to 104). There were no significant outcomes were the Nine-Hole Peg Test (NHPT), the Test d’Evaluation
between group differences on these demographic variables. The du Membre Supérieur pour Personnes Agées (TEMPA) and grip
following changes were noted in the exercise group only. TUG scores strength. ANALYSIS: Data were analyzed on the basis of intention to
had significantly improved (p = 0.00) from 11.9 +/−10.4 at baseline treat. Group comparisons were made using a t-test for independent
to 8.3 +/− 3.8 seconds by 12 weeks. Also the 6MWT distance samples for variables measured on a continuous scale and the
significantly (p = 0.00) improved from 407.0 +/− 136.8 metres at Wilcoxon Rank Sum Test for variables measured on an ordinal
baseline to 469.4 +/− 136.3 metres by 12 weeks. Other changes scale. T-tests and Wilcoxon rank sum test were also done on the
noted included a significant between group difference on HAP at change scores between groups. RESULTS: Six months after the
6 weeks and the instrumental activities of daily living subscore on intervention ended, the walking group lost what they had gained
SMAF at 6 and 12 weeks. There were no significant improvements in from the interventions (6MWT= −35m; SD=46) while the UE group
the quality of life measures or changes in nutritional status in either stayed relatively stable (6MWT= −8 m; SD=64). There were no
group over the course of the study. CONCLUSIONS: The results meaningful changes observed in Box and Block scores for either
of this study provide evidence that exercise had a positive impact group. CONCLUSIONS: Gains observed in walking as assessed
on the physical performance and functional measures for ESRD immediately after a 6-intervention were not maintained after a period
patients on hemodialysis. IMPLICATIONS: Physical exercise should of 6-month when no intervention took place. UE function did not
be incorporated as an integral component of ESRD management. improve nor deteriorate during this same time. IMPLICATIONS:
KEYWORDS: physical exercise; hemodialysis; end stage renal Results indicates that once patients are discharged from therapy
disease; physical performance; nutritional status; quality of life. and no longer being followed and encouraged to exercise, the
FUNDING ACKNOWLEDGEMENTS: The investigators would like to gains obtained during rehabilitation are mostly lost. Development
acknowledge the funding received from The Kidney Foundation of of community programs focusing on exercises for post-rehabilitation
Canada. CONTACT: [email protected] stroke persons may be a solution to maintaining physical gains and
ETHICS COMMITTEE: Research Ethics Board, St. Michael’s function in society KEYWORDS: Stroke, Efficacy, Therapy. FUNDING
Hospital, Toronto, Canada ACKNOWLEDGEMENTS: Operating funds were provided by the
Quebec Réseau provincial de recherche en adaptation-réadaptation,
the Heart and Stroke Foundation of Canada, and the Canadian
Research Report Platform Presentation Stroke Network. Johanne Higgins was supported by a fellowship from
3159 Wednesday 6 June 09:10 the Canadian Stroke Network, McGill University Research Institute
VCEC Meeting Room 16 and the Fonds de Recherche en Santé du Québec. Nancy M.
MAINTENANCE OF ACHIEVED GAINS FOLLOWING TASK- Salbach received a fellowship from the Canadian Institutes of Health
ORIENTED INTERVENTIONS TARGETING WALKING AND ARM Research.
FUNCTION IN PERSONS WITH STROKE: A RANDOMIZED ETHICS COMMITTEE: Faculty of Medicine, Mcgill University
CONTROLLED TRIAL Institutional Review board and Institut de Réadaptation en déficience
physique du Québec Review Board
Mayo N1 , Higgins J1 , Salbach N2 , Wood-Dauphinee S1 ,
Richards C3 , Cote R4 ; 1 School of Physical and Occupational
Therapy, Faculty of Medicine, McGill University. Montreal, Quebec,
Canada; 2 Department of Physical Therapy, University of Toronto,
Toronto, Ontario, Canada; 3 Department of Rehabilitation, Faculty of
Medicine, Laval University, Quebec, Quebec, Canada; 4 Department
of Neurology, Montreal General Hospital, McGill University Health
Centre.Montreal, Quebec, Canada
PURPOSE: To evaluate whether effects arising from a six-week
program of task-oriented interventions aimed at enhancing walking
KNEE JOINT ROTATION IN VIVO MEASUREMENTS – EFFECTIVENESS OF A WORKPLACE PHYSICAL EXERCISE
DEVELOPMENT OF AN EXTERNAL CLINICAL DEVICE AND INTERVENTION ON THE FUNCTIONING, WORK ABILITY, AND
CLINICAL STUDIES WELL-BEING – A CLUSTER RANDOMISED CROSS-OVER TRIAL
Almquist P1 , Fridén T2 , Zätterström R3 , Ekdahl C1 ; 1 Department Sjögren T1 , Nissinen K2 , Järvenpää S2 , Ojanen M3 , Vanharanta H4 ,
of Health Sciences, Division of Physiotherapy, Lund University, Mälkiä E1 ; 1 Department of Health Sciences, University of Jyväskylä,
Lund, Sweden; 2 Department of Orthopedics, Lund University, Finland; 2 Department of Mathematics and Statistics, University
Lund, Sweden; 3 Department of Physical Medicine, Lund University of Jyväskylä, Finland; 3 Department of Psychology, University of
Hospital, Lund, Sweden Tampere, Finland; 4 Leeds Musculoskeletal Service, Leeds England
PURPOSE: Knee joint rotation is important for most weightbearing effects of a workplace physical exercise intervention on physical
movements. During the stance phase of walking, the foot is and psychosocial functioning, work ability, and general subjective
fixed to the ground, this causes internal rotation of the tibia with well-being. RELEVANCE: The chronic outcome effects of the
ankle dorsiflexion and external tibial rotation with plantar flexion intervention were evaluated within the framework of the International
of the ankle. Excessive forces in the knee may tear ligamentous Classification of Functioning, Disability and Health (ICF). During the
structures, resulting in defects in the envelope of passive motion, physical exercise intervention dose of exercise and other physical
including rotatory motions. However, no clinical knee joint rotation activity outside the intervention were controlled for. PARTICIPANTS:
measurement instrument, evaluated regarding validity and reliability The volunteer study population of 124 office workers was drawn
exists, and tibio-femural rotation is hardly ever measured and from four municipal administrative departments. 90 workers (73%)
evaluated in clinical works. The aim of this study was to develop from this population took part in a cluster randomized cross-over
a clinical external cevice for measuring knee joint rotation range of designed physical exercise intervention. METHODS: The intervention
motion, as well as establish age and gender differences in a knee consisted 15 weeks’ light resistance training (30%1RM) with air
healthy reference population. RELEVANCE: The normal range of resistance equipment and guidance. The no-intervention period was
rotation of the knee in various healthy population in vivo is not known, also 15 weeks. During the first five-week intervention period a specific
age and gender differences are not established, and rotation is training programme (6 minutes x 5 times a week x 5 weeks=
hardly ever estimated in clinical works. A device measuring knee joint 435 metabolic equivalent (MET) minutes) was to be performed
rotation could be of great value as a complement to existing clinical once each working day and during the second and third 5-week
tools and examination equipment. PARTICIPANTS: The knee healthy periods 1-2 times each working day (6 minutes x 7 times a week
x 5 weeks =609 MET minutes). The workers completed the Borg
reference population was constituted of 120 persons, 60 females and
CR10 pain scales, modified version of the Nordic questionnaire
60 males, divided into four different age groups, 15-30, 31-45, 46-
on musculoskeletal symptoms, descriptive visual rating scales on
60 and>61 years old. The four age groups were divided to match
psychosocial functioning and well-being, and a work ability index
different age related knee dysfunction problems in future studies.
questionnaire. Muscle strength was measured with the 5 repetition
METHODS: The newly developed measurement instrument was maximum (RM) test. Physical activity was measured by a diary
used in the present study. It’s validity was evaluated by simultaneous and the MetPro questionnaire, and then converted to MET values.
measurements with Roentgen Stereometric Analysis on five male The study was approved by the ethical committee of the University
subjects. The intra- and intertester reliability were evaluated with 10 of Kuopio and the University Hospital of Kuopio. ANALYSIS: The
knee healthy subjects each. 120 knee healthy subjects, divided into statistical analysis was based on linear mixed model. RESULTS:
genders and four different age groups, were used to represent a Specific physical exercise during the working day, with a mean
reference population, with the purpose to establish normal knee joint training time of 5 minutes per working day (average 363 MET
rotation and variations due to age and gender. The subjects were minutes during 5 week), improved the subjects’ physical functioning,
examined in 90, 60 and 30 degrees of knee flexion angle, with 6 and especially in the components of body function and structures. The
9 Nm as well as the examiners apprehension of end-feel. ANALYSIS: intervention alleviated the intensity of headache (p = 0.001) and
Pearson’s coefficient of correlation, Five way analysis of variance, intensity of neck (p = 0.002) and low back (p = 0.020) symptoms
Anova and T-test were used for statistic analysis. RESULTS: The as well as reduced the prevalence of headache (p = 0.41-0.47)
external device showed high validity (r2 0.83-0.90) and intra- and and neck (p = 0.003), shoulder (p = 0.007) and low back (p = 0.000)
intertester reliability (r2 0.74-0.95). The females in the reference symptoms. The intervention improved subjective physical well-being
population showed significant larger (p < 0.001) range of knee joint (p = 0.015), but it had no effect on the other psychosocial functioning,
rotation than the males. Knee joint rotation decreased significantly work ability or general well-being variables. CONCLUSIONS: The
due to age in both genders (p < 0.001), and no differences between intervention benefited in physical functioning and the component of
the right and left knees were found. CONCLUSIONS: The newly body functions and structures, especially musculoskeletal symptoms,
more than psychological functioning or the components of activities
developed device was a valid and reliable measurement instrument.
and participation or social environmental factors. IMPLICATIONS:
In the knee healthy reference population, the females showed
The physical exercise intervention partly created evidence-based
significant larger range of rotation than the males, the knee joint
practices for use in occupational heath. Physiotherapists can
rotation decreased significantly due to age in both genders and
adapt these practices in seeking to maintain physical functioning
no differences between the right and left knees were found. among persons in sedentary occupations. More studies need to
IMPLICATIONS: Further knowledge about normal knee joint rotation be carried out among wider range of working populations or
and variations due to age and genders, which maybe could have among populations with different levels of functioning to learn
an influence in different knee joint disorders. KEYWORDS: Knee, more about the effectiveness of physical exercise interventions on
rotation, measurements. FUNDING ACKNOWLEDGEMENTS: This physical and psychosocial functioning, work ability and general
work was funded by County Council of Halland foundation, Sweden subjective well-being. KEYWORDS: Occupational health, exercise,
and Bertil Hemborgs foundation. evidence based practice. FUNDING ACKNOWLEDGEMENTS: The
ETHICS COMMITTEE: The study was approved by the Ethics study was supported by the Chydenius Institute and University of
Committee of Lund University Jyväskylä, and personal grants from the Finnish Work Environment
Fund, Juho Vainio Foundation and Academy of Finland. CONTACT: analysis is unusual in physiotherapy studies at present, yet in this trial
[email protected].fi it reveals important differences between interventions not apparent
ETHICS COMMITTEE: The study was approved by the ethical from clinical outcomes. Mean LBP-related NHS costs were £206
committee of the University of Kuopio and the University Hospital less per year per patient in functional restoration compared with
of Kuopio. individual physiotherapy. Extrapolating these results, if half of the 1.23
million LBP patients receiving NHS physiotherapy per year received
physiotherapist-lead pain management instead of currently usual
individual physiotherapy, NHS savings would be £126 million/year
2126 Wednesday 6 June 09:10 (2003-4 prices). Given the prevalence of cLBP and its personal
VCEC Meeting Rooms 19-20 and socio-economic costs these findings have important implications
EFFECTIVENESS AND COST-EFFECTIVENESS OF THREE for primary care management. KEYWORDS: Low back pain,
PHYSIOTHERAPY REGIMES COMMONLY USED TO REDUCE economic analysis, exercise. FUNDING ACKNOWLEDGEMENTS:
DISABILITY IN PATIENTS WITH CHRONIC LOW BACK PAIN This study was funded by Arthritis Research Campaign. CONTACT:
Critchley D1 , Ratcliffe J2 , Noonan S3 , Jones R4 , Hurley M1 ; [email protected]
1 Academic Department of Physiotherapy, King’s College London, ETHICS COMMITTEE: Guy’s and St Thomas Local Research Ethics
London, UK; 2 School of Health and Related Research, Sheffield committee
University, Sheffield, UK; 3 Department of Physiotherapy, Guy’s
and St Thomas’ Hospitals, London, UK; 4 School of Medicine, King’s Research Report Platform Presentation
College London, London, UK 1167 Wednesday 6 June 09:30
PURPOSE: To compare the effectiveness and cost-effectiveness of PP Crystal Pavilion A
usual individual physiotherapy, spinal stabilisation, or physiotherapist- PROFESSIONAL IDENTITY FORMATION IN CLINICAL
led pain management in managing chronic low-back pain (cLBP). EDUCATION
RELEVANCE: cLBP is common, disabling and a costly problem
Webb G
for health-care providers. Exercise-based physiotherapy reduces
disability in cLBP, but it is unclear if one form of physiotherapy PURPOSE: This research was concerned with the professional
is most effective or cost effective. PARTICIPANTS: 212 people identity formation of physiotherapy students in clinical practice
with non-specific cLBP already referred to physiotherapy and able and the development of a theoretical model that can underpin
to participate in group exercises. Participants were 44 (range 18- pedagogical partnerships in clinical education between students,
76) years old, 136 (64%) female with a 7.4 (range 0.25-52) years supervisors and academics. RELEVANCE: The aims of the research
history of LBP. Their socio-economic profile was representative were to explore the issues of professional identity formation in un-
of the trial location, inner-city south London: 48% self-described dergraduate physiotherapy students; how they and their supervisors
non-white ethnicities, 58% lived in social housing. METHODS: position themselves in conversations and use reflexive positioning
Participants were randomised to individual physiotherapy (n=71), to create new knowledge and develop professional competency.
spinal stabilisation classes (n=72) or outpatient pain management It explores how language and interpretations of language during
(education and paced exercise)(n=69). Primary outcome was conversations form a critical part of the professionalisation of
Roland-Morris disability score 18 months from baseline. Secondary physiotherapy students in clinical practice. PARTICIPANTS: Third
measures were pain (NAS), quality of life (EQ-5D) and time off- year students and clinicians involved in the clinical program at the
work. Economic measures were UK National Health Service (NHS) School of Physiotherapy at the University of Melbourne. METHODS:
costs associated with low-back pain and quality adjusted life years This qualitative research used interpretative techniques within a
(QALYs) over trial period. ANALYSIS: Clinical outcomes were phenomenological account of the social world of clinical education
compared on an intention-to-treat basis with ANCOVA with baseline in physiotherapy, social agency and the institutions and artifacts
as covariate; economic outcomes were compared with ANOVA and with which the participants are dealing. For this study six students
results confirmed with bootstrapping. Cost-effectiveness acceptability were interviewed three times in the third year of their physiotherapy
curves were constructed and will be presented. RESULTS: 160 degree; before their first major clinical experience, after their first
(75%) participants provided clinical follow-up data at 18 months. clinic and at the end of their third year clinics. All students wrote
Mean(CI) Roland-Morris disability score at baseline, 6, 12, and 18 a reflective essay at the end. ANALYSIS: Themes were developed
months were 11.1(9.6-12.6), 8.0(6.4-9.7), 8.1(6.5-9.8), and 6.9(5.3- from the student interviews.Positioning theory, cultural psychology
8.4) respectively for individual physiotherapy; 12.8(11.4 −14.2), and professional identity formation form the conceptual framework
7.0(5.6-8.5), 7.6(5.9-9.2), and 6.8(4.9-8.6) for spinal stabilisation; around which this data was interpreted. Crucial moments in becoming
and 11.5(9.8-13.1), 6.2(4.6-7.7), 5.8(4.2-7.4), and 6.5(4.5-8.6) for a professional are often couched in successful or unsuccessful
pain management. Improvements from baseline were significant relationships during the experiential learning encountered in clinical
in all arms at all times (P < 0.001). There were similar significant settings. All of the students showed differences in how they
improvements in pain, quality of life and days off-work. Differences engaged in their learning in the clinics and the development of
between treatments were not significant for any clinical outcomes an understanding of what it means to be a physiotherapist. The
at any follow-ups. Pain management participants had far fewer use of indexical grammer demostrated the lack of ownership of
secondary care visits, inpatient procedures, and investigations their learning and responsibility for patient outcomes. RESULTS:
than individual physiotherapy or spinal stabilisation participants. Curricula goals, which recognise the importance of the dynamic
Mean(SD) LBP-related NHS costs and QALY gain over the eighteen- interplay between public /private and individual /collective dimensions
month trial period were £474(840) and 0.99(0.27) respectively of speech in the enactment of the explicit and informal curriculum,
for individual physiotherapy, £379(1040) and 0.90(0.37) for spinal are important (Richardson 2002) to ensure links between the
stabilisation and £165(202) and 1.00(0.28) for pain management. micro-world of systematic theoretical learning and an individual’s
Excluding three patients who received costly spinal surgery did experiences in the life world of professional practice setting. The
not change the result that functional restoration was most cost- social-constructivist model for clinical education proposed begins in
effective. CONCLUSIONS: Physiotherapist-led pain management the world of physiotherapy practice, constructed by humans, where
offers a cost-effective alternative to usual individual physiotherapy for the student is encouraged to elaborate, question and debate with
cLBP and promotes more effective self-management. Improvements others, the ontological constructions being placed on ‘’things’ and
in disability and pain were clinically important and maintained for shared experiences in clinical settings. The supervisors’ role is to
more than one year following treatment. IMPLICATIONS: Economic interpret these dialogues against their own cultural agency. Their
teaching should be inclusive and seen to be so as opposed to that candidates come equally prepared in domains and functions.
exclusive. CONCLUSIONS: Research and curricula models need IMPLICATIONS: Information about potential performance and the
to be developed that attend simultaneously to both the person of influence of time since graduation on examination results is now
the student and the context of learning. Professional knowledge available for candidates. Future research should address the barriers
creation is a complex concept that has not been sufficiently explained to success encountered by the IEC, and the relationship between
by available theories of practice. IMPLICATIONS: The research exam performance and clinical practice. KEYWORDS: licensure,
explores how students are inducted into the profession. It assists examination, competency. FUNDING ACKNOWLEDGEMENTS: This
students and clinicians to understand the complex interactions that research was supported by the Ann Collins Whitmore Memorial
take place in conversations in clincal education. It is important in Award from the Physiotherapy Foundation of Canada and from a
enabling young students to understand the institutional practices Strategic Training Fellowship in Rehabilitation Research from the
KEYWORDS: professional identity formation; clinical education. CIHR Musculoskeletal and Arthritis Institute to PM. CONTACT:
FUNDING ACKNOWLEDGEMENTS: none. [email protected]
ETHICS COMMITTEE: The University of Melbourne ETHICS COMMITTEE: McMaster University Ethics Review Board

FACTORS THAT PREDICT SUCCESSS ON THE WRITTEN CARRY OVER OF LEARNING PROCESS AND SKILLS FROM
COMPONENT OF THE CANADIAN PHYSIOTHERAPY PROBLEM-BASED LEARNING TUTORIALS TO THE PRACTICE
COMPETENCY EXAM SETTING: A STUDENT PERSPECTIVE
Miller P1. , Cooper M2 , Eva K1 ; 1 McMaster University, Hamilton, Quilter J, Dawson L; University of Brighton, Brighton, UK
Ontario, Canada; 2 Canadian Alliance of Physiotherapy Regulators,
PURPOSE: The aim of the study was to uncover physiotherapy
Toronto, Ontario, Canada
students’ perspectives on how the learning process and skills
PURPOSE: The purpose of this study was to examine the gained from problem-based learning (PBL) carried over into the
relationship between demographic factors and performance on the practice setting by asking students to reflect on their experiences
written component of the Canadian Physiotherapy Competency of clinical placement after completing a year of PBL. RELEVANCE:
Exam (PCE). RELEVANCE: The PCE is a requirement for licensure The evolving health care environment demands that educational
in most Canadian provinces. As such, it defines the minimum programmes graduate clinicians whose focus is directed to the
standard of competency required prior to entering the workforce. Little holistic needs of the patient and are capable of adapting to the
is known about factors contributing to successful performance on ever changing nature of clinical practice. It has been argued that
the exam or the ability of the exam to assess clinical competency traditional didactic pedagogy is deficient in preparing students
beyond entry-level. PARTICIPANTS: The sample included results for holistic practice and that student-centred learning, such as
from 2867 examinations, with Canadian-educated candidates (CEC) PBL, facilitates students to make the transition to clinical practice.
making up 75% of the sample (n=2139). In the sample of CEC, 96% PARTICIPANTS: Fourteen second year students on an entry-level
were first-time candidates, and 96% were writing in their year of accelerated master’s programme in physiotherapy were selected
graduation (new graduates). There were 74 CEC candidates with because they had experienced the “phenomena” of PBL and clinical
at least 1 year in practice (CEC-1+). In the sample of internationally- education. The study was approved by the School of Health
educated candidates (IEC) (n=728), 73% were first time candidates, Professions Ethics Panel at the University of Brighton. METHODS:
and 5% were new graduates. METHODS: The PCE is comprised of 2 The research design used a qualitative, phenomenological approach.
components: written and clinical. The candidate has up to 3 attempts Data were collected by means of focus group interviews, facilitated
to pass the written component prior to taking the clinical. The by the researcher and moderated by a colleague, after undertaking
written component is comprised of approximately 200 questions from a pilot study focus group. Focus groups were audio taped and
the musculoskeletal, neurosciences, and cardiorespiratory domains, transcribed verbatim. A transcribed debrief was undertaken by the
addressing the functions of assessment, planning, and intervention. researcher and moderator in order to identify emerging themes and
Anonymized data (demographic factors and performance) from the 24 reflect on potential bias. ANALYSIS: A thematic content approach
sittings of the written examination for the years 2001-2004 were used to data analysis was taken. The researcher invited one participant
in the analyses. ANALYSIS: Descriptive statistics were calculated from each focus group to verify the accuracy of the transcripts and a
and correlational analysis used. RESULTS: The overall pass rate colleague, familiar with qualitative research, to verify the categories
was 85%. The pass-rate for the CEC was 94% and for the IEC and themes generated from the raw data. RESULTS: Five themes
was 60%. Pass rate for CEC and IEC repeat-writers was 78% emerged from the the categories generated through sequential
and 51% respectively. Performance scores declined with increasing analysis of the focus group data; group functioning in learning,
years since graduation when the entire group of candidates was self-directed learning, physiotherapy-specific knowledge and skills,
considered (whole sample: r =-.346, p < 0.01) and whole group health care professional skills and extrinsic factors to the learning
of first-time candidates r=-.311, p < 0.01), however this trend was environment. CONCLUSIONS: PBL was viewed as a pedagogical
not present within the various subgroups (eg. CEC: r =-.043, approach, whose group based process enabled students to learn
IEC: r =-.076, CEC1+: r = −0.057). The 3 domain scores were team work skills necessary for work in practice. Reflecting on the
highly correlated (p < 0.01) as were the 3 function scores for the the PBL experience,students felt that group dynamics developed
CEC, IEC, Canadian new graduates, and the CEC1+ subgroups. their team working skills which eased their transition into the
CONCLUSIONS: Canadian-educated candidates, candidates writing clinical setting and increased their confidence in interprofessional
for the first time, and new graduates perform better on the written working. IMPLICATIONS: The qualitative nature of the study does
component of the PCE. The decline in performance with increasing not permit the author to suggest curricula changes based on its
years in practice seen in the whole group appears to be driven findings. However,in light of the body of literature on PBL and
by the lower scores and greater years post-graduation in the IEC. students perspectives on professional education, it would seem that
The decline in performance with increasing years post-graduation collaborative work in the form of PBL can enhance team working,
seen in other professional groups was not evident when the various confidence, self-directed learning and holistic attitudes, all of which
subgroups were considered. None of the subgroups appeared to are desirable attributes for physiotherapy graduates. KEYWORDS:
perform better in any one domain or any one function, suggesting Problem-based learning; education; clinical education. FUNDING
ACKNOWLEDGEMENTS: The work was unfunded. CONTACT: FUNDING ACKNOWLEDGEMENTS: Partially funded by a SPARC
[email protected]; [email protected] grant from Regis University, Denver, Co.
ETHICS COMMITTEE: School of Health Professions Ethics Panel, ETHICS COMMITTEE: Regis University IRB, Denver, Co, USA
University of Brighton, UK.
2635 Wednesday 6 June 09:30 VCEC Meeting Room 16
VCEC Meeting Rooms 11-12 EXECUTIVE FUNCTION IS INDEPENDENTLY ASSOCIATED
THE INFLUENCE OF FULL FIELD OPTOKINETIC STIMULATION WITH PERFORMANCES OF BALANCE AND MOBILITY IN
WITH AND WITHOUT A CUSTOM EXERCISE PROGRAM ON OLDER ADULTS WITH MILD CHRONIC STROKE
VISUAL VERTIGO Liu-Ambrose T1,4 , Pang M2 , Eng J1,3 ; 1 School of Rehabilitation
Winkler P, Koch A, Limoges A, Perez D, Schrey P, Smith J; Regis Sciences, Department of Physical Therapy, University of British
University, Denver, CO, USA Columbia,; 2 Department of Rehabilitation Sciences, Hong Kong
Polytechnic University, Hong Kong; 3 Rehabilitation Research
PURPOSE: Some individuals with vestibular impairments become
Laboratory, GF Strong Rehabilitation Center, Vancouver, BC,
dizzy and unstable in response to movement of the visual
Canada; 4 Department of Psychology, University of British Columbia,
environment, a symptom called visual vertigo (VV). Optokinetic
Vancouver, BC, Canada
visual stimulation (OPK) is effective in treating visual vertigo,
however no studies have explored whether it is more effective PURPOSE: We examined the independent association of executive-
when combined with a traditional vestibular rehabilitation program. controlled processes (ECPs) with performances of balance and
A secondary purpose was to demonstrate the effectiveness of a mobility in community-dwelling older adults with mild chronic
moderately priced, commercially available system for providing OPK stroke. RELEVANCE: Stroke survivors have a high incidence of
stimulation. RELEVANCE: This research addresses the need for falls. Impaired ECPS are frequent in stroke survivors and are
custom exercises for people with VV. Additionally, OPK stimulation associated with falls in this population. Better understanding of
systems used in published experiments are expensive or not the independent association between ECPs and physiological fall
commercially available PARTICIPANTS: The seventeen participants, risk (i.e., performances of balance and mobility) could enhance
ages 20-65 years old, included individuals with peripheral or future interventions that aim to prevent falls and to promote an
central vestibulopathy diagnosed by neuro-otology. A questionnaire independent lifestyle among stroke survivors. PARTICIPANTS: The
determined sensitivity to movement in the visual environment (VV). sample consisted of 63 men and women with mild chronic stroke,
All subjects had previously received vestibular rehabilitation without aged 50 years and older. We included those who: 1) had a single
resolution of symptoms. METHODS: The study randomly assigned stroke greater >1 year onset; 2) were aged 50 years; 3) were able
subjects. One group (8 subjects) received OPK stimulation for 10 to walk >10 meters independently (with or without walking aids); and
minutes 3 times weekly for 3 weeks. The 2nd group (9 subjects) 4) lived in their own home. We excluded those who: 1) had a history of
received the same intervention plus a customized home exercise serious cardiac disease (e.g., myocardial infarction); 2) uncontrolled
program upgraded weekly. Outcome measures included sway (force blood pressure; 3) had neurological conditions in addition to stroke;
platform), Dynamic Gait Index (DGI), and gait characteristics or 4) obtained a score less than 22 on the Mini-Mental State
measured by Gaitrite. The Dizziness Handicap Inventory (DHI) and a Examination. METHODS: Measures of balance and mobility were:
visual analog scale (VAS) assessed level of dizziness. Measurements Berg Balance Scale, Timed Up and Go Test, 6-Minute Walk Test,
were performed at the first, 9th and at a 1 month follow up visit. A gait velocity, and stair climbing time. Measures of cognitive function
global outcome questionnaire asked the subjects to rate the benefits were the specific ECPs of cognitive flexibility (Stroop Test) and
of the intervention on dizziness, balance, ADLs and overall life working memory (digit span backwards). We also assessed bilateral
improvement. ANALYSIS: Force platform, DGI and GaitRite scores quadriceps strength and current physical activity level (PASIPD
were analyzed in one-factor repeated measures ANOVA and Tukey questionnaire). The study was approved by the relevant University
post hoc test. To analyze the VAS scores (pre-test, post-test at and Hospital ethics boards. All participants gave written informed
each session), a 2x2x3 design was used. Scores from the DHI consent prior to participating in the study. ANALYSIS: The five
were analyzed using a Kruskal-Wallis test. RESULTS: No significant performances of balance and mobility were entered into a principal
differences were found between groups on any of the measures. component analysis (PCA). We set the eigenvalues to be greater
Data analyzed by session showed significant improvements in than 1 in the analysis. One hierarchical linear regression model
both groups in sway and total length of movement on the force was constructed to determine the independent association of ECPs
platform at 9th visit and 1 month follow up. There were significant with the first principal component extracted from the PCA. In this
improvements in single leg stance time, velocity of gait and step model, age, normalized quadriceps strength of the paretic side,
length. The level of dizziness on the VAS was significantly less and the PASIPD score were statistically controlled by forcing these
immediately post intervention when compared to the initial and three variables into the regression model first. Executive-controlled
1 mo follow up visit. Seventy one percent of subjects reported processes, specifically, performance on the interference condition
less dizziness and improved balance, 65% felt they improved in of the Stroop Test, was then entered into the regression model.
IADLs, and 65% said the study had made an important improvement RESULTS: Cognitive flexibility, specifically response inhibition, was
in their life on the global questionnaire. CONCLUSIONS: These independently associated with the balance and mobility principal
findings indicate that a home exercise program may not provide component in the final model, even after adjusting for age, normalized
additional benefits for subjects with VV when compared to OPK quadriceps strength of the paretic side, and the PASIPD score.
stimulation alone. Nine 10 minute intervention sessions were effective Age, normalized quadriceps strength of the paretic side, and the
in improving gait, balance, and decreasing dizziness. A larger sample PASIPD score together accounted for 21.5% of the total variance.
size should be tested to confirm these results. An inexpensive Adding cognitive flexibility resulted in an R-square change of 6.3%
($100.), commercially available (Starball II) OPK system was effective and significantly improved the model (F Change (1, 53) = 4.59,
for intervention. IMPLICATIONS: OPK alone effectively reduces P = 0.04). The total variance accounted by the final model was
symptoms of VV without exercises and may decrease the cost of 27.8%. CONCLUSIONS: our study highlights that cognitive flexibility,
rehabilitation. The Starball II provides a widely available and cost- specifically response inhibition, was independently associated with
effective means of providing the OPK intervention in the clinic or performances of balance and mobility in community-dwelling older
at home KEYWORDS: vestibular, optokinetic stimulation, dizziness. adults with mild chronic stroke. IMPLICATIONS: Clinicians may
need to consider cognitive function when assessing and treating at risk for ACL injury and develop novel strategies to prevent their
impaired balance and mobility in older adults with mild chronic occurrence KEYWORDS: Gender Disparity, ACL, Ligament, Knee,
stroke. KEYWORDS: executive function, balance, mobility, older Womens Health. FUNDING ACKNOWLEDGEMENTS: Supported in
adults, chronic stroke. FUNDING ACKNOWLEDGEMENTS: Teresa part by USPHS Health Disparities Program MD00532-02. CONTACT:
Liu-Ambrose: Supported by a post-doctoral fellowship from the [email protected]
Michael Smith Foundation for Health Research and the Canadian ETHICS COMMITTEE: University of Maryland School of Medicine
Institutes for Health Research (CIHR). Marco YC Pang: Supported Institutional Animal Care and Use Committee
by a post-doctoral fellowship from Natural Sciences and Engineering
Research Council of Canada. Janice J Eng: Supported by a grant-
in-aid from the Heart Stroke Foundation of British Columbia and
Yukon and from career scientist award from CIHR. CONTACT: 3079 Wednesday 6 June 09:30
[email protected] VCEC Meeting Room 18
ETHICS COMMITTEE: Clinical Ethics Board of the University of VALIDATION OF A SHORT-FORM FUNCTIONAL CAPACITY
British Columbia and the Ethics Board of GF Strong Rehabilitation EVALUATION: RESULTS FROM A CLUSTER RANDOMIZED
Centre CONTROLLED TRIAL
Gross D1,2 , Battie M1 , Asante A3 ; 1 Department of Physical
Research Report Platform Presentation Therapy, University of Alberta, Edmonton, Canada; 2 Workers’
Compensation Board Alberta/ Millard Health, Edmonton, Canada;
3030 Wednesday 6 June 09:30 3 Foothills Hospital, Calgary, Canada
GENDER DIFFERENCES IN TYPE-1 AND TYPE-3 COLLAGEN PURPOSE: Functional Capacity Evaluations (FCE) are used for
MRNA EXPRESSION IN THE RAT ANTERIOR CRUCIATE making return-to-work decisions. FCE is a burdensome clinical tool
LIGAMENT in terms of time and cost, yet predictive validity is modest. A short-
form FCE with comparable predictive accuracy would be beneficial.
Romani W, Witherspoon J; University of maryland School of
Medicine Department of Physical Therapy and Rehabilitation Our objective was to evaluate a short-form FCE. RELEVANCE:
Science, Baltimore, Maryland, USA Physical Therapists often perform fitness-for-work assessments
using FCE, however, it is unknown which form of assessment is
PURPOSE: The purpose of this study was to determine the gender most effective or efficient for promoting return-to-work and making
differences in type-1 and type-3 collagen mRNA expression in clinical decisions. PARTICIPANTS: Participants included twenty-
skeletally mature Sprague Dawley rats. RELEVANCE: Women are six Physical, Occupational and Exercise Therapists employed at
between 2 and 10 times more likely to injure their anterior cruciate the Workers’ Compensation Board-Alberta’s rehabilitation facility
ligament (ACL) than men participating in similar military and athletic who were trained and experienced with FCE administration. Data
activities. Gender specific differences in the hormonal milieu and was collected on all workers’ compensation claimants undergoing
response to specific steroid sex hormones have been suggested as FCE at the rehabilitation facility over the trial period. Subjects
potential causes for this disparate injury rate. Type-I alpha-1 (T1C) included 552 claimants (265 tested with short-form FCE) who
and type-3 collagen (T3C) are the crucial structural components that were predominantly employed (58%) males (72%) with chronic
define the ligament’s ability to withstand tensile loads. Synthesis and musculoskeletal conditions (mean duration 709 days). METHODS:
remodeling of collagen follows the transcription of T1C and T3C Four region-specific FCE protocols were created from items within
mRNA and conversion of procollagen into collagen fibers. If sex the full Isernhagen Work Systems’ FCE protocol. To test the
hormones influence ACL strength in a gender specific manner they utility and effectiveness of the short-form FCE protocols, a cluster
must do so by mediating the transcription that regulates the collagen randomized controlled trial was conducted. Fourteen FCE clinicians
essential to the ligament’s mechanical strength. PARTICIPANTS: were randomized to an intervention group while the remainder
Two groups of male (N= 10, 11) and of female (N= 11, 10) 13 formed a control group. Clinicians in the intervention group were
week old Sprague-Dawley rats were used in this study. METHODS: trained to conduct the short-form FCE and used these protocols
Female rats were cycled daily and euthanized when they were in through the trial’s duration. Clinicians in the control group continued
the diestrous phase of their estrous cycle. One ACL was harvested, routine FCE procedures. All injured workers seen for FCE at the
the mRNA isolated, and reverse transcribed. Quantitative polymerase rehabilitation facility were therefore entered into clusters based
chain reaction analysis was carried out with an MJ SYBR green on whether they were assessed using the short-form or routine
kit and an MJ Chromo 4 Real Time Detector. 18S was used as FCE. Data on subject characteristics, return-to-work outcomes and
an internal control. ANALYSIS: Two separate one-way ANOVAs claimant satisfaction with care were extracted from the WCB-Alberta
were used to determine differences in mRNA expression between computer databases. Clinicians logged amount of time during the
hormone treated and control groups. Significance was set at p < 0.05. assessment. Focus groups were held with clinicians using the
RESULTS: As expected female rats had higher mRNA expression of short-form to determine their satisfaction with the protocol’s clinical
T3C than males (P = 0.001). Males had higher expression of T1C utility. ANALYSIS: Analysis included examining differences between
but these differences were not statistically significant (P = 0.191). groups on baseline characteristics and on indicators of fitness-to-
CONCLUSIONS: These results indicated that gender differences in work, efficiency, and claimant and clinician satisfaction. Multivariable
collagen mRNA expression existed in our rat model. Although T1C regression was used to evaluate differences in outcomes between
and T3C likely play a role in the tensile strength of the ACL, changes groups while controlling for potential confounders. We accounted for
in the expression of mRNA do not necessarily indicate a change in within-cluster dependence using a small inflation factor (intra-cluster
protein content or ligament strength. However, higher concentrations correlation = 0.05) as claimants were assigned to therapists in a
of the more elastic T3C in may result in a down stream reduction in non-systematic, relatively random fashion. RESULTS: No significant
the relative strength of the ACL while increases of T1C may increase differences were observed between the intervention and control
tensile strength. Further studies are needed to determine the gender groups on baseline characteristics including age, sex, duration of
specific mechanism of collagen remodeling and the role of steroid injury, employment status, pain intensity, or self-rated disability. No
sex hormones on metabolism, matrix metalloproteinases and ACL adverse consequences or complications from FCE testing were ob-
strength IMPLICATIONS: Understanding of the mechanism by which served. The distribution of return-to-work determinations were similar
sex hormones influence collagen content and ACL strength will fur- between groups as were claimant satisfaction ratings (~90% satisfied
ther explain the gender disparities in ACL injury rate. These findings with the process). Focus groups with participating clinicians indicated
are important as they will help direct future studies to identify women adequate satisfaction with the short-form FCE’s clinical utility. A 57%
efficiency gain in time of functional assessment was seen, whereas observational grids to measure changes in the quality of movement
overall efficiency gain was 24%. One-year follow-up on administrative can provide a useful alternative indicator of outcome in the field of
return-to-work outcomes is nearing completion. CONCLUSIONS: A low back pain rehabilitation. It may be more relevant to the goals of a
short-form FCE appears to have adequate clinical utility while not rehabilitation programme than some of the timed measures that are
affecting clinician return-to-work decisions when compared to routine currently used. KEYWORDS: Back pain, video, outcome. FUNDING
FCE administration. Further evaluation of return-to-work outcomes ACKNOWLEDGEMENTS: The study was supported by a project
is underway. IMPLICATIONS: Short-form FCEs may be a cost- grant from the OHSRC. CONTACT: [email protected]
effective option for Physical Therapists performing fitness-for-work ETHICS COMMITTEE: Oxford LREC
assessments. KEYWORDS: Occupational Health; Musculoskeletal;
Measurement in Practice. FUNDING ACKNOWLEDGEMENTS:
Funding was received from the Clinical Research Partnership Fund Research Report Platform Presentation
sponsored by the Alberta Physiotherapy Association and University 2459 Wednesday 6 June 09:50
of Alberta’s Department of Physical Therapy. WCB-Alberta assisted PP Crystal Pavilion A
with data acquisition. CONTACT: [email protected]
RELIABILITY OF A COGNITIVE ADMISSION TEST FOR THE
ETHICS COMMITTEE: University of Alberta’s Health Research
STUDIES IN PHYSIO-/OCCUPATIONAL THERAPY
Ethics Board
Genucchi R; Schule für Physiotherapie am UniversitätsSpital,
Zürich, Switzerland
2422 Wednesday 6 June 09:30 PURPOSE: For the new established Swiss studies in physio-
VCEC Meeting Rooms 19-20 /occupational therapy (BSc), starting in autumn 2006, 180 study
places (120 PT, 60 OT) are provided in Zurich and 44 (PT) in
USE OF VIDEOTAPES IN DETERMINING OUTCOME AFTER
Berne. A two-stage admission test has been developed based on
INTENSIVE REHABILITATION FOR CHRONIC BACK PAIN
job specification, which describes important attributes and skills for
Barker K1 , Allen A1 , Frost H2 ; 1 Physiotherapy Research Unit, the studies and later occupational activity. In the first part (written test)
Nuffield Orthopaedic Centre NHS Trust, Oxford, UK; 2 Department primarily cognitive skills are tested and in the second part (practical
of Public Health, University of Warwick, Warwick, UK test/interview) primarily communicative and sensomotor skills. Is the
PURPOSE: To investigate using videotaped recordings of patients difficulty level and selectivity of test items of the written test good
performing functional tasks to evaluate change following a pain enough for reliable differentiation of the performance? Is the reliability
rehabilitation programme. RELEVANCE: There is a need to assess (internal consistency) of the written test good enough to examine the
the benefit derived from treatment programmes. Currently a number required attributes of the candidates? RELEVANCE: The results of
of self-report questionnaires and timed performance tests are used. the written test are used as selection criterion for participation in the
These are effective at documenting changes in the quantity of move- second part of the admission procedure. In order to select suitable
ment and in patient reported function. However, they do not reflect candidates, the test items should dispose of good selectivity, item
changes in the quality of movement. This study presents a method of difficulty and internal consistency. A literature search found similar
recording this information. PARTICIPANTS: 120 patients with chronic tests for admission to medical studies but not for physiotherapy
back pain attending a rehabilitation programme. METHODS: Video- studies. DESCRIPTION: The four parts of the written test (80
tapes were recorded of patients performing two standard tasks, walk- multiple-choice questions) should examine the following cognitive
ing and sitting down on a chair, 3 weeks apart at the beginning and attributes: 1. capacity for observation/remembering (COR), 2. basic
end of a rehabilitation programme. Two experienced physiotherapists understanding of science (BUS), 3. interpretation of diagrams/tables
scored the videos using observational grids. Walking was scored us- (IDT), and 4. spatial sense (SPS). BUS, IDT, SPS follow the Swiss
ing the modified Rivermead Mobility Index; sit to stand based on devi- admission test for medical studies in their methodology sections, but
ation from an ideal normalised posture and observed pain behaviour the content is adapted for physiotherapy purposes. The COR section
using the system of Keefe (1). Changes in observed performance was newly developed. In order to economize costs, the four-hour test
were compared with changes in other standard outcome measures, was held jointly by two universities of applied sciences (Zurich, Berne)
Oswestry Disability Index (ODI), Pain Self Efficacy (PSE) and Tampa and included the study courses physio- and occupational therapy.
Kinesiphobia Scale (TKS); and three timed performance measures: The second stage of the admission test was planned separately by
the shuttle walking test, stairs climbed and sit to stand in 60 seconds. each course. EVALUATION: 787 applicants (Zurich: 316 PT, 179
ANALYSIS: Inter-rater reliability was calculated using ICC. Changes OT, Berne: 291 PT) attended the written test. A maximum of 20
after treatment by students paired t- test. Associations between the points in each section could be achieved. The mean results of the
observational and other outcome measures were analysed using three groups did not differ significantly (PT Zurich: 41.62, PT Berne:
Pearson’s Correlation coefficient. RESULTS: The inter-rater agree- 41.48, OT Zurich: 39.90). Internal consistency (cronbach a) was
ment for walking was I.C.C. 0.969 (C.I. 0.954–0.979); p < 0.001; sit to 0.62, sections COR/IDT display clearly lower reliability (0.22/0.30).
stand 0.785 (C.I. 0.686–0.853) p < 0.001 and pain behaviour 0.870 Cronbach a remains 0.61 when COR section is omitted. 58% of test
(CI 0.811-0.911), p < 0.001. There were significant improvements items display sufficient selectivity (R>0.10), 62% display adequate
in the measures between baseline and end of the programme for item difficulty (P=40-90). CONCLUSIONS: The attribute COR cannot
observed gait, sit to stand and pain behaviour (p < 0.001). There were be assessed by this test. Item difficulty of the BUS/IDT sections
only weak associations between the observed function and perfor- was too high. Reliability is weak for a test with drastic personal
mance in timed tests (observed gait and shuttle walking test p < 0.01; consequences. To obtain reliability of 0.80 the test with similar
observed and timed sit to stand p < 0.05). There was no correlation item quality should theoretically consist of 190 items and would
between pain behaviour and performance in timed tests, nor with the be uneconomical. The same result is found when test items with
ODI, PSE or TKS. CONCLUSIONS: The interrater reliability of the insufficient selectivity are analyzed and eliminated and replaced
observational grids was high and they were sensitive to changes over with qualitative better items. The test is thus expanded to 84
time. The percentage improvement measured by observation was questions (reliability improvement after G. Lienert). IMPLICATIONS:
similar to those measured using timed tests; indicating that the grids Further research is necessary to bring the quality of test items to a
have good criterion-related validity. The lack of any strong association standardized level and develop an adequate test for the COR section.
between the observed and timed measures indicates that improved KEYWORDS: Physiotherapy Studies, Admission Test, Reliability.
quality of movement did not correlate with improvements in the speed FUNDING ACKNOWLEDGEMENTS: No funding was received for
or quantity of physical performance. IMPLICATIONS: The use of this work. CONTACT: [email protected]
EVALUATION OF VISUAL VERTIGO WITH 2-DIMENSIONAL A PILOT RANDOMIZED CONTROLLED TRIAL TO EVALUATE
VIDEO-OCULOGRAPHY THE SAFETY AND FEASIBILITY OF VERY EARLY MOBILIZATION
IN ACUTE STROKE UNITS (AVERT)
Dannenbaum E1 , Ip A2 , Stuart R3 , Paquette C1,4 , Fung J1,4 ;
1 Jewish Rehabilitation Hospital Research Site of the Montreal
Bernhardt J1,2 , Dewey H1,3 , Collier J1,3 , Thrift A1 , Donnan G1,3 ;
Center for Interdisciplinary Research in Rehabilitation, Laval, QC, 1 National Stroke Research Institute, Melbourne, Australia; 2 School
Canada; 2 Faculty of Medicine, McGill University, Montreal, QC, of Physiotherapy, La Trobe University, Melbourne, Australia;
Canada; 3 Department of Biology, Western Washington University, 3 Department of Neurology, Austin Health, Melbourne, Australia
Washington, USA; 4 School of Physical and Occupational Therapy,
McGill University, Montreal, QC, Canada PURPOSE: Very early mobilization may be an important component
of effective stroke unit care. Identifying effective components of
PURPOSE: Visual vertigo (VV) is induced by exposure to visually stroke unit care can improve standards of care and outcomes
moving environments. Quantitative assessments of clients with VV for stroke survivors. RELEVANCE: Physiotherapy research trials
are not yet available. The goal of this study was to investigate commonly fail to evaluate the implimentation of new intervention
eye movements generated by viewing a moving target or a moving protocols and the potential for patient harm. Prior to commencement
background in clients with VV. RELEVANCE: In vestibular rehabili- of a large randomized controlled trial of very early mobilization
tation, VV is a debilitating symptom frequently reported by clients. (VEM), we aimed to investigate both the safety and feasibility
Objective outcome measures are lacking. An accurate evaluation of of a VEM protocol. PARTICIPANTS: Patients were recruited from
VV will contribute towards more efficient treatment. PARTICIPANTS: two Melbourne metropolitan stroke units. We included people
Ten clients with VV were recruited from a vestibular rehabilitation admitted to hospital within 24 hours of confirmed stroke, whose
program. The inclusion criteria were that the client’s symptoms were physiological parameters fell within set limits. Patients with severe
provoked by performing at least 5 of these 6 activities: television, premorbid disability, severe comorbidities or requiring palliative care
movie, grocery shopping, malls, traffic, escalators, and checkered were excluded. METHODS: Patients were randomized to VEM or
floor. A convenience sample of 10 age- and gender-matched controls standard care (SC). Patients in the control group received SC.
also participated. METHODS: In a controlled experiment, subjects Patients receiving VEM commenced mobilisation within 24 hours
tracked a horizontally moving target (covering 30 deg of visual angle), post stroke and were provide frequent daily mobilizations for 14
projected on a screen 2m in front of them. Two velocities at 10 and 20 days or until discharge (whichever was sooner). VEM was provided
deg/sec were tested. In a second series, subjects viewed a moving by a physiotherapist and nurse team. Assessments at days 7,
background (alternating colored bars moving across the screen) at 14 and 3 months were conducted by a blinded assessor. The
the same velocities. Stimuli of 20-s durations were generated with primary safety outcome was death at 3 months. Secondary safety
an infrared camera-based 2D video-oculography (2D VOG) system. outcomes included the number of falls, number of serious adverse
Both protocols were tested in sitting, standing and standing on events (SAEs), deterioration in the first 14 days, excessive fatigue
foam. ANALYSIS: The main outcome variables for the respective after treatment and failure to mobilize due to blood pressure drops
paradigms were (1) Proportion of smooth pursuit eye movements of >30 mmHg. The main feasibility outcome was the total “dose”,
generated by subjects (Amplitude of Smooth Pursuit / [Amplitude measured in minutes of mobilization. Secondary feasibility outcomes
of Smooth Pursuit + Amplitude of Saccadic Movement] * 100) and included the time from stroke to first mobilisation, and whether
contamination of SC occurred. ANALYSIS: Analyses were intention
(2) gain of the nystagtmus slow phase velocity (SPV) relative to the
to treat. Fischer’s exact test was used for analyses. RESULTS:
stimulus velocity (SPV / stimulus velocity * 100). Three-way mixed
Seventy one patients were recruited between March 2004 and
effects analyses of variances were performed to test the effects
February 2006. Patient mean age was 74.7 years, 54% were male,
due to group (VV vs. control), stimulus velocity (10 deg/s vs. 20
87% had infarcts, and 58% had an admission National Institute
deg/s) and testing position (sit vs. stand vs. foam). A p-value of less
Health Stroke Score >7. More patients in the VEM group died
than 0.01 was accepted as significant, after adjusting for multiple
(8/38 VEM; 3/33 SC). The risk difference was 12% (95% CI −4–
comparisons (Bonferoni’s test). RESULTS: In the smooth pursuit
28%, p = 0.16), and was in the expected range. There were no
paradigm, the clients with VV used significantly more saccades.
severe falls, no failures to mobilize due to postural BP drop and the
Stimulus velocity however, did not affect smooth pursuit control. The
number of SAEs was similar (35/38 VEM; 27/33 SC). Total dose
moving background induced significant main effects due to group
was 255.6 minutes for VEM and 125.4 minutes for SC (p = 0.011).
and stimulus velocity such that clients with VV showed a significantly
Median time to first mobilization was 18.5 (IQR 13.7-21.9) hours for
higher gain than controls and that gain significantly decreased with VEM and 30.8 (IQR 23.0-39.9) for SC (p < 0.0001). There was no
increasing stimulus velocity. In both paradigms the testing position evidence of contamination of SC. CONCLUSIONS: VEM appears
has no significant effect on eye movements CONCLUSIONS: Clients safe and feasible. IMPLICATIONS: Given these findings, a phase
with VV generated more saccades during smooth pursuit than control III trial to test efficacy is underway. KEYWORDS: safety, feasability,
subjects in tracking a moving target, reflecting either an inability to randomized controlled trial. FUNDING ACKNOWLEDGEMENTS:
anticipate movement of the target or control gaze smoothly. With the Affinity Health and National Heart Foundation (Australia). CONTACT:
moving background stimulus, many of the controls were able to inhibit [email protected]
eye movements at will while clients with VV constantly responded to ETHICS COMMITTEE: Human Research Ethics Committee, Austin
the stimulus. The fact that testing position did not affect oculomotor Health; Human Research Ethics Committee, St. Vincents Hospital
control, suggests that the safest testing position (i.e. sitting) should
be used to assess clients with VV. IMPLICATIONS: Promoting eye
stabilization by fixating on stable targets on moving backgrounds
may be an excellent training technique for clients with VV. This
could help in learning to suppress eye movements when faced with
moving environments. KEYWORDS: Visual-vertigo, eye movements.
FUNDING ACKNOWLEDGEMENTS: Repar, JRH foundation, CFI.
ETHICS COMMITTEE: Centre de recherche interdisciplinaire en
réadaptation du Montréal métropolitain
ACOUSTIC STIFFNESS INDEX OF ARTICULAR CARTILAGE THE INFLUENCE OF A CONTINUUM OF CARE MODEL ON THE
AFTER AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION REHABILITATION OF CLAIMANTS WITH SOFT TISSUE INJURY
SURGERY AND CARE FOR PHYSICAL THERAPY
Stephens B1 , Gross D1,2 ; 1 Workers’ Compensation Board Alberta,
Kuroki H1 , Nakagawa Y2 , Mori K3 , Kobayashi M2 , Okamoto Y2 , Edmonton, Canada; 2 Department of Physical Therapy, University
Yasura K2 , Nishitani K2 , Sakakima H1 , Nakamura T2 ; 1 Department of Alberta, Edmonton, Canada
of Physical Therapy, School of Health Sciences, Faculty of
Medicine, Kyoto University; 2 Department of Orthopaedic Surgery, PURPOSE: Soft tissue musculoskeletal conditions continue to
Graduate School of Medicine, Kyoto University; 3 Department be leading causes of disability and work loss in Canada and
of Applied Medical Engineering Science, Graduate School of internationally. From 1996 through 1997, the Workers’ Compensation
Medicine, Yamaguchi University Board of Alberta (WCB-Alberta) implemented a soft tissue injury
continuum of care model to guide physical therapy and rehabilitation
PURPOSE: Autologous osteochondral transplantation (AOT) is the
service delivery. The model was designed as a high-level decision-
surgery to reconstruct focal cartilage lesion. Although reports on the
making tool to promote a consistent, evidence-based approach to
surgery state that AOT successfully reconstructs the lesion, no report
care provision within the jurisdiction. The model involved three main
focuses on physical therapy (PT) after AOT. We have demonstrated
and published cartilage acoustic stiffness index in animal experiments components: 1) staged application of various rehabilitation services
using ultrasound. The purpose of study, therefore, is to investigate depending on progress of recovery; 2) case management protocols
the cartilage acoustic stiffness index after AOT and to discuss when and checkpoints integrated into case planning; and 3) contracted
care for PT should be taken. RELEVANCE: For successful PT and services with rehabilitation providers (physical therapy, chiropractic,
for evidence based PT after AOT it is important to understand multidisciplinary assessment and rehabilitation centres). As contin-
acoustic stiffness index of articular cartilage because cartilage uums of care have been little studied, we evaluated the impact of
with low acoustic stiffness index that suggests decreased collagen the WCB-Alberta model on sustained return-to-work. RELEVANCE:
cartilage is affected by repeated mechanical stress and is easy This study is important for physical therapy practice as little is known
to deteriorate. PARTICIPANTS: Thirty-six Japanese white rabbits about the effectiveness of funder-based models (i.e. continuums of
were used (Approval number: Med Kyo 04202). METHODS: In 36 care) or rehabilitation provider networks. PARTICIPANTS: The model
rabbits, an osteochondral plug, 6 mm in diameter, was removed from was implemented province-wide, therefore, the entire population of
the right patellar groove and grafted into a recipient hole, 5 mm workers ensured by the WCB-Alberta was the object of investigation.
in diameter, in the left patellar groove. Specimens at 2, 4, 8, 12, The model was directed at workers with uncomplicated soft tissue
24 and 52 weeks postoperatively were assessed by macroscopic injuries (i.e. injury claims for strain, sprain or tear to muscles,
and histological observation and by an ultrasound system. Using tendons or ligaments involving only one body part). An intervention
ultrasound, acoustic stiffness index of plug cartilage and percentage group was created from all claimants with soft tissue injuries to
acoustic stiffness index (ratio to adjacent intact cartilage) after AOT the low back, ankle, knee, elbow, and shoulder identified using
was examined. ANALYSIS: Acoustic stiffness index and percentage ICD-9 and National Work Injury Statistics Program coding. The
acoustic stiffness index was analyzed using the non-parametric comparison group was formed of workers experiencing fractures or
Kruskal-Wallis test and the post-hoc Holm’s test. RESULTS: Acoustic other traumatic non-soft tissue injuries. METHODS: A population-
stiffness index of control knee cartilage was 3.18 (relative value, based before-and-after design with concurrent control group was
unitless). Acoustic stiffness index of plug cartilage of AOT knees used. Data was extracted from the WCB-Alberta administrative
at weeks 2, 4, 8, 12, 24 and 52 postoperatively was 2.17, 2.04, database from two years prior to model implementation to five
1.23, 1.01, 1.95 and 3.94, respectively. Acoustic stiffness index of years after. Information on potential confounders was obtained
plug cartilage decreased up to 12 weeks but then increased at including age, gender, wage, industrial sector and occupation, past
24 and 52 weeks after AOT. The acoustic stiffness index at 52 claim history, employer size, and employment status at time of
weeks postoperatively was significantly higher than that at 8 or 12 claim acceptance. Primary outcome measure was a surrogate
weeks (P < 0.01). Percentage acoustic stiffness index decreased up indicator of sustained return to work, cumulative days receiving wage
to 8 weeks (58.7%) but then recovered to 83.9% at 12 weeks and
replacement benefits. Cost savings were also estimated. ANALYSIS:
102.7% at 24 weeks and increased to 196.3% at 52 weeks after
To determine the impact of model implementation while controlling
the surgery. CONCLUSIONS: Although percentage acoustic stiffness
for potential confounders, survival analytic techniques including Cox
index decreased up to 8 weeks postoperatively, it recovered well
regression were used. Data was censored at one year. RESULTS:
at 52 weeks after AOT. After 8 weeks postoperatively, menu for
Over the entire study period, 70,116 claimants experienced soft
PT can be able to be increased. IMPLICATIONS: Postoperative
tissue injuries (14,217 pre-implementation) while 101,620 claimants
care in physical therapy up to 8 weeks should be taken after AOT.
KEYWORDS: autologous osteochondral transplantation, ultrasound, experienced non-soft tissue injuries (12,236 pre-implementation).
acoustic stiffness index. FUNDING ACKNOWLEDGEMENTS: This In the intervention group, significant improvement in outcome was
study was supported in part by a grant from the Grant-in-Aid for observed after implementation (adjusted Hazard Ratio 1.54(1.50-
Scientific Research, Japan. CONTACT: [email protected] 1.58). Median duration of wage replacement benefits decreased
ETHICS COMMITTEE: The Animal Research Committee of Kyoto from 13 days to 8 days while mean duration lowered from 39 to
University Graduate School of Medicine (approval number; Med Kyo 20 days. Little change was seen in the control group’s disability
04202). duration over the same periods (median survival consistently 10
days). Total estimated cost savings was $21.5 million (CDN).
CONCLUSIONS: Implementation of a soft tissue injury continuum of
care involving staged, evidence-based application of various types
of physical therapy and rehabilitation services resulted in more
rapid and sustained return-to-work. IMPLICATIONS: Implementation
of a continuum of care model may result in better return-to-work
outcomes from physical therapy and rehabilitation. KEYWORDS:
Occupational Health; Musculoskeletal; Service Delivery/Models of
Practice. FUNDING ACKNOWLEDGEMENTS: No funding was
received in support of this research. WCB-Alberta assisted with data FUNDING ACKNOWLEDGEMENTS: The study was funded by The
extraction. CONTACT: [email protected] Arthritis fundation, Motor Authority Association and the University of
ETHICS COMMITTEE: Approval was given by the WCB-Alberta’s Sydney SESQUI grant. CONTACT: [email protected]
Strategic Management Council. ETHICS COMMITTEE: The University of Sydney Ethics Committee

RELATIONSHIP BETWEEN SPINAL STIFFNESS AND OUTCOME TRUNK POSTURE AFFECTS REGIONAL CHEST WALL
IN PATIENTS WITH CHRONIC LOW BACK PAIN MOVEMENT DURING BREATHING
Ferreira M1,2 , Ferreira P1,3 , Latimer J1 , Herbert R1,4 , Maher C1,4 , Lee L, Coppieters M, Hodges P; Division of Physiotherapy, School
Refshauge K1 ; 1 School of Physiotherapy, The University of Sydney, of Health and Rehabilitation Sciences, University of Queensland,
Sydney, Australia; 2 Departamento de Fisioterapia, Pontifı́cie Brisbane, Australia
Universidade Católica de Minas Gerais, Belo Horizonte, Brazil;
3 Departamento de Fisioterapia, Universidade Federal de Minas PURPOSE: Changes in spinal alignment are likely to influence rib
mechanics, which in turn impact ventilation. Although it is known that
Gerais, Belo Horizonte, Brazil; 4 Center for Evidence-Based
gross changes in posture (eg. scoliosis) lead to regional changes
Physiotherapy, The University of Sydney, Sydney, Australia
in ventilation and chest wall movement, whether subtle postural
PURPOSE: (i) To investigate whether spinal joint stiffness changes changes influence chest wall motion is unclear. This study aimed
after treatment, or if it is changed by treatment; (ii) to investigate to investigate the influence of subtle changes in spinal curvature on
the relationship between pre-treatment spinal stiffness and change chest wall motion and adaptation of breathing pattern to increased
in stiffness with treatment; (iii) to assess the relationship between respiratory demand. RELEVANCE: Assessment and treatment of
stiffness, pain, disability and Global Perceived Effect scores (iv) breathing pattern and capacity is an important component of
to investigate whether stiffness predicts response to treatment cardiovascular and musculoskeletal physical therapy. Commonly,
in chronic low back pain patients. RELEVANCE: Posteroanterior people present with subtle variations in spinal posture, which
pressure is commonly used by manipulative therapists to assess may affect accurate assessment, treatment, and research design.
the extent and quality of spinal stiffness in people with spinal PARTICIPANTS: Seven volunteers (three males, four females)
pain. However, only few studies have investigated the influence of with no history of spinal pain or scoliosis, any neurological
treatment on spinal joint stiffness and the relationship between spinal condition, or any respiratory condition participated. METHODS:
stiffness and outcomes such as pain, disability and health status. Three-dimensional (3D) motion of the chest wall was recorded using
PARTICIPANTS: 191 subjects with chronic low back pain (CLBP) an electromagnetic tracking device. Sensors placed over landmarks
were randomly allocated to groups that received either spinal manip- on the upper and lower ribcage, spine, and abdomen measured
ulative therapy, specific segmental exercise, or a general exercise spinal alignment and chest wall motion. Subjects breathed through
program. METHODS: Before and after receiving the intervention a mouthpiece; flow was measured with an pneumotachometer and
subjects were manually assessed for spinal stiffness. Spinal stiffness volume calculated by integrating the flow signal. Seated subjects
assessments were performed using a reference-based protocol. adopted seven postures: self selected, neutral, slump, thoracolumbar
ANALYSIS: Paired samples t-tests were used to test change in extension (military), half trunk rotation, full trunk rotation, and
stiffness with treatment. Differences between the three treatment lateral ribcage shift. In each position subjects breathed quietly
groups’ mean changes were analyzed using independent samples (QB) and with an increased dead-space to increase respiratory
t-tests. Pearson’s correlation was used to analyze the relationship demand. ANALYSIS: Times of end-inspiration and expiration were
between pre-treatment stiffness scores and change in stiffness with identified from the volume data. Displacement of the movement
treatment and to analyze the relationship between stiffness change sensors in three planes between inspiration and expiration was
and change in clinical outcome measures. Multiple linear regression calculated and diameter changes for chest wall and abdomen
was used to determine if stiffness predicted outcome. RESULTS: All were determined. Movement data were normalised to that recorded
three intervention groups showed a significant decrease in stiffness during a vital capacity maneuver. Spinal angles in the sagittal
following treatment (p < 0.001). No difference between groups was plane were calculated. Repeated-measures ANOVAs were used
observed. There was a significant negative correlation between pre- to compare differences in spinal angles between postures and
treatment stiffness scores and change in stiffness scores for all differences in chest wall movement between postures and different
subjects (r = −0.61, p < 0.001) and for each group (r = −0.40, p = 0.02 levels of respiratory demand. RESULTS: Subjects successfully
for the Specific Stabilisation Group, r = −0.77, p < 0.001 for the Spinal attained the target postures, evidenced by differences in thoracic,
Manipulative Therapy Group, and r = −0.62, p < 0.001 for the General thoracolumbar, and lumbar spine angles between postures in the
Exercise Group). There was a significant but low correlation of sagittal plane(p < 0.001). Chest wall motion was different between
0.18 (p = 0.02) between stiffness change and change in Global postures. In mililtary posture there was more lateral movement
Perceived Effect of treatment for all subjects, and a significant of the lower ribcage compared to all other postures(p < 0.002). In
but low correlation between stiffness change and Patient Specific slump posture there was greater upper chest movement in both
Functional Scale change for subjects in the Spinal Manipulative lateral and anteroposterior (AP) planes compared to the neutral
Therapy Group (−0.28; p = 0.02). No significant association was position(p < 0.004), and in full rotation there was decreased upper
observed between initial stiffness score and any of the final outcome ribcage movement in the lateral direction(p < 0.05) and increased
measures following treatment. CONCLUSIONS: Spinal stiffness has AP abdominal movement(p < 0.02) compared to the neutral position.
been considered an important factor in the assessment and treatment CONCLUSIONS: Subtle changes in postural alignment in both
planning of patients with low back pain. Stiffness decreases over the sagittal and transverse planes affect chest wall motion, both
the course of an episode of treatment, more so in those with the during quiet breathing and when respiratory demand is increased.
stiffest spines, but the decrease is not dependent on treatment Further studies are required to determine whether the underlying
and is not generally related to outcome. Measures of stiffness mechanisms are mechanical or muscular, and to determine if these
cannot be used to assess outcomes. IMPLICATIONS: Our results changes in chest wall motion impact distribution of ventilation.
suggest that clinicians might be overestimating the usefulness of the IMPLICATIONS: Physical therapists involved in both clinical as-
information gathered from spinal stiffness assessment. KEYWORDS: sessment and treatment of respiratory function and in respiratory
Low back pain, spinal stiffness, exercise, spinal manipulative therapy. research need to consider that spinal alignment has the potential to
affect diagnostic measures, treatment efficacy, and standardization Organisation for the financial support of this study. We would also like
of research protocols. KEYWORDS: thorax, respiration, chest to thank the Vice-Chancellor for Research Affairs of the Mazandaran
wall motion. FUNDING ACKNOWLEDGEMENTS: Linda-Joy Lee is University of Medical Sciences for his contribution and kind support.
supported by the Canadian Institutes of Health Research (CIHR). CONTACT: [email protected]
Paul Hodges is supported by the National Health and Medical ETHICS COMMITTEE: Medical Ethics Board at the Mazandaran
Research Council of Australia. Michel Coppieters is supported by University of Medical Sciences
the University of Queensland. CONTACT: [email protected]
ETHICS COMMITTEE: Medical Research Ethics Committee of the
University of Queensland
3155 Wednesday 6 June 10:10 VCEC Meeting Rooms 19-20
VCEC Meeting Room 18 PREDICTIVE FACTORS FOR DISABILITY AFTER 1 AND 5 YEAR
THE EFFECT OF AN EXERCISE PROGRAM AND ERGONOMIC IN PATIENTS SEEKING PRIMARY CARE FOR LOW BACK PAIN
ADVICES IN LOW BACK PAIN: A RANDOMISED CLINICAL Enthoven P1 , Skargren E1 , Carstensen J2 , Öberg B1 ; 1 Department
TRIAL IN NURSING POPULATION of Health and Society Phyriotherapy, Linköpings universitet;
2 Department of Health and Society Tema Health and Society,
Mohseni Bandpei M1 , Fakhri M2 , Bagheri Nessami M2 , Ahmad
Shirvani M2 , Khalilian A1 , Shayesteh Azar M1 ; 1 School of Medicine, Linköpings universitet
Mazandaran University of Medical Sciences; 2 School of Nursing
PURPOSE: To assess the independent predictive value of a
and Midwifery, Mazandaran University of Medical Sciences
number of potential predictive factors for disability at the 1-year
PURPOSE: Annually, one third of work related injuries belongs to the and 5-year follow-ups, and to examine whether prediction models
musculoskeletal disorders and low back pain is the most commonly were improved by replacing baseline health-state-related variables
reported injury. There are many therapeutic interventions available with corresponding variables after treatment. A further aim was
in the treatment of low back pain, but the most effective treatment to describe possible differences between those on sick leave,
is yet to be demonstrated. The present study was designed to early retirement or disability pension, and those who were not.
compare the effect of an exercise program and ergonomic advices RELEVANCE: Many patients seeking primary care for low back
in the treatment of chronic low back pain with adequate long term pain continue to report disability several years after their initial
follow up. RELEVANCE: Back injuries are a major category of visit, and about one third of the patients seek care again every
occupational injuries and nursing personnel have a higher prevalence six months. PARTICIPANTS: The study sample comprised 148
and incidence rate of back injuries than most occupational groups participants in a previous randomized trial in primary care who
in the healthcare sector as well as in all industries. This study were eligible for sick leave benefits. METHODS: Prospective cohort
determines how effective exercise programs and ergonomic advices study. Baseline factors for the prediction of future disability were
could be in reducing the impact of low back pain in nursing staff. age, gender, self-reported physical-activity-related and work-related
PARTICIPANTS: 236 registered nurses matched by age, gender factors, expectations of treatment, similar problems previously,
and body mass index were randomly recruited for the purpose of duration of episode, more than one localization, sick leave, pain
this study. METHODS: Following ethical approval, a randomised frequency, disability and well-being. ANALYSIS: Simple and multiple
controlled clinical trial was carried out to assess the effect of an logistic regression analyses were used to identify predictive factors.
exercise program and ergonomic advices in the treatment of low RESULTS: At the 5-year follow-up, 37% (n=19/52) of the patients
back pain. Participants were randomly divided into four groups.
with disability were on sick leave or were receiving early retirement
The first three groups were received different intervention (group
or disability pension. For those without disability the corresponding
1, therapeutic exercise combined with ergonomic advices; group 2,
figure was 9% (n=8/92). Being a woman, duration of the current
therapeutic exercise only; and group 3, ergonomic advices only). The
episode, similar problems during the previous 5 years, exercise level
fourth group was given no intervention. Pain on visual analogue scale
before the current episode, pain frequency at baseline, and disability
and disability on Oswestry low back disability questionnaire were
after treatment emerged as predictive factors for disability at the
measured at 1, 3, 6 and 12 months after intervention. ANALYSIS:
5-year follow-up. Replacing baseline health-state-related measures
Descriptive analysis, a Repeated Measurements test, ANOVA and
with corresponding measures after the treatment period as well as
Dunet test were used to analyze data. RESULTS: Statistical analysis
indicated that there was significant differences on pain and disability adding physical-activity-related and work-related factors improved
measurements in all instances using ANOVA (p < 0.001). A Repeated prediction of future disability. CONCLUSIONS: At the 5-year follow-
Measurements test showed significant improvements in the first three up patients with disability were more often on sick leave or receiving
groups both on pain and disability following intervention (p < 0.01). No early retirement or disability pension than patients without disability.
significant changes were found in the fourth group (control group) Predictive factors for disability after 5 years were partly different
neither on pain nor disability scores at different period of follow from predictive factors for disability after 1 year. Replacing baseline
up. Dunnet test revealed a significant difference between each first health-state-related measures with corresponding measures after the
three group (group 1, 2 and 3) and the fourth group on pain and treatment period, and adding physical-activity-related and possibly
disability (p < 0.001 in both instances). CONCLUSIONS: The results work-related factors might improve the likelihood of predicting future
demonstrate that therapeutic exercise and ergonomic advices could disability. Confidence intervals were wide in several cases, and
be considered as effective approaches in the treatment of low back the results must be interpreted with caution. IMPLICATIONS: Early
pain in nursing population. Therefore, more emphasis should be put identification of factors predicting different health outcome may
on regular exercise and ergonomic advices in nursing population improve treatment management, avoid unnecessary treatments and
in order to prevent and control such a common and costly health improve information to the patients about the course of their condition.
problem. IMPLICATIONS: Exercise program and ergonomic advices KEYWORDS: Low back pain; Prognostic factors, physical activity.
may play an important role to reduce the prevalence and incidence FUNDING ACKNOWLEDGEMENTS: The study was supported
of low back pain in nursing profession. KEYWORDS: Occupational by the County Council of Östergötland and Linköping University,
injury; low back pain; nurses; ergonomic advice; exercise. FUNDING Sweden. CONTACT: [email protected]
ACKNOWLEDGEMENTS: We would like to express our sincere ETHICS COMMITTEE: The research ethic committee at Linköping
appreciation to the Mazandaran Province Management and Planning University, Sweden
Research Report Platform Presentation supported by grants from The Research and Development Unit,
1433 Wednesday 6 June 10:45 Beställare Vård, Stockholm County Council, Sweden. CONTACT:
PP Crystal Pavilion A [email protected]
CATASTROPHIZING, FEAR-AVOIDANCE BELIEFS, PHYSICAL ETHICS COMMITTEE: The Local Ethic’s Committee, The Karolinska
ABILITY AND HEALTH-RELATED QUALITY OF LIFE AMONG Hospital, Solna, Sweden.
WOMEN WITH AND WITHOUT LUMBOPELVIC PAIN IN EARLY
PREGNANCY
Olsson C1,4 , Buer N2 , Holm K3 , Harms-Ringdahl K4 , Nilsson- 1571 Wednesday 6 June 10:45
Wikmar L4 ; 1 Center for Family and Community Medicine (CeFAM), VCEC Ballroom A
Huddinge, Sweden; 2 Department of Health Sciences, Örebro
CLOSED KINETIC CHAIN EXERCISE RESTORES MUSCULO-
University, Örebro, Sweden; 3 Team Aktiv, Hässelby, Stockholm,
SKELETAL REFLEX FUNCTION IN QUADRICEPS FEMORIS IN
Sweden; 4 Department of Neurobiology, Care Sciences and Society,
THE JOINT HYPERMOBILITY SYNDROME
Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
Tennant N1 , Ferrell W2 , Baxendale R3 , Kusel M3 , Sturrock R2 ;
PURPOSE: It seems that there is a relationship between fear- 1 Physiotherapy Department, Royal Infirmary Glasgow, Scotland,
avoidance beliefs and activity level as well as between catastrophiz- UK; 2 Centre for Rheumatic Diseases Royal Infirmary, Glasgow,
ing and pain, and it seems that these relationships play an active Scotland, UK; 3 Institute of Biomedical and Life Sciences, University
role in the transition from acute to chronic pain. About 50% of all of Glasgow, Scotland, UK
pregnant women report lumbopelvic pain which is also the most
common reason for sick leave during pregnancy. Many women state PURPOSE: We previously observed impaired proprioception in
that their back problems started during pregnancy. The purpose of patients with Joint Hypermobility Syndrome (JHS) compared to a
the study was to compare catastrophizing, fear-avoidance beliefs, control group. We then demonstrated that a closed kinetic chain
physical ability and health-related quality of life in pregnant women (CKC) exercise program enhanced knee joint proprioception and
with and without lumbopelvic pain in early pregnancy. RELEVANCE: in addition reduced pain and improved function. Patients with JHS
In order to form effective treatment and prevent future pain and often report instability (’giving way’) at the knee joint. The purpose
disability more knowledge is needed about the significance of of this study was therefore to investigate whether reflex function at
catastrophizing and fear-avoidance beliefs in the development of the knee is impaired in patients with JHS and if so whether this
pregnancy-related lumbopelvic pain. These variables might also be can be improved by exercise. Further to this we investigated the
helpful in the early identification of women at risk of developing consequences of hyperextension of the knee joint on reflex function
chronic problems. Increased knowledge about how women’s lives RELEVANCE: This group of patients have been traditionally difficult
are affected if they suffer from pregnancy-related lumbopelvic pain is to manage responsding poorly to conventional physiotherapy. In
of great importance for the whole society. PARTICIPANTS: Three addition it is crucial for our profession to investigate interventions
hundred and four women in the 19th-21th week of pregnancy, at physiological level thereby providing objective evidence of our
attending five specific midwife receptions filled out questionnaires. efficacy. PARTICIPANTS: Fifteen patients diagnosed with JHS
METHODS: The questionnaires included: general questions about were recruited from the Hypermobility Clinic at Glasgow Royal
background factors, the Pain Catastrophizing Scale (PCS)(0-52) for Infirmary. Diagnosis of JHS was based on the revised Brighton
exaggerated negative thoughts about pain experiences, the Fear- criteria which includes the Beighton scoring system. Eleven healthy
Avoidance Beliefes Questionnaire (FABQ)(0-24) for beliefs about normomobile individuals with no history of joint disease, were
how physical activity affect back pain, the Disability Rating Index recruited from the university student and staff population. METHODS:
(DRI)(0-100) to score the physical ability, and The Nottingham Electromyographic (EMG) recordings were obtained via surface
Health Profile (NHP)(0-100) for assessing health-related quality electrodes from the quadriceps femoris muscle while brief electrical
of life. ANALYSIS: For comparison between the two groups the pulses (1.3 times motor threshold) were applied to the common
Mann-Whitney U-test was used. RESULTS: The 304 women who peroneal nerve. A reflex was considred to have occurred if the
answered the questionnaires were divided into women with (LP; average signal exceeded two standard deviations from the baseline,
n=135) and without (NLP; n=169) lumbopelvic pain. The women with (average of the 30msec period preceeding the elctrical stimulus).
lumbopelvic pain rated significantly (p < 0.05) higher catastrophizing Reflex status was confirmed by repeat testing. An eight week
(PCS; Md, (range) LP 15.0(0-48), NLP 10.0(0-43), higher level of home-based exercise program was delivered via a diary after initial
fear-avoidance beliefs (FABQ; Md, (range) LP 12.0(0-23), NLP 6.0(0- demonstration. Final testing was performed on program completion.
24, lower physical ability (DRI; Md, (range) LP 26.3(0-89.5), NLP ANALYSIS: Data analysis was performed using ANOVA and t-tests
9.6(0-98.4) and lower health-related quality of life (NHP; Md, (range) (Sigmastat, SPSS Inc, USA), all tests being two-tailed with P less
LP 17.4(0-83.3), NLP 3.3(0-73.8), compared to women without than 0.05 being considered significant. RESULTS: Electrical activity
lumbopelvic pain. CONCLUSIONS: Even during early pregnancy consistent with a segmental spinal reflex (~26msec) was present
many women suffer from pregnancy-related lumbopelvic pain and in quadriceps femoris in all normomobile subjects but in only half
it seems that catastrophizing and fear-avoidance beliefs are involved the JHS group, the difference being significant (P < 0.01). Following
in the development of such pain. The women with pregnancy- the exercise program the reflex could be elicited in all patients in
related lumbopelvic pain had more exaggerated negative thoughts whom it was previously absent. Joint position affected the magnitude
about pain experiences and more fear-avoidance beliefs than those of the reflex, diminishing significantly both on flexion (P < 0.05) and
without lumbopelvic pain. They also had a lower physical ability hyperextension (P < 0.03)of the knee. CONCLUSIONS: Musculo-
and a lower health-related quality of life compared to women skeletal reflex function is compromised in some patients with JHS
without lumbopelvic pain. More knowledge should be acquired in but can be restored by an eight week CKC exercise program. This
this area, in early pregnancy and also in other occasions like provides objective evidence of the effect of exercise on physiological
later during pregnancy and after delivery. IMPLICATIONS: To form function. In addition hyperextension of the knee joint apart from
effective treatment strategies for pregnancy-related lumbopelvic pain being biomechanically unsound has adverse neurophysiological
it’s important to consider catastrophizing and fear-avoidance beliefs consequences in terms of facilitation of quadriceps femoris function.
and not only the intensity and duration of pain. The effect pregnancy- IMPLICATIONS: As a significant number of patients with JHS are
related lumbopelvic pain has on womens lives should be taken compromised neurophysiologically and this can be rectified with a
into account by general health care and society whenever there CKC exercise program the management of this patient group has
is a discussions about sick-leave. KEYWORDS: women’s health, been significantly improved. Demonstration of impairment and then
disability, pain,. FUNDING ACKNOWLEDGEMENTS: This study was restoration of function at physiological level is not only exciting but
critical to the standing of our profession in the scientific world. Further Research Report Platform Presentation
research could be directed at investigating the absence of the reflex 599 Wednesday 6 June 10:45
in patients with JHS and the reflex status of other patient populations. VCEC Meeting Rooms 11-12
KEYWORDS: Reflex, Exercise, Joint Hypermobility Syndrome. AEROBIC EXERCISE TRAINING EFFECTS IN AFRICAN
FUNDING ACKNOWLEDGEMENTS: The Arthritis Research Cam- AMERICAN WOMEN WITH BREAST CANCER
paign (ARC). CONTACT: [email protected]
Adams Jr J1 , Kline J1 , Kim S1 , Drouin J1 , Birk T2 ; 1 University
ETHICS COMMITTEE: Glasgow Royal Infirmary Research Ethics
Of Michigan-Flint, United States; 2 Wayne State University-Detroit,
Committee United States
PURPOSE: Early evidence suggests there are physiological and

psychological differences between African Americans (AA) and
Research Report Platform Presentation Caucasians (CC) during and after treatment for breast cancer.
1270 Wednesday 6 June 10:45 Although exercise has been found to promote physiological and
VCEC Meeting Rooms 1-3 psychological factors during breast cancer treatment, no studies
VALIDITY AND RELIABILITY TEST OF OPTOELECTRONIC were found that examined the effects of aerobic exercise training
MOTION ANALYSIS AND ULTRASONOGRAPHY OF CHEST in AA women or that compared training adaptations with Caucasian
WALL MOTION AND DIAPHRAGMATIC EXCURSION women. RELEVANCE: There is limited evidence to support reha-
bilitation practices during treatment for cancer in racial and ethnic
Liing R1 , Lin K1 , Lu T2 , Wang H1 ; 1 School and Graduate Institute of minorities. This study provides physical therapists with evidence on
Physical Therapy, College of Medicine, National Taiwan University,
the efficacy of aerobic exercise training during radiation treatment
Taipei, Taiwan; 2 Institute of Biomedical Engineering, College of
for breast cancer in AA women to enable safe and effective
Medicine, National Taiwan University, Taipei, Taiwan
design of rehabilitation interventions. PARTICIPANTS: Following
PURPOSE: The purposes of this study were to investigate the human subject approvals, 7 AA and 6 CC women were recruited
test-retest reliability and validity of lung volume estimated by chest through oncologists. Participants were between age 35 and 65,
wall motion and diaphragmatic excursion. RELEVANCE: It has scheduled for radiation for breast cancer [stage 0 (Ductal Carcinoma
been suggested that optoelectronic motion analysis system and Insitu) to III), and sedentary for 3 months prior to the study.
ultrasonography (USD) were good evaluation tools to describe the METHODS: Participants performed self monitored walking, 3-5
volume changes of chest wall and diaphragmatic excursion, but days per week, at 50-70% of their measured maximum heart
there is lack of reliability and validity analysis. PARTICIPANTS: rates, during seven weeks of radiation. Pre and post tests were
Seven healthy male subjects (age: 21.43±1.13 yrs; mean body administered one week before and one week following the radiation
height: 180.57±2.64 cm; mean body weight: 69.57±6.92 kg) were regimen. Tests included symptom limited graded exercise testing
recruited in this study. METHODS: All subjects were asked to with oxygen uptake analysis, serum blood draws, Profile of Mood
take deep inspiration and expiration with mouth obtaining lung States, Revised-Piper Fatigue Scales, Kilogram weight, Skin Caliper
volume by spirometry (Microspiro HI-601, Janpan) in sitting position measures, and Body Mass Index. ANALYSIS: Wilcoxon Signed
synchronously. Meanwhile, right diaphragmatic movement was mea- Rank examined pre-post differences and Wilcoxon-Mann-Whitney
sured by USD (Sonosite, USA). Totally, 86 infrared-reflective markers U assessed between group differences (p < 0.05). RESULTS: AA
were applied on subjects’ body surface to acquire volume changes physiologic measures for peak VO2 (p = .001), lactate threshold
of chest wall from optoelectronic motion analysis system (Vicon 250, (p = .014), treadmill time (p = .014) and maximum pulse oxygen
UK). The subjects repeated two trials in one session. ANALYSIS: (p = .014) improved significantly, while resting heart rate (p = .034)
Matlab program7.01 and SPSS13.0 were used for data analysis. increased significantly. All AA anthropometric measures improved
The intraclass correlation coefficient (ICC) was used to evaluate test- significantly (p = .014). Compared to CC participants, AA physiologic
retest reliability. The concurrent validity was estimated by Pearson measures were significantly lower for peak VO2 (p = .037) and
correlation test. The significant level was set at 0.05. RESULTS: The treadmill time (p = .023), and higher for resting heart rate (p = .025),
results showed that the test-retest ICC of diaphragmatic excursion and resting (p = .043) and maximum (p = .013) diastolic pressures.
measurd by USD was 0.99 (p < 0.05), and the test-retest ICC of chest Serum erythrocytes increased non-significantly in both groups, while
wall volume changes measured by optoelectronic motion analysis serum immune measures declined significantly in both groups. Final
system was 0.85 (p < 0.05). The relation between diaphragmatic fatigue (p = .058) and psychological (p = .10) measures were better in
excursion (3.47±0.97 cm) and spirometry (mean lung volume: AA participants however differences were not statistically significant
2.14±0.39 liter) was 0.68 (p < 0.05). The relation between chest between groups. CONCLUSIONS: Results from this study suggest
wall volume changes and spirometry (mean value of maximum lung that AA women experience significant improvements in physiologic
volume: 4.81±0.49 liter) was 0.97 (p < 0.05). CONCLUSIONS: The and anthropometric measures from aerobic exercise training during
results showed high test-retest reliability and moderate to good radiation for breast cancer; however final physiological measures
validity of USD and optoelectronic motion analysis system in healthy for fitness, resting heart rates, diastolic blood pressures, and body
subjects. Therefore, lung volume can be estimated noninvasively composition were poorer than in CC participants. Interestingly,
in healthy subjects, and the application in patients would require although having lower fitness, AA women reported less fatigue and
further study. IMPLICATIONS: It is possible that optoelectronic had higher psychological scores than CC women. IMPLICATIONS:
3-dimensional motion analysis can describe abnormal chest wall This study provides physical therapists with evidence for the efficacy
motion and breathing pattern. Furthermore, USD can be used as the of aerobic exercise training during radiation for breast cancer in AA
screening test of diaphragmatic weakness. KEYWORDS: Optoelec- women. Future study is recommended on whether these changes
tronic motion analysis system, Ultrasonography, Chest wall motion, positively affect physical function, health, and survival rates in AA
Diaphragmatic excursion. FUNDING ACKNOWLEDGEMENTS: This women, as well as reasons for the differences observed between
study was granted by National Science Council, Taiwan (Grant # AA and CC women. KEYWORDS: Breast Cancer; Aerobic Exercise;
NSC94-2314-B-002-075). Thanks to Yu-Kuang Wu, Sheng-Chang African American; Women. FUNDING ACKNOWLEDGEMENTS:
Chen, Ying-Chen Chen, and Chia-Chieh Chang for their assistance. Elsa U Pardee Foundation – Midland, Mi; Max & Victoria Dreyfus
CONTACT: [email protected] Foundation – White Plains, NY. CONTACT: jeromea@umflint.edu
ETHICS COMMITTEE: Department of Medical research, National ETHICS COMMITTEE: Wayne State University and Karmanos
Taiwan University Hospital, Taiwan. Cancer Institute (Both Detroit, MI, United States)
WHOLE BODY VIBRATION EXPOSURE IN ALL TERRAIN AN EXPLORATION OF HOW PHYSIOTHERAPY AFFECTS THE
VEHICLE USE IN NEW ZEALAND AGRICULTURE SOCIAL INCLUSION OF PERSONS WITH RA
Milosavljevic S, Carman A, Pal P; School of Physiotherapy, Areskoug-Josefsson K; Värnamo Sjukhus, 331 85 Värnamo, Sweden
University of Otago, Dunedin, New Zealand
PURPOSE: To explore patients opinions of how physiotherapy affects
PURPOSE: Although New Zealand (NZ) farmers have a high patients with RA from the perspective of the relational model of
incidence of low back pain (LBP) many of these episodes are social theory which considers Body, Work, Citizenship, Identity and
due to unknown causes. Associations have previously been shown Territory to determine if physiotherapy can enhance social inclusion
between LBP and whole-body vibration (WBV) in occupational RELEVANCE: The aim of physiotherapy intervention is to maximise
driving. All Terrain Vehicles (ATVs) are used extensively in rural independence and mobility. An ability to work is a primary concern for
NZ potentially exposing farmers to prolonged periods of WBV. The persons with RA. In order to measure the outcome of physiotherapy
purpose of this study is to measure the vibration exposure of and to evaluate treatment effect it is important to bring forward the
daily rural ATV use and compare to vibration exposure guidelines. view of the patient. PARTICIPANTS: A consecutive selection of 8
RELEVANCE: Evidence for cumulative WBV exposure as a risk persons with a diagnosed RA (ACR criteria) >4 years, who did not
factor for the development of LBP in NZ farmers will allow rural rural have any other chronic illness and who were permanent residents of
heath practitioners, ergonomists, and rural industry groups to inform the same geographical region. Each, during their period of illness,
farmers as to appropriate farming practice to reduce WBV exposure had participated in more than ten physiotherapy treatment sessions.
and reduce the risk of developing occupational LBP. PARTICIPANTS: Each gave written consent to participate in the project. METHODS: A
Following ethical approval from the University of Otago Human Ethics phenomenological qualitative study design was used which facilitated
Committee, 30 experienced male sheep and beef farmers from the data collection to establish views on whether treatment has an
Otago region of New Zealand were recruited. They had a mean age effect on social inclusion. Semi-structured interviews were chosen
of 47 years, a mean height of 1.80 metres, a mean weight of 86.0 kgs to allow the interviewer to probe the experience of the participant.
and a mean 27 years of farming experience. METHODS: To gather They were conversational in style and focused onto the participant’s
vehicle and body vibration data tri-axial gravitational accelerometers experience and views of the effect of physiotherapy. ANALYSIS:
were mounted on a helmet, pelvis, and on the ATV chassis of each Each interview was tape-recorded and transcribed verbatim. The
farmer. For frequencies of interest between 0-100 Hz, accelerometer interviews were analysed within a phenomenological framework
data were recorded at 200Hz, from each participant working on based on the role of physiotherapy concerning social inclusion, the
their farm over the full working day. These data were stored on a categories were sorted into the five dimensions of the relational
data logger mounted to the ATV. A Global Positioning System (GPS) model of social theory. Data were sorted into categories concerning
recorded position and velocity data. ANALYSIS: The Vibration Dose the phenomena of “effect of physiotherapy” and “effect of RA” on
Value (VDV) for each farmer was calculated from all driving episodes social activities. In this process two subgroups of “the role of the
over the working day. To determine the frequency spectrum a Fast physiotherapist” and “physiotherapy in the future” emerged. Each of
Fourier Transform (FFT) was applied to the vibration data from all the four perspectives included the five dimensions of the relational
driving episodes using a 400 sample window, for 12 Hz resolution model: body, work, citizenship, identity, and territory, and were
between 0-100 Hz. For each farmer the maximum amplitude at each integrated into an explanatory model. RESULTS: These participants
discrete frequency across all FFT windows was obtained. Data experiences physiotherapy in group training as giving a positive
were then pooled to obtain average maximum amplitude at each effect on the perspective of citizenship and on identity, particularly
discrete frequency across the 30 farmers. RESULTS: The total after physical training, and increase self esteem. Ability to work
average daily Vibration Dose Value (23.1 m/s1.75) was above the was connected with independence. Physiotherapy played an active
maximum recommended limit of 21 m/s1.75. On average 1 hour and important role in giving self-managing strategies, and providing
of rural ATV use reached VDV limit value. The ATV, pelvis and social contact in training groups. The role of the physiotherapist was
helmet experienced substantial vibrations at the lower frequencies seen to be a motivator of physical activity and self-management
(2-20 Hz). These included the adverse resonant frequencies of the strategies. CONCLUSIONS: Informants experienced physiotherapy
spine (2–12Hz), with dominant axes being the vertical and anterior in a body perspective with effects on participation in their environment
directions. Little ATV vibration above 35 Hz was transmitted to the and their work. Physiotherapy can lead to increased quality of life
pelvis or helmet. CONCLUSIONS: Daily ATV use by NZ farmers through increased body function which might increase ability to
exposes them to cumulative vibration in excess of recommended work. IMPLICATIONS: The findings from this study could be of
limits. Exposure to such vibration provides a plausible explanation for interest to other EU states since the participants of this study are
the high incidence of LBP in New Zealand farmers. IMPLICATIONS: similar (concerning gender, age, sick leave from work, and duration
The results indicate a need for change in ATV use and design to of illness) An increased knowledge of how the persons with RA
reduce the exposure to such adverse vibrations. Such information experience the effect of physiotherapy is of interest concerning
will be invaluable for those health professionals who work and development of physiotherapy treatment strategies. KEYWORDS:
advise in the rural occupational health sector. KEYWORDS: Low Social inclusion. FUNDING ACKNOWLEDGEMENTS: This project
back Pain, Vibration, Farming. FUNDING ACKNOWLEDGEMENTS: achieved financial support from the regional organisation for persons
University of Otago Research Grants (UORG) 2005. CONTACT: with Rheumatoid Arthritis and from Futurum, Academy of Health,
[email protected] County of Jönköping, Sweden. CONTACT: [email protected]
ETHICS COMMITTEE: University of Otago Human Ethics Committee ETHICS COMMITTEE: Ethical inspection by the standards of the
local county (Jönköpings läns landsting; Sweden) and the University
of Karlstad, Sweden.
Research Report Platform Presentation Physical Education and Physiotherapy – Vrije Universiteit Brussel
1373 Wednesday 6 June 10:45 (VUB), Brussels, Belgium (OZR project OZ.R. 1234/MFYS Wer2).
VCEC Meeting Room 18 CONTACT: [email protected]
PSYCHOLOGICAL DETERMINANTS OF CHRONIC ETHICS COMMITTEE: Committee Medical Ethics Academic Hospital
MUSCULOSKELETAL PAIN AND DAILY FUNCTIONING IN Vrije Universiteit Brussel, Brussels, Belgium
CHRONIC FATIGUE SYNDROME
Meeus M1,2 , Nijs J1,2 , Van Mol E1 , Truijen S1 , De Meirleir K2 ;
1 1. Division of Musculoskeletal Physiotherapy – Department of Research Report Platform Presentation
Health Care Sciences – University College Antwerp (HA), Antwerp, 783 Wednesday 6 June 10:45
Belgium; 2 2. Department of Human Physiology – Faculty of VCEC Meeting Rooms 19-20
Physical Education and Physiotherapy – Vrije Universiteit Brussel IS ELECTRO-ACUPUNCTURE A USEFUL ADJUNCT IN THE
(VUB), Brussels, Belgium TREATMENT OF LEG ULCERS? A PILOT STUDY
PURPOSE: The present study aims at examining the role of Tebbutt E; Coventry University, Coventry, United Kingdom
catastrophising, coping, kinesiophobia and depression in chronic,
widespread, musculoskeletal pain complaints and daily functioning PURPOSE: To investigate the effects of electro-acupuncture, applied
in patients with Chronic Fatigue Syndrome (CFS) having chronic, to the upper limb, on leg ulcers, specifically in relation to pain, mobility
widespread musculoskeletal pain. RELEVANCE: In addition to the and healing. RELEVANCE: Within the UK, prevalence of leg ulcers
debilitating fatigue, the majority of patients with CFS experience in over 65’s is 3-5% and costs the national health service between
chronic widespread pain, in particular myalgias and arthralgias. £300 and £600 million/year. Leg ulcers are of direct relevance to
This chronic pain contributes to self-reported activity limitations physiotherapists who treat elderly people as they have a significant
and participation restrictions. Despite the clinical relevance of this impact on mobility (due to pain). Some research suggests that
complaint, studies regarding chronic pain in CFS are scarce. electro-acupuncture at remote sites may be of benefit to ulcer healing,
However, evidence for the role of kinesiophobia, depression, pain and mobility but it is of poor quality and more research is
catastrophising and copings strategies in maintaining the chronic pain warranted. PARTICIPANTS: 6 participants were recruited from a leg
complaints has been supported in patients with fibromyalgia (FM), ulcer clinic and elderly rehabilitation wards within South Birmingham
chronic low back pain, and other disorders associated with chronic primary care trust. They were aged between 65 and 87, with venous
musculoskeletal pain. PARTICIPANTS: One hundred and three CFS or mixed venous/arterial leg ulcers. During a 4 month period, all
patients with musculoskeletal pain participated in the study. They patients with a leg ulcer and who could give informed consent were
were selected following several criteria: all subjects fulfilled the approached. Patients were excluded if: A) any contra-indications for
1994 Centre for Disease Control and Prevention (CDCP) criteria for electro-acupuncture were present B) they were receiving concurrent
CFS, all patients experienced chronic widespread pain, as defined treatment that would affect healing. METHODS: Patients received 10
by the American College of Rheumatology and finally all study electro-acupuncture treatments over a 5 week period. Treatment was
participants had Dutch as their native language, and were within the standardised and 8 needles were inserted into acupoints on the hand
age range of 18 to 65 years. METHODS: The participants completed and forearm (LI4, LI11, SJ5, SI3). Outcome measurements were
a battery of standardized and valid questionnaires evaluating pain, taken pre-treatment, post-treatment and 3 months after treatment.
daily functioning and psychological characteristics, such as the The researcher carried out the acupuncture and other therapists
degree of depression, kinesiophobia, pain coping style, and pain completed the outcome measurements. The faces pain scale was
catastrophising. ANALYSIS: In order to examine the associations used to measure pain and patients’ subjective reporting was also
between pain and daily functioning on the one hand and cognitive and documented. The 10 metre timed walk and elderly mobility scale were
behavioural aspects on the other hand, Pearson correlation analyses used to measure mobility. Ulcer area was calculated using tracings
were used. For interpreting correlation coefficients and defining and qualitative information regarding the wound was also collected.
predictors for pain and functioning, multiple regression analysis was ANALYSIS: Descriptive statistics were analysed individually and as
performed. RESULTS: The strongest correlations with pain intensity a group, using timeline graphs for visual analysis. Qualitative data
and daily functioning were found for catastrophising (respectively r=- was analysed individually, as a group and in relation to quantitative
.462 and r=.435; p < 0.001) and depression (respectively r= -.439 results. RESULTS: 5 patients’ ulcers were smaller post-treatment
and r=.481; p < 0.001). The stepwise multiple regression analysis (between 20-40%) and 1 patient’s ulcer could not be measured due
revealed that catastrophising was the main predictor for pain (20.2%) to diffuse spread. At 3 month follow-up, 1 ulcer was fully healed, 1
and depression for daily functioning (23.2%). Kinesiophobia and had continued to improve, 2 had partially regressed and 1 patient was
the coping styles “resting” and “worrying” were also significantly not available. A ceiling effect was observed for the mobility scales.
related to pain intensity and daily functioning. CONCLUSIONS: Pain Patients reported subjective improvements in mobility. Faces pain
catastrophising and depression were associated with pain intensity scale scores were unreliable as they did not correlate with subjective
and the associated functional disabilities. Kinesiophobia and several pain reporting. No adverse effects were observed. CONCLUSIONS:
passive coping styles were even so related to pain and functioning, The study was successful as a pilot as flaws and essential
but catastrophising and depression were the main predictors for pain elements on which to base future research design were identified.
and functioning in patients with CFS having chronic widespread A randomised controlled trial is recommended in order to determine
musculoskeletal pain. IMPLICATIONS: These findings give new whether improvements observed were due to acupuncture or other
insights in the history of chronic pain in CFS. It is shown that there is factors. IMPLICATIONS: electro-acupuncture is a safe, minimally
a relation between pain and these psychosocial factors. Although invasive treatment and could have a useful role in the treatment of
the direction of this relationship remains unclear, it is important leg ulcers, particularly when applied to acupuncture points outside
to be aware of the association. Physical therapists, together with the area of compromised skin. Many lessons were learned that
other health care providers, may be able to influence psychosocial can be shared with other novice researchers, notably in relation
factors and in consequence eventually pain. But this last hypothesis to recruitment and selection of outcome measures. KEYWORDS:
needs to be investigated in further research projects. KEYWORDS: Electro-acupuncture; Leg Ulcers; Outcome Measures. FUNDING
Catastrophising, coping, kinesiophobia, depression, daily functioning, ACKNOWLEDGEMENTS: West Midlands Workforce Development
fibromyalgia. FUNDING ACKNOWLEDGEMENTS: Mira Meeus is Confederation; Chartered Society of Physiotherapy Charitable Trust.
financially supported by a PhD grant supplied by the Higher Institute CONTACT: [email protected]
of Physiotherapy, Department of Health Sciences, University College ETHICS COMMITTEE: Local Research and Ethics Committee
Antwerp, Antwerp, Belgium (G 807) and co-financed by Faculty of (LREC)
Research Report Platform Presentation KEYWORDS: Lumbopelvic pain, pregnancy, prevention. FUNDING
2006 Wednesday 6 June 11:05 ACKNOWLEDGEMENTS: The Norwegian Fund for Postgraduate
PP Crystal Pavilion A Training in Physiotherapy and Norwegian Women’s Public Health
DOES GROUP TRAINING DURING PREGNANCY PREVENT Association. CONTACT: [email protected]
LUMBOPELVIC PAIN? ETHICS COMMITTEE: The Regional Committee for Research Ethics
in Sør-Trøndelag,Norway
Mørkved S1,2,5 , Salvesen K3,5 , Schei B2,3 , Lydersen S4 , Bø K6 ;
1 Clinical Service, St.Olavs Hospital, Trondheim, Norway;
2 Department of Community Medicine and General Practice, Research Report Platform Presentation
Norwegian University of Science and Technology, Trondheim, 2175 Wednesday 6 June 11:05
Norway; 3 Department of Obstetrics and Gynaecology, Norwegian VCEC Ballroom A
University of Science and Technology, Trondheim, Norway; 4 Unit CHANGES IN LOWER EXTREMITY MOVEMENT PATTERNS ARE
for Applied Clinical Research, Department and Cancer Research ACCOMPANIED BY MOTOR CORTEX NEUROPLASTICITY: A
and Molecular Medicine, Norwegian University of Science CASE REPORT
and Technology, Trondheim, Norway; 5 National Center for Fetal Powers C, Fisher B, Lin J, Kantak S, Tan C, Pollard C, Sigward S;
Medicine, St.Olavs Hospital, Trondheim, Norway; 6 Department of Division of Biokinesiolgy & Physical Therapy, University of Southern
Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway California, Los Angeles, CA, USA
PURPOSE: Prevention of lumbopelvic pain in pregnancy has been PURPOSE: There is increasing evidence suggesting that changes in
sparsely studied. One aim of this study was to assess if a 12 primary motor cortex (M1) play an important role in skill acquisition.
week training program during pregnancy can prevent and/or treat Although M1 changes have been documented in relation to upper
lumbopelvic pain. RELEVANCE: A high percentage of women suffer extremity motor learning tasks, there is little evidence demonstrating
from low back and pelvic girdle pain (lumbopelvic pain) during M1 changes in response to lower extremity skill acquisition. The
pregnancy and after delivery. The average prevalence from different purpose of this case report was to determine whether an intensive
studies of lumbopelvic pain in pregnancy is 45%, and of all women three-week training program aimed at improving lower extremity
postpartum 25%. The condition may influence daily activities, cause kinematics and kinetics would result in changes in M1 excitability as
withdrawal from social situations and physical activities and lead measured by transcranial magnetic stimulation (TMS). RELEVANCE:
to reduced quality of life. Lumbopelvic pain is the most common Lower extremity training programs are gaining popularity as a means
reason for sick leave during pregnancy in the Scandinavian countries. to reduce knee injuries, particularly anterior cruciate ligament tears.
PARTICIPANTS: 301 healthy nulliparous women were included at Whether or not observed changes in behavior following such training
20 weeks of pregnancy, and randomly allocated to a training group programs are accompanied by central nervous system changes
(148) or a control group (153). Exclusion criteria were pregnancy has not been examined. PARTICIPANTS: A 28 year old female
complications,or diseases that could interfere with participation. with no history of lower extremity injury. METHODS: The subject
METHODS: A randomised controlled trial was conducted at Trond- underwent two phases of data collection: 1) TMS assessment to
heim University Hospital and three outpatient physiotherapy clinics. map the representative area of the contralateral vastus lateralis
The outcome measures were self reported symptoms of lumbopelvic (VL) in M1, and 2) biomechanical evaluation of the lower extremity
pain (once per week or more), sick leave and functional status while performing a drop-jump task. First, the optimal spot over
(Disability Rating Index). Pain drawing was used to document the the M1 to elicit motor evoked potentials (MEP) in the VL was
painful area of the body. The intervention included daily pelvic determined. Motor threshold (MT) was defined as the minimal
floor muscle training at home, and weekly group training in 12 intensity of stimulation capable of inducing MEPs of >50 mV. The
weeks including aerobic exercises, pelvic floor muscle and additional TMS coil was moved on the scalp in 1 cm increments to identify
exercises, and information related to pregnancy. ANALYSIS: The all positions that produced VL MEPs. Five TMS pulses with an
main analysis was by intention to treat. Risk differences were intensity 10% above MT were applied at each position. MEPs
analysed by Pearson’s chi squared test, and by computing 95% were recorded with surface electrodes from the VL. Lower extremity
confidence intervals. Possible influences of covariates (age, BMI, kinematics (8 camera Vicon motion system; 250 Hz) and kinetics
leisure time physical activity and pelvic floor muscle strength) on (2 AMTI force platforms; 1,500 Hz) were measured as the subject
risk differences was explored using logistic regression. Students performed a series of 3 drop-jump maneuvers from an 18 inch
t-test was used to compare distributions between groups. In an box. Following the initial TMS and biomechanical evaluations, the
exploratory analysis of a possible association between pelvic floor subject underwent a 3 week plyometric training program designed to
muscle strength and lumbopelvic pain, we grouped women according improve sagittal plane deceleration and prevent knee valgus forces.
to self reports of pain instead of the randomised groups. Two- The subject trained a ANALYSIS: Pre-post training changes in the
sided P-values <0.05 were considered significant. RESULTS: At 36 size of the cortical motor output map was defined as the number
weeks of gestation women in the training group were significantly of positions whose stimulation evoked MEPs >50 mV. Changes in
less likely to report lumbopelvic pain: 65/148 (44%) versus 86/153 knee flexion and knee valgus moment were compared pre and
(56%) (p = 0.03). Three months after delivery the difference was post training. RESULTS: Following the training program, the subject
39/148 (26%) in the training group versus 56/153 (37%) in the demonstrated a 40% increase in knee flexion (75º vs. 105º) and
control group (p = 0.06). There was no difference in sick leave during a 40% reduction in the knee valgus moment (0.5 vs. 0.8 Nm/kg-
pregnancy, but women in the training group had significantly (p = 0.01) bwt). The M1 representation of VL was significantly smaller post
higher score on functional status. Analyses of Numbers Needed training. In addition, the number of active scalp positions was
to Treat (NNT) demonstrated that this specific training program decreased when compared to baseline. CONCLUSIONS: Behavioral
prevented lumbopelvic pain in about one in 8.1 women during changes in lower extremity kinematics and kinetics following an
pregnancy, and one in 9.8 women after delivery. There was no intensive lower extremity training program were accompanied by
association between mean pelvic floor muscle strength at 36 weeks of decreased M1 excitability. IMPLICATIONS: Our findings suggest that
pregnancy and 3 months after delivery, or changes in strength, and improved performance in functional tasks following training can be
lumbopelvic pain CONCLUSIONS: A 12 week specially designed accomplished with less voluntary effort which is consistent with the
training program during pregnancy was effective in preventing basic principles of skill acquisition and motor learning. KEYWORDS:
lumbopelvic pain in pregnancy. IMPLICATIONS: Physiotherapists Lower extremity, biomechanics, neuroplasticity, transcranial magnetic
should engage in pre- and postnatal care. However, it is essential stimulation. FUNDING ACKNOWLEDGEMENTS: None.
that future service for women during pregnancy is organised – as ETHICS COMMITTEE: Institutional review board, University of
far as possible – according to results from controlled clinical trials. southern california
Research Report Platform Presentation this research was provided by the Ontario Lung Association and the
1388 Wednesday 6 June 11:05 Canadian Lung Association. CONTACT: [email protected]
EFFECT OF COMBINED INSPIRATORY MUSCLE TRAINING AND
EXERCISE COMPARED WITH EXERCISE ALONE FOR INDIVID-
UALS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE 768 Wednesday 6 June 11:05
O’Brien K1 , Geddes L2 , Reid D3 , Brooks D1 , Crowe J2 ;
1 Department of Physical Therapy, University of Toronto, Toronto, IMPACT OF LYMPHOEDEMA ON ARM FUNCTION AND
HEALTH-RELATED QUALITY OF LIFE IN WOMEN FOLLOWING
ON, Canada; 2 Department of Rehabilitation Science, McMaster
BREAST CANCER SURGERY
University, Hamilton, ON, Canada; 3 School of Rehabilitation
Sciences, Division of Physical Therapy, University of British Dawes D1 , Latella J2 , Meterissian S2 , Goldberg M1 , Mayo N1 ;
1 McGill University, Montreal, Canada; 2 McGill University Health
Columbia, Vancouver, BC, Canada
Centre, Montreal, Canada
PURPOSE: To determine the effect of combined inspiratory muscle
training (IMT) and exercise compared with exercise alone for indi- PURPOSE: To estimate the extent to which the impairments
viduals with stable chronic obstructive pulmonary disease (COPD). associated with lymphoedema are linked to arm dysfunction and
RELEVANCE: IMT can reduce dyspnea and improve exercise sub-optimal health related quality of life. RELEVANCE: Breast
tolerance; however, the literature has provided conflicting results, cancer is the most commonly diagnosed malignancy among
and the effect of co-interventions with IMT are largely unknown. Canadian women with over 18,800 new cases per year. Post-
PARTICIPANTS: Adults (18 years) living with COPD. METHODS: surgical lymphoedema has impact on physical function, psychological
We conducted an update to a systematic review on IMT and COPD distress and health-related quality of life (HRQL). PARTICIPANTS:
up to December 2005 according to Cochrane Collaboration protocol. Women surgically treated for stage I or II breast cancer at the
Inclusion criteria included randomized controlled trials, published in McGill University Health Centre from January 1992 to January 2002.
English comparing IMT or combined IMT and exercise/pulmonary METHODS: A cross-sectional study within the context of a pilot
rehabilitation with other rehabilitation interventions among individuals study. Phase 1: postal survey including a series of questions on
with stable COPD. Abstracts were reviewed independently by two the presence of signs and symptoms of lymphoedema. Phase 2:
investigators to determine study eligibility. Data were abstracted Women who responded positively to any one of these questions
from studies that met inclusion criteria using standardized data had a comprehensive assessment. Measures used: Tonometer,
abstraction forms. Methodological quality of included studies was water displacement, lymphometer, spring-loaded tape, McGill pain
assessed. ANALYSIS: Meta-analyses using random effects models questionnaire, Box & Block, Nine-hole Peg, TEMPA, JAMAR,
wherever possible, were performed using RevMan computer soft- Disabilities of Arm Shoulder & Hand Questionnaire (DASH), SF36 &
ware. RESULTS: Two new studies met the inclusion criteria and EORTC. ANALYSIS: Descriptive statistics were calculated on all
were included with the 16 studies in the original review. One study variables and bi-variate associations were calculated between pairs
compared combined IMT and pulmonary rehabilitation with education of variables. A separate regression model was developed for each
alone. The other study compared combined IMT plus exercise with outcome. Path analysis was completed using a medical model.
exercise alone. Eight new meta-analyses were performed with the RESULTS: Women with self reported symptoms of lymphoedema
latter new study and two originally included studies. Meta-analyses (72 of 204 respondents) had a significantly higher score on the
compared targeted/threshold IMT and exercise combined to exercise DASH questionnaire (mean difference = 23.4, 95% CI 19.3 to
alone for outcomes of inspiratory muscle strength (maximum inspi- 27.5) indicating activity limitation and participation restriction. As
ratory pressure), inspiratory muscle endurance (minute ventilation), the number of positive screening items increased so did the arm
exercise capacity/performance (maximum oxygen consumption, work volume with an estimated effect of 66 ml. (p < 0.0001), per additional
rate maximum, heart rate maximum, and maximum tidal volume) and positive item. Pain was consistently related to disability as measured
quality of life (dyspnea and fatigue scales of the Chronic Respiratory by the DASH and HRQL (SF-36, EORTC) but not volume. Path
Questionnaire (CRQ)). Results showed significant improvements in analysis provided a close description (Chi-squared probability=0.22,
maximum inspiratory pressure of 8.60 cmH2 O and maximum tidal CFI=0.98) of the relationships between the variables being studied.
volume of 0.14 L favouring combined IMT and exercise compared No relationship was found between volume increase and disability,
with exercise alone. In contrast, significant greater improvements in but there is a strong correlation between the number of symptoms
the CRQ Dyspnea Scale of 1.94 points were found favoring exercise of lymphoedema experienced and the volume difference between
alone compared with combined IMT and exercise. CONCLUSIONS: arms (for every additional symptom an increase of 132 ml of
Performing a combination of targeted/threshold IMT plus exercise water). There is no significant relationship between the number of
at least 3X/wk for 8 weeks may lead to significant improvements symptoms experienced and level of disability. Pain is related to
in inspiratory muscle strength and endurance for individuals with disability (for an increase of one unit in McGill pain score there is
COPD. These results should be interpreted cautiously due to a an increase in the DASH score of 0.73), and the level of disability,
small number of trials (n=3) and a maximum of 99 participants as measured by the DASH questionnaire is significantly related to
in the meta-analyses. Findings are limited to those participants health related quality of life (SF36). CONCLUSIONS: The use of
who continued to carry out the IMT and exercise interventions. measurements of pain, activity limitation, participation restriction and
In conclusion, combined IMT and exercise might be beneficial health related quality of life may be more meaningful than volume
for adults living with COPD. Results pertaining to quality of life measurements alone with this group of women. Further research
outcomes, including dyspnea are less clear. IMPLICATIONS: Results needs to be done with a sufficiently large sample size to fully
suggest that combining IMT with other exercise interventions may be understand the role of pain and lymphoedema. IMPLICATIONS: For
beneficial for increasing inspiratory muscle strength and endurance the majority of women, treatment should be aimed at decreasing pain,
outcomes for individuals with COPD. Further trials are required to activity limitations and participation restrictions. Success of physio-
investigate the effect of IMT or combined IMT plus other rehabilitation therapeutic treatment should be measured by a woman’s ability to
interventions compared to other rehabilitation interventions without participate in activities of daily life rather than by reduction in volume
IMT for outcomes of exercise capacity/tolerance, dyspnea and alone. KEYWORDS: Lymphoedema, Breast cancer, Measurement.
quality of life. Further research also is needed to determine the FUNDING ACKNOWLEDGEMENTS: McGill University Health Re-
optimal IMT frequency, intensity, and time to maximize outcomes search Institute. CONTACT: [email protected]
for individuals with COPD. KEYWORDS: inspiratory muscle training, ETHICS COMMITTEE: Research Ethics Board, Surgery, of the
exercise, COPD. FUNDING ACKNOWLEDGEMENTS: Funding for McGill University Health Centre.
PARENTING WITH A DISABILITY PHYSIOTHERAPY AND ALTERNATIVE THERAPY: THE SEARCH
Cooper N1,2 , Yoshida K1,2 ; 1 Graduate Department of Rehabilitation FOR PAIN RELIEF IN PEOPLE WITH CHRONIC FATIGUE
Science, University of Toronto, Toronto, Canada; 2 Department SYNDROME (CFS) / MYALGIC ENCEPHALOMYELITIS (ME)
of Physical Therapy, University of Toronto, Toronto, Canada Marshall R, Paul L, Wood L; Glasgow Caledonian University,
Glasgow, Scotland
PURPOSE: The objective of this project was to describe the
prevalence, frequencies and significant relationships associated PURPOSE: It is widely accepted that pain and fatigue are the two
with the parenting phenomena in a large sample of women with most common symptoms in CFS/ME, but there have been few studies
various physical health conditions in Canada. RELEVANCE: Women investigating chronic pain in this condition. Treatment for pain in
living with physical disabilities often face a difficult time fitting into CFS/ME relies heavily upon pharmacological intervention and many
an ablest society, especially within the roles of motherhood and people have experienced serious side affects from taking medication.
parenting. Qualitative studies and narratives report that they may Therefore, the aim of this study was to investigate the therapies
also experience the additional challenges of receiving appropriate people have tried to ease painful CFS/ME symptoms. RELEVANCE:
health care during this time. Physical therapists, working with women No previous research has explored the variety of therapies that
living with physical disabilities, are in the ideal position to help people with CFS/ME have experienced. This study could provide
connect these women with the various resources they may require. valuable knowledge about treatments that could help relieve pain
PARTICIPANTS: A convenience sample of women was utilized. and suggestions for future Physiotherapy research. PARTICIPANTS:
Participants were at least 18 years of age and older, living with a There were 42 people recruited to this study, including seven people
physical or sensory disability and resided in Canada. Those with who were severely affected and were either housebound or bed
only one health condition who were parenting were selected for bound. The mean age of participants was 47.8 (±9.8) years old.
analysis, resulting in 143 participants. Of the 143 parents, 36% The duration of illness ranged from 14 months to 26 years and
reported a neurological condition, 36% a sensory impairment, 22% three months. Participants were recruited via local CFS/ME support
indicated a musculoskeletal condition, with the remaining indicating a groups and CFS/ME charities. All recruits successfully passed a
cardio-respiratory, gastro-intestinal, environmental or another health diagnostic screening questionnaire that was based on the CDC
condition. METHODS: A self-completed mailed survey was used to criteria (Fukuda, 1994) and the Canadian Guidelines (Carruthers et
gather information from the participants related to general health, al, 2003). METHODS: This study was of a descriptive, cross-sectional
disability and parenting. ANALYSIS: Descriptive statistics were used design. All participants were required to complete a structured
to characterize the sample. Bi-variate analysis was run between subjective interview. Accounts of all previous treatments and the
the independent and dependent variables for parenting for each effects it had upon participants painful CFS/ME symptoms were
of the parenting dependent variables. All relevant variables were documented. ANALYSIS: The data collected from the interviews was
examined for collinearity after bi-variate analyses and prior to coded and entered in to SPSS 14.0 for analysis. Descriptive statistics
multivariate analyses. Logistic regressions were used to determine were incorporated to explore pain characteristics. RESULTS: 40.5%
the proportional odds of having negative parenting experiences. of participants had received physiotherapy treatment for pain
RESULTS: Looking at the ability to care for children without caused by CFS/ME. The treatments and benefits varied; 14.8%
assistance from another individual; those who utilized personal of participants were given graded exercise by Physiotherapists,
assistance (OR=0.21±0.16, ø 0.05) or those with a musculoskeletal all experienced exacerbation of their symptoms. However, 11.1%
health condition (OR=0.23±0.16, ø 0.05), were more likely to of participants were treated with neck and gentle exercises with
require assistance in caring for their children. Conversely those with positive results. At the time of the interview 14 participants were
household sizes of three or more (OR=5.87±4.19, ø 0.05) were currently receiving treatment, four were having acupuncture, and
less likely to need assistance with care. When examining if the only one person was receiving physiotherapy. Nineteen variations
women were worried about dying or becoming too disabled to care of alternative treatment have been sampled by participants, e.g,
for their children, those with an activity limitation were six times reflexology, reiki, massage; The most popular and beneficial was
more likely to worry (OR=6.0±5.11, ø 0.05) than those without a acupuncture (18.8%). CONCLUSIONS: The results of this study
limitation in their activity. Lastly, when questioned about the ability suggest some physiotherapy and alternative therapy treatments
to find assistive devices, those without pain were more likely to may help people manage painful symptoms. Furthermore, additional
be able to find the assistive devices they required (OR=0.09±0.08, information from the interview could help towards developing a pain
ø 0.05) than those who usually experienced pain. CONCLUSIONS: management programme. This research has emphasized that there
Among these women parenting with a disability, those with activity is a poor evidence base and almost no research on the effectiveness
limitations required more assistance and had greater worries about of alternative therapies in CFS/ME. IMPLICATIONS: The implications
being able to care for their children in the future. In addition the of this research suggest that physiotherapy is ideally positioned to
presence of pain made it more difficult to find the necessary assistive offer an evidence based service to people suffering with CFS/ME.
devices that were required during parenting. IMPLICATIONS: The Numerous Physiotherapists are also licensed to practice alternative
relationship between pain and finding devices needed for parenting therapies; this would not only reduce the risk of people with CFS/ME
is one that physical therapists are ideally situated to influence; being exposed to unregistered therapists, but also the financial
through treatments to reduce pain, and by assisting women parenting burden of paying for treatments. KEYWORDS: CFS/ME, Treatment,
with disabilities find the assistive devices they require. Further Pain. FUNDING ACKNOWLEDGEMENTS: The funding for this
research is required to better understand the issues faced by research was jointly provided by Glasgow Caledonian University and
women living with physical disabilities who are parenting within the ME Research UK. CONTACT: [email protected]
areas examined above. KEYWORDS: women, disability, parenting. ETHICS COMMITTEE: The ethics committee from the School of
FUNDING ACKNOWLEDGEMENTS: University of Toronto Open Health and Social Care at Glasgow Caledonian University approved
Fellowship. CONTACT: [email protected] this research.
ETHICS COMMITTEE: University of Toronto, Health Science II
Research Ethics Board
Research Report Platform Presentation Telephone Helpline. The purpose of the helpline is to disseminate
1272 Wednesday 6 June 11:05 general exercise and pregnancy guidelines to pregnant and pre-
VCEC Meeting Rooms 19-20 pregnant women who call requesting information. RELEVANCE:
EFFECT OF ACU-TENS ON FORCED EXPIRATORY FLOW RATE This evaluation of an innovative care delivery model will result in
AND DYSPNOEA IN PATIENTS WITH COPD enhanced quality of care. The unique needs of pregnant women
are addressed by this telephone helpline service that empowers
Jones A1 , Lau K2 ; 1 Department of Rehabilitation Sciences, The
women to lead an active lifestyle during pregnancy. PARTICIPANTS:
Hong Kong Polytechnic University, Hong Kong; 2 Department of
Pregnant and pre-pregnant women who had questions related to
Physiotherapy, Kowloon Hospital, Hong Kong
exercise during pregnancy were the target population for this study.
PURPOSE: Traditional acupuncture has been used for thousands This included those who were regular exercisers prior to pregnancy
of years in China and international interest in unlocking its secrets and those who wanted to begin an exercise routine at the time of
continues. Reports of the efficacy of acupuncture in the management pregnancy. METHODS: Twelve consecutive, English speaking callers
of breathlessness in patients with Chronic Obstructive Pulmonary to the helpline who agreed to participate in the study were sent
Disease (COPD) have aroused controversy. Manual acupuncture a survey one month following the initial phone call and exercise
is invasive and carries risks. Transcutaneous Electrical Nerve prescription. The survey asked about the perceived usefulness
Stimulation (TENS), a non-invasive modality, is widely used for pain of written materials, the verbal information and the in-person
relief in both acute and chronic conditions. It is hypothesized that consultation (if performed) via rating scales. An overall review of
application of TENS over specific acupuncture points (Acu-TENS) the helpline was surveyed with rating scales. ANALYSIS: Descriptive
associated with the respiratory system will elicit similar respiratory statistics were calculated to describe the baseline characteristics of
responses to manual or electro-acupuncture. The effect of Acu-TENS the study population. Frequencies and percentages were calculated
on respiratory responses has not been reported. This study aimed for the quantitative survey data. RESULTS: The average age of
to investigate the effect of Acu-TENS on forced expiratory flow rate women calling the helpline was 33±3.87 years. The average length
in 1 second (FEV1) and on the sensation of dyspnoea in patients of pregnancy at the time of the call was 4.3±2.9 weeks, with 3
with COPD. RELEVANCE: Unwanted effects of medication have callers phoning pre-pregnancy. 67% of callers had not received
encouraged alternative approaches to management of patients with any advice regarding exercise and pregnancy prior to calling the
chronic illness. Identification of non-invasive treatment interventions helpline. 83% of callers believed their knowledge had improved
which assist management of breathlessness is one important role by phoning the telephone helpline. 100% of the callers found the
of a respiratory physical therapist. PARTICIPANTS: Patients aged information provided was useful (75% very useful, 25% somewhat
60 yrs or over with a medical diagnosis of COPD and members useful). 75% strongly agreed with statement that the information
of elderly community centres within one geographic district were was easy to understand and that they were given clear directives.
invited to participate in the study. Forty-six patients (mean age 75 67% thought the information given was specific to their situation.
±6.9 yrs) were recruited. METHODS: TENS was randomly applied, Overall 75% of callers were very satisfied with the service and
to 23 of the 46 patients, for 45 minutes, bilaterally, to the acupoint 100% would recommend the service to others. CONCLUSIONS:
Ex-14 (Ding Chuan) (0.5 cun lateral to the spinous process of C7) The results reflect that callers perceived the information provided
(1 cun= distance between the medial ends of the creases of the through the Exercise and Pregnancy Helpline is relevant although it
interphalangeal joints of the individual’s middle finger). The other did not always fulfill the role of addressing caller’s specific situations.
23 patients had electrodes attached to similar sites but received no IMPLICATIONS: Callers to the helpline were satisfied with this model
output from the TENS machine, although the output light flashed of service delivery. The Exercise and Pregnancy Telephone Helpline
(placebo-TENS group). ANALYSIS: FEV1 and subjective sensation provides an alternative mode of education dissemination that allows
of breathlessness measured by a visual analogue scale (VAS), for global service delivery to a target population. This is relevant as
before and after TENS intervention, were compared using paired- it brings clinical expertise to outreach communities in a cost effective
t-test analysis. RESULTS: FEV1 increased by 12% after TENS in manner. KEYWORDS: exercise and pregnancy, service delivery,
the Acu-TENS group (p < 0.005). There was about 1% increase in women’s health. FUNDING ACKNOWLEDGEMENTS: Sunnybrook
FEV1 in the placebo-TENS group after intervention but the result and Women’s College Health Sciences Centre, Practice-based
was not significant (p = 0.81). Similarly, dyspnoea score improved Research Grant. CONTACT: [email protected]
by 17% in the Acu-TENS group (p < 0.005) and 3.7% (p = 0.08) ETHICS COMMITTEE: Sunnybrook & Women’s College Health
in the placebo-TENS group. CONCLUSIONS: Acu-TENS applied Sciences Centre Research Ethics Board
for 45 minutes to EX-14 appears to be a useful non-invasive
intervention in the management of dyspnoea in patients with COPD.
IMPLICATIONS: Acu-TENS could be considered as an useful adjunct
in alleviation of the distress and anxiety associated with the sensation 2993 Wednesday 6 June 11:25
of dyspnoea in patients with COPD. KEYWORDS: Acu-TENS, VCEC Ballroom A
COPD, FEV1, Dyspnoea. FUNDING ACKNOWLEDGEMENTS: Not FUNCTIONAL KNEE STABILITY DURING BALANCE
applicable. CONTACT: [email protected] PERTURBATION
ETHICS COMMITTEE: Departmental Research Committee, The Vaes P1 , Barrat D1 , Duquet W1 , Van Gheluwe B1 , Meirhaeghe E1 ,
Hong Kong Polytechnic University. Pollet V2 , Handelberg F2 ; 1 Physical Education and Physiotherapy
Faculty, Vrije Universiteit Brussel-BELGIUM; 2 Orthopaedics and
Research Report Platform Presentation Traumatology Department Academic Hospital Vrije Universiteit
2586 Wednesday 6 June 11:25 Brussel-BELGIUM
PP Crystal Pavilion A PURPOSE: To evaluate and document stability control mechanism
AN EVALUATION OF AN EXERCISE & PREGNANCY HELPLINE in patients with complaints of knee instability. RELEVANCE: There is
a need for good predictors of functional outcome in patients following
Alleyne J1,2 , Farrer C1,2 , Cruz L1,2 , Robinson H1 , Weind K1 ;
1 Women’s College Hospital, Toronto, ON Canada; 2 University of knee trauma. Assessment of reaction patterns of the lower extremity
during a sudden perturbation of the knee in the sagital plane using
Toronto
a ‘genupulse’ procedure can possibly offer objective evaluation of
PURPOSE: A pilot study was conducted to evaluate the perceived patient complaints. PARTICIPANTS: A total of 29 patients and 22
usefulness of the information provided by trained health care control subjects were recruited for the study. Patients were included
professionals given through an existing Exercise and Pregnancy if diagnosed with unilateral anterior cruciate ligament rupture based
on arthroscopic or magnetic resonance imaging. METHODS: An 6MWT between Day 1 and Day 2: HR −1.71[-6.01 to 2.60]beats/min;
anteriorly directed force (a constant pressure of 8 bar produced an Vt 17.21[-117.47 to 51.90]ml; Ve −0.17[-5.05 to 4.70]Lmin−1 ; RR
impulse force of 353 N) was applied to the proximal upper third −0.13[-1.13 to 0.87]breaths/min; phase angle 0.11[-1.01 to 1.22];
of the posterior aspect of the tibia in monopodal weight bearing SaO2 1.94[-3.49 to 7.38]%. There were no differences in peak
position. Electrogoniometric, accelerometric and electromyographic cardiorespiratory responses to MST between Day 1 and Day 2:
registrations were obtained during a ‘genupulse’ antero-posterior HR −0.14[-2.05 to 1.79]; Vt 5.97[-22.22 to 4.16]ml; Ve 2.24[-0.44
balance disturbance. The data of the genupulse test were examined to 4.91]Lmin−1 ; RR −0.03[-0.72 to 0.66]; phase angle 0.04[-0.93
for reproducibility and compared with data of healthy subjects. to 1.01]; SpO2 1.04[-0.59 to 2.67]%. There were no significant
ANALYSIS: Patients in the experimental group were clustered in differences between cardiorespiratory responses to the stair test
copers and non-copers based on their functional status. Test-retest between Day 1 and Day 2: HR 1.55[-2.14 to 5.24]beats/min; Vt
evaluations, and t-test comparisons within and between healthy −43.72[-162.09 to 4.65]ml; Ve −1.44[-5.94 to 3.06]Lmin−1 ; RR 0.47[-
individuals and patients with invalidating knee joint instability were 1.02 to 1.95]; phase angle 0.47[-2.36 to 3.31]; SaO2 −3.44[-13.44
carried out. RESULTS: Analysis revealed significant differences to 6.55]%. On both days exercise performance was significantly
(p < 0.05): 1) patients had higher knee angular displacement and greater in healthy individuals than patients with CF. Ve recorded
higher knee angular velocity following perturbation than healthy during comparable periods of these exercise tests were greater in
subjects. 2) copers decelerated earlier following perturbation in CF versus healthy controls although these differences only reached
comparison to non-copers. All of these significant parameters were critical level of significance (p < 0.05) for the stair test and the MST:
shown to be reproducible. CONCLUSIONS: Using this perturbation mean Ve recorded during the 6MWT: CF 35.31(20.47)Lmin−1 versus
device we could differentiate copers from non-copers based on a healthy controls 31.74(20.47)Lmin−1 ; mean during 1st minute stair
reproducible parameter “time of the deceleration point”, whereby non- test CF 37.76(16.62)Lmin−1 versus healthy 26.73(16.20)Lmin−1 ; MST
copers needed significantly more time to decelerate after perturba- (mean min 6-9): CF 15.18(23.61)Lmin−1 versus healthy controls
tion. IMPLICATIONS: With an operationalized balance disturbance 3.55(23.49)Lmin−1 . CONCLUSIONS: This study suggests that the
procedure deficiency in joint stability and more specifically complaints cardiorespiratory responses recorded by the LifeShirt system during
of functional instability can be documented. KEYWORDS: Knee endurance and peak exercise tests are repeatable and the LifeShirt
instability, sensorimotor control, proprioception, joint perturbation, is able to distinguish between responses to exercise in patients with
joint stability, ACL, copers. FUNDING ACKNOWLEDGEMENTS: The CF and healthy controls IMPLICATIONS: The LifeShirt system offers
research committee of the Physical Education and Physical Therapy a unique opportunity to record multiple cardiorespiratory measures
Faculty of the Vrije Universiteit Brussel funded this research project- outside the laboratory in ambulatory patients. This study provides
OZR 608. CONTACT: [email protected] preliminary evidence for the use of the LifeShirt as an outcome
ETHICS COMMITTEE: Ethics Commission of the Academic Hospital measure in CF. KEYWORDS: Lifeshirt: Exercise: Cystic Fibrosis.
Vrije Universiteit Brussels-BELGIUM FUNDING ACKNOWLEDGEMENTS: Research and Development
Office Northern Ireland. CONTACT: [email protected]
ETHICS COMMITTEE: Queens University Belfast Northern Ireland
VCEC Meeting Rooms 1-3 Research Report Platform Presentation
REPEATABILITY OF CARDIORESPIRATORY MEASUREMENTS 1071 Wednesday 6 June 11:25
RECORDED BY THE LIFESHIRT SYSTEM AND COMPARISON VCEC Meeting Rooms 11-12
BETWEEN PATIENTS WITH CF AND HEALTHY CONTROLS SURVEY OF ARM ACTIVITY AFTER BREAST CANCER
Bradley J1,2 , BoyleL2 , Elborn J2,3 ; 1 Health
and Rehabilitation TREATMENT
Sciences Research Institute, School of Health Sciences, University Lee T1 , Kilbreath S1 , Sullivan G2 , Refshauge K1 , Beith J3 ; 1 School
of Ulster, Belfast, United Kingdom; 2 Adult Cystic Fibrosis Centre, of Physiotherapy, University of Sydney, Australia; 2 Faculty of
Belfast City Hospital, Belfast, United Kingdom; 3 Department of Education and Social Work, University of Sydney, Australia; 3 Sydney
Respiratory Medicine, Queen’s University, Belfast, United Kingdom Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
PURPOSE: To determine if the LifeShirt system is a repeatable PURPOSE: Women are advised to avoid strenuous arm exercise
method of assessing cardiorespiratory responses during exercise in order to avoid lymphedema, while at the same time, they are
and if the LifeShirt system can distinguish between cardiorespiratory advised to perform strenuous arm exercise to regain shoulder range
responses during exercise in patients with cystic fibrosis (CF) and and strength. There is good evidence that strenuous arm activity is
healthy controls RELEVANCE: The LifeShirt system offers the not related to lymphedema, and that it is beneficial in preventing
possibility to measure the cardiorespiratory responses to activity musculoskeletal problems which may result from arm disuse. Our
outside the laboratory environment. It therefore has the potential to hypothesis is that some of the chronic upper limb impairments found
be an important outcome measure in clinical trials. PARTICIPANTS: in breast cancer survivors after surgery may result from women
20 stable patients with CF (11M; age 26[9]yrs; FEV1 67[23]%) over-protecting their arm. RELEVANCE: The inability to return to
and 20 age matched healthy individuals (9M; age 24[5]yrs; FEV1 normal life due to physical restrictions is frustrating and distressing.
92[8]%). METHODS: All subjects wore the LifeShirt system during It is the primary aim of physical therapists to rehabilitate the upper
a 6 minute walk test (6MWT), a stair test, and a modified limb of breast cancer survivors so that they may resume normal
shuttle test (MST) on 2 occasions at least one week apart. Data activities of living. PARTICIPANTS: Women were eligible for the
relating to various cardiorespiratory parameters including: HR (heart study if they had surgery 6-15 months ago, had no recurrence since
rate) Vt (tidal volume); Ve (minute ventilation); RR (respiratory surgery, and could read and comprehend English. METHODS: A self-
rate); phase angle, and SpO2 for the 6MWT (mean values), stair administered, anonymous survey was pre-tested, then distributed to
test (mean values), and the MST (peak values) were analysed. 144 consecutive breast cancer survivors, who completed it in the
ANALYSIS: Descriptive statistics, t tests and repeated measures waiting room of 2 public hospitals and 2 private treatment facilities.
ANOVA assuming compound symmetry. RESULTS: There was no A reply-paid envelope was supplied in circumstances where the
difference in mean exercise performance between Day 1 and Day 2 survey was not finished in the waiting room. ANALYSIS: Bivariate
in any of the tests in either patients with CF or healthy controls which and multivariate analyses were performed to assess the relationship
enabled the groups to be combined to determine the repeatability between treatment variables, participant demographics, perceptions,
of cardiorespiratory responses recorded by the LifeShirt system. intentions, and arm symptoms/function. Stepwise linear regressions
There were no differences in mean cardiorespiratory responses to were conducted to determine perceptions that were likely predictors
of participants’ intentions to use their affected arm. RESULTS: Upper or altered work habits after injury. The anatomical area most often
limb impairments were present in women 6-15 months following affected was the low back, and those injuries occurred most often with
breast cancer surgery. Many of the women (47%) intended to patient transfers. Injuries occurred most often in hospital settings, and
avoid strenuous arm exercise. In contrast, only 27% of women the most frequent altered work habit was using additional personnel.
intended to perform strenuous exercise. Women who intended to CONCLUSIONS: While there was no significant difference between
avoid strenuous arm exercise were twice as likely to have shoulder our subjects and those in other studies, it is intereting to note
restriction, 4.6 times more likely to have arm swelling, and 3.5 that 31% of those injured chose or had to change work settings
times more likely to have arm weakness. Five perceptions explained or retired as a result of being injured. It was also interesting to
75% (F=82, p = 0.000) of the variance in the intention to avoid note that while the practice setting in which most injuries occurred
strenuous arm activity. These perceptions were that: strenuous was the hospital (acute care), the number of injuries in the sub-
activity exacerbates arm swelling; family encourage rest; confidence acute setting were so few the results fell into the “other” category.
in avoiding strenuous activity; arm swelling affects lifestyle; and health IMPLICATIONS: A high geriatric population does not increase the
professionals advised against strenuous exercise. Similarly, 5 percep- risk of getting injured on the job. However, for a profession that
tions explained 65% (F=51, p = 0.000) of the variance in the intention embraces safety and teaches good body mechanics to health care
to perform strenuous arm exercise. These included perceptions colleagues and patients, we need to find better and more effective
that: strenuous exercise helps resolve shoulder restriction, strenuous ways to preserve our bodies while actively engaging in the practice
exercise helps resolve weakness; other breast cancer survivors have of physical therapy. KEYWORDS: work-related injuries; musculo-
problems with shoulder restriction; they will be unhappy to live life skeletal injuries. FUNDING ACKNOWLEDGEMENTS: This was a
with limited shoulder range; and health professionals’ advised the self-funded study.
performance of strenuous exercise. CONCLUSIONS: Women are ETHICS COMMITTEE: Internal Review Board, Nova Southeastern
still receiving conflicting information about avoidance of strenuous University
arm activity, with some health professionals advocating avoidance,
whilst others advocating its performance. Women who followed the
advice to avoid strenuous arm activity were more likely to have upper
limb impairments. IMPLICATIONS: In order to change women’s 1275 Wednesday 6 June 11:25
perception of how vigorously they can use their arm, more emphasis VCEC Meeting Room 17
could be placed on the development of musculoskeletal problems EXPERIENCES OF THE ENCOUNTERING PROCESS AFTER
after surgery. KEYWORDS: Breast Cancer, Lymphedema, Exer- TRANSFEMORAL AMPUTATION FROM THE PATIENTS’
cise. FUNDING ACKNOWLEDGEMENTS: Not funded. CONTACT: PERSPECTIVE
[email protected] Sjödahl C1,2 , Gard G2 , Jarnlo G2 ; 1 Department of Psychiatry,
ETHICS COMMITTEE: Sydney South West Area Health Human Landskrona, Lund University Hospital; 2 Department of Psychiatry,
Ethics Committee Landskrona, Lund University Hospital
PURPOSE: To describe, by use of a phenomenological approach,
Research Report Platform Presentation how transfemoral amputees experience their encounter with health-
871 Wednesday 6 June 11:25 care providers in the acute phase and over time. RELEVANCE:
VCEC Meeting Room 16 Depression and anxiety are well documented consequences of
PREVALENCE OF WORK-RELATED MUSCULO-SKELETAL trauma and these reactions can cause delay of the rehabilitation
INJURIES IN PHYSICAL THERAPISTS process and have a negative effect on outcome. Understanding
of the encountering process may facilitate communication and
Hill C1 , Bumgardner J1 , Bustos M1 , Hellman M1 ; 1 Nova
interaction thereby improving patient satisfaction and rehabilitation
Southeastern University; 2 ; 3 ; 4
outcomes. PARTICIPANTS: Eleven trans-femoral amputees with
PURPOSE: The physical demands commonly encountered by trauma or tumour-related amputation, median age 33.5 years, were
physical therapists during patient treatment pre-disposes clinicians to interviewed. Amputation was made in median 7.5 years before the
work-related musculo-skeletal injuries. The purpose was to identify interview. The informants were community dwelling and managed
the prevalence and long term effects of these injuries in physical well indoors. One had a half disablement pension and all the
therapists practicing within the state of Florida. We hypothesized that others were working or studying full time. METHODS: Data was
given the large geriatric population in Florida, our physical therapists collected by use of a semi-structured interview for 60 to 90 minutes.
would have a greater percentage of work-related musculo-skeletal The interviews were tape-recorded and transcribed verbatim. All
injuries than has been reported in other studies. RELEVANCE: gave their written consent. The study was approved by the Ethical
Attrition from the profession occurs for a number of reasons, Committee of Lund University (LU 34-95). ANALYSIS: Data was
including injuries sustained on the job. Knowing whether the patient processed and analyzed by a phenomenological approach to enable
population increases the likelihood of injury is important to know for the researchers to gain a deeper understanding of the unique
injury prevention. PARTICIPANTS: Five hundred physical therapists experience of the individuals. This analysis consisted of the following
were randomly selected from the database of all licensed physical steps: a/ All the interviews were read separately several times in
therapists maintained by the state of Florida. METHODS: A slightly order to get an understanding of the essence of each interview.
modified version of the survey used by Holder et a. (1999) was b/ The interviews were read to identify and categorize the primary
used to gather work-related musculo-skeletal information from the patterns in the data. c/ Meaning units were formulated to try to
respondents. Respondents who indicated they were not currently catch the essence and meaning of the statements. d/ Clusters of
practicing or had not practiced in Florida were excluded from the different aspects emerged in the coded data and were organised
study. ANALYSIS: Descriptive statistics were used to quantify the in categories. e/ These clusters were referred back to the raw
injuries by anatomical area, injuries by activity being performed, data, which was read through once again. The raw interviews were
altered work habits after injury, and injuries by practice setting. Chi coded again and the coded sentences were cut out and placed
square was used to see if there was any difference between the in a ‘scrapbook’ arranged by category. This was done to validate
subjects in this study and other related studies. RESULTS: Fifty-three the categories and make sure that no essential aspect had been
percent of respondents indicated they had sustained a work-related left out. f/ The raw data as well as the significant statements
musculo-skeletal injury.There was no higher incidence of injury in our extracted from these transcriptions was read and coded separately
population that that reported in other studies. In addition, there was by all the authors. This was done to obtain consensus between
no significant difference in anatomical areas of injury, practice setting, the authors, and to make sure that no further aspects appeared
and that the coding of the data was correct. g/ Three categories than the combined effect of pain intensity and fatigue. Functional
were described. RESULTS: Preliminary results were structured in self-efficacy played a particularly important role, with lower levels of
three categories, in which the respondents expressed problems self-efficacy being related to lower functional ability. IMPLICATIONS:
in the encountering process 1) communication/information – lack Physical therapists need to target cognitive factors when treating
of preparation for the new situation 2) empathy and emotional patients with CFS. Specifically, increasing a patient’s functional self-
support and 3) difficulties to meet the need of individually tailored efficacy should be a primary objective. KEYWORDS: Chronic Fatigue
rehabilitation/training. CONCLUSIONS: Increased awareness of how Syndrome, Cognitive Factors. FUNDING ACKNOWLEDGEMENTS:
communication and interaction influence the rehabilitation process This study was funded by Pennine Acute NHS Trust. CONTACT:
may further improve patient satisfaction and rehabilitation outcomes. [email protected]
IMPLICATIONS: Knowledge and understanding of how encountering ETHICS COMMITTEE: North Manchester Local Research Ethics
processes influence rehabilitation outcomes may lead to use of Committee
a conscious therapeutic approach. KEYWORDS: encountering,
amputation, communication. FUNDING ACKNOWLEDGEMENTS:
This study was supported by grants from the Gyllenstiernska Research Report Platform Presentation
Krapperups’ Foundation. 2547 Wednesday 6 June 11:25
ETHICS COMMITTEE: the Ethical Committee of Lund University, VCEC Meeting Rooms 19-20
Sweden (LU 34-95)
DOES ACUPUNCTURE HAVE A SPECIFIC EFFECT IN ACUTE
NON SPECIFIC LOW BACK PAIN: A PILOT STUDY
McDonough S1 , Kennedy S1 , Bradbury I2 , Kerr D3 , Baxter D4 ,
1980 Wednesday 6 June 11:25 Park J5 ; 1 Health and Rehabilitation Sciences Research Institute,
VCEC Meeting Room 18 School of Health Sciences, University of Ulster, Northern Ireland;
2 Public Health, Medicine and Primary Care, Queens University
PREDICTING FUNCTIONAL ABILITY IN PATIENTS WITH
CHRONIC FATIGUE SYNDROME: THE IMPORTANT ROLE OF Belfast, N Ireland; 3 School of Health Sciences, University of
COGNITIVE FACTORS Ulster, N Ireland; 4 Centre for Physiotherapy Research, School
Woby S1,2 , Urmston M1,2 , Oldham J2 ; 1 Department of of Physiotherapy, University of Otago, New Zealand; 5 Division
Physiotherapy, North Manchester General Hospital, Manchester, for Research and Education in Complementary and Integrative
United Kingdom; 2 Centre for Rehabilitation Science, University Medical Therapies, Harvard Medical School, Osher Institute, USA
of Manchester, Manchester, United Kingdom PURPOSE: This double-blind, randomized controlled pilot study
PURPOSE: The cognitive behavioral paradigm posits that cognitive assessed the feasibility of a trial to investigate the efficacy of
factors are an important determinant of functional ability. Therefore, acupuncture compared to placebo needling for the treatment of acute
the purpose of this study was to determine the extent to which certain low back pain. The study was designed to establish the credibility of
cognitive factors were differentially related to the functional ability the placebo control, and to provide data to inform a power analysis
of patients with chronic fatigue syndrome (CFS). RELEVANCE: to determine numbers for a future trial. RELEVANCE: Increasing
Physical therapists often treat patients with chronic fatigue syndrome. numbers of physical therapists use acupuncture for pain relief but
When treating such patients a primary objective is to increase there is no evidence to support the specific effect of acupuncture
functional ability. The extent to which cognitive factors influence over placebo effects in acute low back pain. PARTICIPANTS: All
the functional ability of patients with CFS within a physical therapy consenting patients meeting the inclusion criteria who were referred
context is unclear. Delineating the extent to which certain cognitive to the South and East Trust for physiotherapy were recruited into
factors affect the functional ability of patients with CFS is essential the study. METHODS: Patients (n=48) with acute low back pain
as these findings would alert practitioners to those cognitive factors were randomized to verum or placebo acupuncture in a double
that need to be targeted during treatment. PARTICIPANTS: Data blind randomised controlled trial. The Roland and Morris Disability
were collected from 68 patients with chronic fatigue syndrome who Questionnaire (RMDQ), Visual Analogue Scale (VAS), medication
had been referred to a physical therapy department. Eighty percent use and an exit questionnaire were completed at baseline, end
were female, the mean age was 41.8 years (SD=10.8) and the mean of treatment, and at 3 month follow up. ANALYSIS: Intention-to
duration of symptoms was 6.2 years (SD=4.8). Forty-eight percent treat analysis was carried out by an investigator who was masked
had not been in employment because of their CFS symptoms for to treatment allocation. Analysis of Covariance (ANCOVA), using
a mean duration of 4.9 years (SD=4.9yrs). METHODS: Prior to pretreatment value as the covariate, was used to determine any
treatment, patients completed a series of measures that assessed differences between the two groups at the post-treatment and follow-
function, pain, fatigue, self-efficacy, catastrophizing, acceptance, up visits RESULTS: 94% of patients completed assigned treatment,
hypervigilance, anxiety and depression. ANALYSIS: The relation 83% completed the 3 month follow-up. The sham needle proved
between the cognitive factors and functional ability was initially to be credible with 91.7% in the placebo group and 95.8% in the
explored via partial correlations (covariates were age, sex, fatigue verum group believing they had received acupuncture. There was
and pain). Those cognitive factors that were related to functional no significant difference between the groups on the RMDQ over
ability were subsequently entered into a two step hierarchical multiple time. For pain, the only statistically significant difference was at the 3
regression analysis to determine their relative importance. Age, sex, month follow up (worst VAS, point estimate, 26.95, 95% CI 9.561 to
pain intensity and fatigue were entered in Step 1, and the cognitive 44.34, p < 0.01). The majority of patients were taking some form of
factors were entered in Step 2. RESULTS: Age, sex, pain intensity analgesic medication for LBP at the start of treatment (n=44; 92%)
and fatigue explained 21% of the variance in functional ability with the verum acupuncture group taking significantly fewer tablets
(P < 0.01). Interestingly higher pain intensity (b = 0.28; P < 0.01), but (mean (SD): 0.82±1.2) than the placebo group (mean (SD), 3.2±3.2,
not fatigue (b = −0.10; P = 0.27), was uniquely related to functional p < 0.05) at the end of treatment CONCLUSIONS: Based upon these
ability. After controlling for the aforementioned factors, the cognitive data, power analysis indicated that 120 participants (60 per group)
factors explained an additional 33% of the variance. Of the cognitive would be needed to complete an adequately powered randomized
factors, only functional self-efficacy explained unique variance (b = controlled trial IMPLICATIONS: These preliminary results support
−0.52; P < 0.001). The final model accounted for 58% of the total a specific effect of acupuncture in reducing low back pain and the
variance in functional ability. CONCLUSIONS: Cognitive factors were requirement for pain relieving medication in an acute episode of
related to the functional ability of patients with CFS. Furthermore, low back pain KEYWORDS: low back pain, acupuncture, placebo.
these cognitive factors were a stronger predictor of functional ability FUNDING ACKNOWLEDGEMENTS: The Department of Education
in Northern Ireland Strategic Priority fund supported this work. of research supporting physical therapy interventions, this condition
CONTACT: [email protected] is under diagnosed and under treated. Traditional professional
ETHICS COMMITTEE: Royal Hospitals Research Ethical Committee development activities have largely proven to be ineffective in
changing clinician practice and educators emphasize the need for
learning strategies that are multifaceted, interactive and embedded
in the context of clinical practice. One such approach is the
3255 Wednesday 6 June 11:45 community of practice model based on social learning theory
PP Crystal Pavilion A in which participants are mutually engaged in a joint enterprise
PREGNANCY INFLUENCES SPINAL LIGAMENT ENDOCRINE in the context of their practice moving beyond passive learning
RECEPTORS to understanding and creating new knowledge to move their
practice forward. PARTICIPANTS: Subjects included physical and
Doschak M, Emami S, Kawchuk G; University of Alberta
occupational therapists who were recruited and selected from four
PURPOSE: The goal of this project was to characterize the expres- sites in northern and southern Ontario, where there was a shortage
sion of endocrine receptors in the spinal ligaments of pregnant and of family physicians, high volumes of fractures and limited access to
non-pregnant rabbits. RELEVANCE: Low back pain is a significant osteoporosis care. METHODS: A design research approach involving
cause of maternal distress during pregnancy. While the etiology of progressive refinement of processes to develop the community
pregnancy-related back pain has not been characterized fully, some and advance practice was used. During the four cycles, design
believe an increase in the laxity of spinal ligaments is a potential innovations were made to respond to the challenges and facilitators
cause of pregnancy-related back pain. While increased expression to inform the next cycle of development. The goal of the community
of progesterone receptors has been shown to occur in peripherial of practice was to advance practice through the development of
ligaments during pregnancy (Hart et al., 2002), we are not aware of exemplar cases to be used as a learning resource. ANALYSIS:
any evidence that the stiffness of spinal ligaments is modulated by the Qualitative (grounded theory approach) and quantitative analyses
endocrine system. PARTICIPANTS: Primigravida pregnant and virgin (t tests) were carried out to determine how the multiple variables
control female New Zealand White rabbits. METHODS: Estrogen and design iterations contributed to knowledge and practice advance-
receptor and progesterone receptor expression were assessed using ment, development of the community and emerging exemplar cases.
reverse-transcriptase polymerase chain reaction (RT-PCR). Samples Data sources included the Knowledge Forum® database; audio-
of the supra-spinous ligament (SSL) were isolated from between taped synchronous discussions and individual feedback interviews.
adjacent vertebrae of each rabbit. Ligaments were flash frozen RESULTS: Participants (n=6)in the online community of practice
and pulverized in liquid nitrogen using a ball-bearing dismembrator progressed through four cycles of innovation shifting from individual
(Mikro-Dismembrator S, Sartorius, Germany). ANALYSIS: After task based activity to collective advancement of practice using
digestion with Trizol reagent, samples of mRNA were extracted using evidence and theories to address authentic clinical problems. The
the Qiagen RNeasy kit and reverse transcribed into copy-DNA for use community created 14 exemplar cases based on practice situations
with conventional semi-quantitative PCR. Specific oligonucleotide and identified that their practice had advanced in the assessment
PCR primers were synthesized against both estrogen receptor and and management of low trauma patients. Multi-medium technology
progesterone receptor, and standardized against housekeeping gene played an essential role in the development and sustainability of
(GAPDH) expression. RESULTS: Results showed that a 17-fold the community of practice. The use of a design research approach
increase in progesterone receptor expression was measured in SSL allowed for “just in time” innovations. CONCLUSIONS: An online
from pregnant rabbits when compared to that from virgin control community of practice is an innovative approach to professional
rabbits. In contrast, estrogen receptor expression was relatively development that allows for the collective creation and distribution
constant, with only a 1.5-fold increase in pregnant rabbits over that of knowledge in ways that exceed individual capabilities, contributing
from virgin control rabbits. CONCLUSIONS: We believe that these to the advancement of practice related to low trauma fracture.
data are the first to suggest that hormonal changes during pregnancy Future research should study how emerging technologies can further
may influence spinal ligament laxity. IMPLICATIONS: In the future, support communities of practice as a professional development
pharmacologic modulation of spinal ligament progesterone receptor strategy. IMPLICATIONS: Online communities of practice have the
expression may prove to be important toward the management capacity to bring together physical therapists and researchers,
of pregnancy-related back pain. KEYWORDS: Pregnancy, Back transcending geographical and temporal boundaries to advance
pain. FUNDING ACKNOWLEDGEMENTS: Natural Sciences and practice which is vital to moving physical therapy forward to create
Engineering Research Council of Canada (NSERC). CONTACT: its future. KEYWORDS: professional development, community of
[email protected] practice, osteoporosis. FUNDING ACKNOWLEDGEMENTS: This
research was supported by the Physiotherapy Foundation of Canada
and Ontario Ministry of Health Primary Health Care Transition Fund.
2998 Wednesday 6 June 11:45 ETHICS COMMITTEE: University of Toronto, Education Research
PP Crystal Pavilion B & C Ethics Review Board
AN ONLINE COMMUNITY OF PRACTICE AS A PROFESSIONAL
DEVELOPMENT APPROACH TO ADVANCING THE PHYSICAL
THERAPY MANAGEMENT OF OSTEOPOROSIS Research Report Platform Presentation
Evans C1 , JaglalS2 ; 1 University
of Toronto, Toronto, Canada;
2 University of Toronto and Osteoporosis Research Program, VCEC Ballroom A
Women’s College Hospital, Toronto, Canada INTER OBSERVER RELIABILITY OF TWO MEASUREMENTS FOR
DETERMINING SUBTALAR POSITION IN HEALTHY SUBJECTS
PURPOSE: The purpose of this study was to investigate whether
Oosterveld F, Niessink P, van der Weit-Seales E, Schoenmaker W;
participants in an online community of practice advanced their
Saxion University, Enschede, The Netherlands
knowledge and skills in the management of low trauma fracture
associated with osteoporosis. This research also examined design PURPOSE: The purpose of this study was to investigate the inter
innovations used to create and sustain an online community of observer reliability of two different methods for assessing subtalar
practice. RELEVANCE: Osteoporosis is a major health problem char- joint position: the inclino measurement (Rippstein plurimeter) of the
acterized by compromised bone strength, leading to an increased risk calcaneus position perpendicular to the floor and the analysis of a
of fracture causing significant disability. Despite a substantial body standing foot blue print. RELEVANCE: Subtalar joint measurement
is a common procedure in daily practice of physiotherapists with physiotherapist and child. Moreover, the magnitude of force applied
expertise in foot problems and is clinically used to determine the during physiotherapy in this population may be related to differences
position of the calcaneus. According to recent literature, there are in age and chest wall compliance. PARTICIPANTS: Mechanically
fewer consensuses about the reliability of the tools. In different stud- ventilated children (aged 0-16 years) at Great Ormond Street
ies, poor, moderate or even good reliability was reported. However, Hospital for Children were recruited if they were clinically stable,
research methods and measurement methods differ, are not quite heavily sedated or paralyzed and required chest physiotherapy
comparable and large studies are exceptional. PARTICIPANTS: 102 (assessed by the physiotherapist and the medical team). METHODS:
Healthy subjects, 67 female and 32 male, with a mean age of 24 sd 10 Prior to physiotherapy, a lightweight, flexible, prototype force-
years (median 20 years; range from 17 to 58) were recruited among sensing mat (Novel Pliance® ) was placed over the area requiring
students and staff of Saxion University. METHODS: Two second year treatment, between the child’s chest wall and the therapist’s hand.
bachelor students, blinded for each other’s outcome, performed the Physiotherapists administered treatments in their usual manner and
inclino measurements. Results were expressed in degrees and also forces applied through the mat were transmitted to the Pliance®
transferred to nominal data in varus, neutral or valgus. Subsequently system. Algorithms and an analysis program were devised in
standing blue prints on the Harris mat of both feet of the subjects were Labview™ using the Pliance® force system’s summary ASCII format
made. Two experienced physiotherapist-podiatrists examined the file (comprising time and force data). Force-time profiles, including
prints determining the subtalar joint position by drawing a rectangular maximum force and duration of vibration, and the amplitude, number
line on the central transversal axis-line from the os naviculare. Then and frequency of oscillations, were calculated for all chest wall
the length of the medial (AB) and the lateral (BC) line was measured. vibrations. ANALYSIS: Average values for the maximum force applied
The difference was expressed in mm. ANALYSIS: Cohen’s Kappa during each vibration were calculated for every treatment session.
was used for nominal data and Pearson’s correlation coefficient The median and range of these values between treatments were
for continuous data to estimate inter observer agreement. Also, then reported. The extent to which forces varied according to age
differences between the measurements were expressed in mean was also examined. RESULTS: Nine senior physiotherapists were
and standard deviation using T-tests. Based on these SD’s and recruited to treat 40 mechanically ventilated children (median age:
correlation coefficients the Smallest Detectable Difference (SSD) 1.5 years [range 0.2–14yrs], weight: 10kg [4.7–50kg]). Maximum
was calculated. RESULTS: Inter observer reliability for inclinometer applied forces ranged from 21–165 Newtons (N) (median: 40N) and
measurements was relatively low. The mean difference was 0.2 were strongly associated with age. For every 1 year increase in age
sd 3.6 (p = 0.62), with a Pearson’s correlation coefficient of 0.33 there was a 9N increase in Force applied (P < 0.0001) and these
(p = 0.01), while the SSD as 8.6. In nominal measurements Cohen’s correlated significantly (r2 =0.72). There was marked variability in the
Kappa’s results also indicates poor agreement (0.13; p = 0.075). pattern of force-time profiles between physiotherapists with respect
Inter observer reliability of blue print analysis by experienced to the duration of vibration, and amplitude, number and frequency
physiotherapist-podiatrists is better, regarding the good correlation of oscillations. However this pattern was generally consistent within
coefficients (0.82; p = 0.000) and moderate Cohen’s Kappa’s (0.5; individual therapists, regardless of the child’s age. CONCLUSIONS:
p = 0.000). Nevertheless, the variance in the measurements between There was considerable variation in the magnitude of forces applied
the two physiotherapist-podiatrists is rather large (1.4 sd 6.3; by different physiotherapists and these were significantly related
p = 0.025), still leading to a relatively big SDD (9.7). CONCLUSIONS: to the age of the child. It is likely that this association reflects
Reliability of inclino measurements done by students is rather modification of treatment in response to differences in chest wall
poor; deviation from the neutral less than approx. 8 degrees compliance, this being considerably higher during early life. Further
may not have any clinical implications. Experienced professionals research should examine other factors influencing physiotherapist’s
perform better on their analysis of footprints, but the validity of application of manual techniques, including how applied forces may
their diagnosis of the calcaneus positions is questionable in a differ in the treatment of adults. IMPLICATIONS: The variations
range between 5 and 10 mm difference in AB vs. BC line. in force patterns between physiotherapists raise questions about
IMPLICATIONS: Some caution in the interpretation of this diag- the relative importance of individual components of chest wall
nostic measure is necessary. KEYWORDS: measurements, validity, vibrations and how these are anticipated to affect respiratory or
reliability. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: physiological change. Developments to combine force analysis
[email protected] with airflow data could prove invaluable in future intervention
trials and for training purposes. KEYWORDS: Respiratory Therapy,
Intensive care, Pediatrics. FUNDING ACKNOWLEDGEMENTS:
Research Report Platform Presentation Sport Aiding Medical Research for Kids (SPARKS); Great Ormond
1756 Wednesday 6 June 11:45 Street Hospital Physiotherapy Research Fellowship. CONTACT:
THE RELATIONSHIP BETWEEN AGE AND FORCES APPLIED ETHICS COMMITTEE: South and West Local Research Ethics
DURING CHEST PHYSIOTHERAPY IN MECHANICALLY Committee. Great Ormond Street and Institute of Child Health Local
VENTILATED CHILDREN Research Ethics Committee, London.
Gregson R1,2,4 , Shannon H2 , Main E1,2 , Dunne C1 , Warner J4 ,
Goldman A3 , Stocks J2 ; 1 Physiotherapy Department, Great Ormond Research Report Platform Presentation
Street Hospital for Children, London, United Kingdom; 2 Portex 2165 Wednesday 6 June 11:45
Respiratory Unit, UCL Institute of Child Health, London, United VCEC Meeting Rooms 11-12
Kingdom; 3 Intensive Care Units, Great Ormond Street Hospital for
BREAST CANCER PATIENTS’ PAIN EXPERIENCES 6 AND 12
Children, London, United Kingdom; 4 School of Medicine, University
MONTHS AFTER OPERATION
of Southampton, United Kingdom
Kärki A; Satakunta University of Applied Sciences, Pori, Finland
PURPOSE: To assess, via an innovative new method (Novel
Pliance® ), the variability of forces applied to mechanically ventilated PURPOSE: The purpose of the study was to describe pain
children during chest wall vibrations, and the extent to which experiences and intensity of the pain 6 and 12 months after
these vary according to the age of the child. RELEVANCE: Chest breast cancer operation. Another purpose was to find out the
wall vibrations are commonly used during respiratory physiotherapy impact of pain on activity limitations and participation restrictions.
treatments. However, this technique remains largely unquantified. In RELEVANCE: In the review by Rietman et al. (2003) the prevalence
order to understand its effects, it is essential to measure the force and of pain ranged from 12 to 51% among breast cancer patients and
characteristics of techniques involving manual contact between the Tengrup et al. (2000) showed that even one third of the patients
experienced pain in the arm as long as five years after operation. Patients with GAD often seek primary health care because of their
The level of functioning and participation should be major concern muscular pain caused by anxiety-provoked tension. This is one
among physiotherapists working with breast cancer patients with reason why patients with GAD often are referred to physiotherapeutic
pain experiences. PARTICIPANTS: The population consisted of treatment. The aim of this study was to explore the long-term
110 patients with breast cancer from Satakunta district, Finland. effect of Affect- focused Psychodynamic Body Therapy (PBT)for
Mean annual number of new cases in 1996-7 in this area was patients with GAD. RELEVANCE: Patients with GAD is a challenge
149. One hundred and five patients answered the first survey for physiotherapists because symptomatic treatment generally only
and 96 (91.4%)the second. METHODS: The prospective survey 6 achieves short-term relief. Affect-focused Body Therapy offers a more
and 12 months after operation was done by questionnaires. The holistic approach by focusing on how the mind/body unity is lived. The
questions concerned experienced impairments, activity limitations affect-focused psychodynamic body therapy is a physiotherapeutic
and participation restrictions. Pain was examined by SF-MPQ treatment method especially suited for patients with psychosomatic
(Short Form McGill Pain Questionnaire) and severity of pain by and psychiatric problems. There is empirical support for its use in
modified VAS. Modified Behavioural Rating Scale for Breast Cancer the treatment of patients with chronic pain, but it has not been
Patients was used to find out the possible pain impact on activity evaluated for patients with GAD.There is still no state of the art
and participation. ANALYSIS: Descriptive statistics were used, treatment for GAD patients and recovery rates reported are around
correlations were calculated and the Wilcoxon Signed Rank Test 60%. Therefore there is a need to develop and evaluate alternative
was used for counting changes of pain, activity limitations and treatment strategies. It is also vital to the physiotherapy profession
participation restrictions. One-way Anova was used to determine that new methods such as the PBT are evaluated. PARTICIPANTS:
differences between operation types. A Paired Samples Test was The patients were recruited consecutively through the first-line
used for assessment of changes between VAS-values. Linear psychiatric outpatient clinics south of Stockholm. The total patient
regression analysis was done to determine the effect of pain on group consisted of 61 patients with GAD; 42 women and 19 men,
limitations and restrictions. RESULTS: Neck and shoulder pain was mean age 37 years (range 21-55). METHODS: Of the 61 patients
the most common pain experienced by the breast cancer patients, 33 were randomised to PBT and 28 to psychiatric treatment as
38.5% at 6-month and 40.6% at 12-month follow-up. VAS-values were usual (TAU). The patients were assessed before treatment and
also the highest varying from 27 mm to 28 mm. Modified radical followed-up one and two years after inclusion. Four physiotherapists
mastectomy (MRM) patients experienced increasing limb ache in administered the PBT once weekly during one year. Three self report
one year follow-up. Most common pain descriptions at 6-month and questionnaires were administered; SCL-90, Beck Anxiety Inventory
12-month follow-up were sharp 18.8% to 14.6%, shooting 22.9% to (BAI) and the WHO (Ten) Well-being Index (WWB). ANALYSIS: A
20.8% and tender 45.8% to 38.6%. MRM group described their pain repeated measures multivariate analysis of covariance (MANCOVA)
as fearful more often than breast saving operation (BSO) group. was performed. We also calculated within-group effect sizes, d, on
BSO group experienced more severe axilla pain and breast pain the raw scores on each outcome variable. Between group effect
than MSM group. Axilla pain, breast pain, upper limb ache, neck sizes, D, were calculated according to Becker. RESULTS: Both
and shoulder pain were shown to be the determinants of activity groups improved significantly in all scales and the improvement was
limitations and sleep impairment together with other determinants somewhat more pronounced in the PBT group. A MANCOVA with
like edema, age, shoulder movement restriction and upper limb occasions as a within-subjects factor and groups as a between -
weakness. CONCLUSIONS: Breast cancer patients described their subjects factor, using age, sex and number of personality disorder
pain as mostly sharp, shooting and tender. These descriptions diagnosis as covariates gave a significant multivariate effect of
represent the sensory dimension of pain; tender in the sensory occasions (p < 0.05) with significant univariate effects on BAI and
miscellaneous, shooting in the sensory spatial and sharp in the Global Severity Index of the SCL-90. CONCLUSIONS: PBT seems
sensory pressure subclass. The pain values in VAS were less than to be a viable treatment alternative for patients with GAD. In
30 mm, and should not affect daily activities (Tengrup et al. 2000), terms of general symptom relief it might even be more efficient
however we found that most of the activities were affected by pain than treatment as usual. IMPLICATIONS: As patients with GAD
symptoms. IMPLICATIONS: Pain should be assessed and treated frequently present bodily symptoms their first treatment contact in
during rehabilitation process of each patient, while it will cause many cases is with a doctor in the somatic health care where
suffering, activity limitations and sleep disturbances. KEYWORDS: they are examined to exclude any circulatory or endocrinological
Breast cancer, pain, VAS, modified radical mastectomy, breast saving problem. A physiotherapist with training in PBT may then offer an
operation. FUNDING ACKNOWLEDGEMENTS: The study was sup- adequate treatment for patients with a predominantly psychological
ported by the Satakunta Foundation. CONTACT: anne.karki@samk.fi aetiology. KEYWORDS: Affects, Generalised Anxiety Disorder,
ETHICS COMMITTEE: The Finnish Social and Health Ministry has Outcome, Physiotherapy, Psychodynamic Body Therapy. FUNDING
approved the study in 1997. ACKNOWLEDGEMENTS: This study was supported by grants from
Vårdalstiftelsen, Karolinska Institutet, the Boëtius foundation, the
Bror Gadelius foundation and the Psychiatric Clinic and research
Research Report Platform Presentation department at Karolinska University Hospital – Huddinge. CONTACT:
1453 Wednesday 6 June 11:45 [email protected]
VCEC Meeting Room 17 ETHICS COMMITTEE: The ethical committee at Huddinge hospital
AFFECT-FOCUSED PSYCHODYNAMIC BODY THERAPY 1998
IN PATIENTS WITH GENERALISED ANXIETY DISORDER:
EVALUATION OF INTEGRATIVE TECHNIQUES
Levy Berg A1 , Sandell R2 , Sandahl C3 ; 1 Division of Physiotherapy,
Department of Neurobilogy, Caring Sciences and Society,
Karolinska Institutet and Department of Physical Therapy,
Karolinska University Hospital Huddinge, Sweden; 2 Department of
Behavioural Science, Linköping University, Sweden; 3 Department of
Learning, Informatics, Management and Ethics (LIME), Karolinska
Institutet, Stockholm, Sweden
PURPOSE: Generalised Anxiety Disorder (GAD) is a common
problem with high incidence rates in middle age groups. GAD is
associated with a wide spectrum of somatic and mental disorders.
Research Report Platform Presentation is financially supported by a PhD grant supplied by the Higher
2036 Wednesday 6 June 11:45 Institute of Physiotherapy, Department of Health Sciences, University
VCEC Meeting Room 18 College Antwerp, Antwerp, Belgium (G 807) and co-financed by
INFLUENCE OF THE KNOWLEDGE OF PAIN NEUROPHYSIOL- Faculty of Physical Education and Physiotherapy – Vrije Universiteit
OGY ON COPING, CATASTROPHISING, KINESIOPHOBIA AND Brussel (VUB), Brussels, Belgium (OZR project OZ.R. 1234/MFYS
PAIN IN PATIENTS WITH THE CHRONIC FATIGUE SYNDROME Wer2). CONTACT: [email protected]
ETHICS COMMITTEE: Committee Medical Ethics Academic Hospital
Meeus M1,2 , Nijs J1,2 , Van Oosterwijck J1 , Van Alsenoy V1 ,
Vrije Universiteit Brussel, Brussels, Belgium
Truijen S1 , De Meirleir K2 ; 1 Division of Musculoskeletal
Physiotherapy – Department of Health Care Sciences – University
College Antwerp (HA), Antwerp, Belgium; 2 Department of Human Research Report Platform Presentation
Physiology – Faculty of Physical Education and Physiotherapy – 2808 Wednesday 6 June 11:45
Vrije Universiteit Brussel (VUB), Brussels, Belgium VCEC Meeting Rooms 19-20
PURPOSE: The present study aimed at investigating whether an A PILOT STUDY ON THE EFFECT OF ACU-TENS DURING
education session on the neurophysiology of pain is capable of EXERCISE ON POST-EXERCISE EXPIRATORY FLOW RATE IN
reducing pain catastrophising, kinesiophobia, passive coping and SUBJECTS WITH ASTHMA
pain in patients with the Chronic Fatigue Syndrome (CFS), suffering Ngai S, Jones A, Hui-Chan C; Department of Rehabilitation
from chronic widespread pain. RELEVANCE: Besides the debilitating Sciences, The Hong Kong Polytechnic University
fatigue, the majority of CFS patients experiences chronic widespread
pain. In patients with chronic low back pain the efficacy of education PURPOSE: Exercise can induce asthma in susceptible individuals
sessions on the neurophysiology of pain has already been shown. and patients with symptoms of asthma may therefore be reluctant
The patient education aims at reconceptualising “pain” by providing to exercise. Suppression of hyperventilation may reduce stimulus
correct information on the function and the mechanism of pain. Up to asthma and allow patients to perform at a higher workload to
to now, there is no evidence for the efficacy of such education maximize their exercise capacity. Acupuncture stimulation is believed
session in CFS patients suffering from chronic musculoskeletal pain. to promote health by restoring the free flow of energy (qi) along
PARTICIPANTS: Forty-eight patients fulfilling the 1994 Centre of meridians. Effects of acupuncture stimulation on cardiovascular and
Disease Control and Prevention (CDCP) criteria for CFS and the respiratory systems have been reported in literature. Explanations for
1990 American College of Rheumatology criteria for widespread pain acupuncture effect in asthma include suppression of inflammatory
were included in the study. All participants had Dutch as native markers and release of endogenous opioids, which may in turn
language and were aged between 18 and 65 years. METHODS: reduce hyperventilation during exercise, and thereby subdue airway
Participants were subjected to a pain threshold measurement and irritation and alleviate asthmatic symptoms. Acupuncture is however
filled out a list of Dutch questionnaires evaluating their knowledge invasive. Transcutaneous Electrical Nerve Stimulation (TENS) is
on pain neurophysiology, coping strategies, kinesiophobia and pain a non-invasive modality, which when applied over acupuncture
catastrophising. Afterwards patients were randomly assigned to points (Acu-TENS) may elicit similar responses to acupuncture.
the experimental group or the control group. The experimental The aim of this study was to investigate the effect of Acu-TENS
group (n=24) received a 30 minutes-lasting individual information applied during exercise, on post-exercise forced expiratory flow
session about the neurophysiology of pain: the mechanism, the rate, in subjects with asthma. RELEVANCE: TENS is a non-
function and the modulation of pain. The control group (n=24) had invasive electrophysical modality commonly employed by physical
an individual lesson of 30 minutes on self-management pacing therapists. Acu-TENS may permit higher training intensity in patients
techniques. Finally the second blind researchers repeated the pain with asthma thereby improving musculoskeletal and cardiovascular
threshold measurements and patients completed the questionnaires fitness. PARTICIPANTS: Patients aged between 18 to 70, diagnosed
for the second time. ANALYSIS: Two-way ANOVA was used to with asthma for over 5 years, and attending follow up at a large district
reveal a possible therapy effects on the questionnaire score and pain hospital were recruited. Patients were free from musculoskeletal
thresholds. RESULTS: After the intervention, the experimental group disorders which could limit their performance in a treadmill exercise
presented a significant better knowledge on the neurophysiology of test. Sixteen subjects were recruited. METHODS: Subjects were
pain, compared to the control group. Secondly, in the experimental randomly assigned into one of the three groups: Group 1 received
group a significant reduction was found in the passive coping TENS over the acupoints: Lieque (LU 7–1.5 cun above transverse
strategies “worrying” and in the subscale “ruminating” of the Pain crease of wrist between tendons of brachioradial muscle and
Catastrophising Scale, in comparison to the controls. Furthermore, abductor pollicis longus) and Dingchuan (EX 14–0.5 cun lateral to
a significant increase in the active coping strategy “distraction” was the spinous process of C7) (1 cun= distance between the medial
revealed. Finally, the pain thresholds of the treatment group increased ends of the creases of the interphalangeal joints of the individual’s
after the education session, but compared to the control group it middle finger) for 45 minutes prior to a submaximal treadmill exercise
was not a significant therapy effect. CONCLUSIONS: The present test (Naughton protocol). Group 2 similar to Group 1 except that
study revealed some interesting therapy effects of an individual application of acu-TENS continued during the exercise test. Group
education session on the neurophysiology of pain for CFS patients 3 (Placebo-TENS) similar to Group 1 but there was no electrical
experiencing chronic pain. Despite frequently reported concentration output from TENS machine despite apparent activation of the output
problems, CFS patients are able to understand and learn the indicator. ANALYSIS: Percentage of drop in forced expiratory volume
neurophysiology of pain, and this knowledge has immediate effects in 1 second (FEV1) after exercise test was compared amongst the
on pain behaviour. Reconceptualisation of pain by an education three groups using one way ANOVA. RESULTS: The percentage
session on the neurophysiology of pain has an influence on drop of FEV1 after exercise was smallest in Group 2 (acu-TENS
pain catastrophising and pain coping. Further investigation should before and during the exercise text) (−1.9%) and greatest in the
focus on long-term therapy or long-term effects on pain and pain Group 3 (Placebo-TENS) (−6.9%). However the differences did not
behaviour. IMPLICATIONS: With these results in mind, physical reach statistical significant level (p = 0.53). CONCLUSIONS: This
therapists could provide education for CFS patients with pain, study did not support the hypothesis that Acu-TENS improves FEV1
in order to influence negative thoughts, pain behaviour and on in subjects with asthma. Failure to reach significance is probably
long term eventually pain, since catastrophising is known to be a related to the small sample size. IMPLICATIONS: Stabilising airway
predictor of chronic pain. KEYWORDS: Chronic Fatigue Syndrome, patency (as reflected by maintenance of FEV1) with Acu-TENS
chronic pain, catastrophising, coping, kinesiophobia, education, pain applied before and during exercise suggests that studies of similar
neurophysiology. FUNDING ACKNOWLEDGEMENTS: Mira Meeus nature with a larger sample size are indicated. KEYWORDS: Asthma,
TENS, FEV1, Acupuncture. FUNDING ACKNOWLEDGEMENTS: for graduates who demonstrate professional promise. Exploration
This project was supported by Area of Strategic Development Grant, of the professional development of promising novice therapists
Department of Rehabilitation Sciences, The Hong Kong Polytechnic during early years to generation of a working grounded theory on
University. novice development. KEYWORDS: professional development, novice
ETHICS COMMITTEE: Ethics committee of the Hong Kong therapist,. FUNDING ACKNOWLEDGEMENTS: None.
Polytechnic University ETHICS COMMITTEE: Institutional Review Board approval at
Creighton University, Central Michigan University, Northeastern
University and University of Indianapolis
3182 Wednesday 6 June 12:05 Research Report Platform Presentation
THE FIRST YEAR OF CLINICAL PRACTICE: AN INVESTIGATION VCEC Ballroom A
OF THE PROFESSIONAL DEVELOPMENT OF PROMISING
STEADINESS ON DESCENDING A STEP IN SUBJECTS WITH
NOVICE PHYSICAL THERAPISTS
CHRONIC ANKLE INSTABILITY
Black L1 , Mostrom E2 , Perkins J2 , Jensen G1 , Hayward L3 , Kedroff L, Egan E, Morrissey M; Division of Applied Biomedical
Blackmer B3 , Ritzline P4 ; 1 Creighton University; 2 Central Michigan Research, King’s College London, London, UK
University; 3 Northeastern University; 4 University of Indianapolis
PURPOSE: The aim of this study was to investigate whether subjects
PURPOSE: This qualitative multiple case study describes the with chronic ankle instability (CAI) have altered trunk and lower
learning and professional development of promising novice physical limb steadiness during a daily activity, stair descent. RELEVANCE:
therapists during their first year of clinical practice. RELEVANCE: Ankle sprains are common and disabling with over 30% of patients
While a moderate amount of cross-sectional research has been progressing to CAI (Konradsen et al, 2002). Rehabilitation programs
conducted on expertise in physical therapy and differences between focusing on lower limb balance and steadiness have been shown to
novice and expert practitioners, there are few longitudinal studies reduce recurrence of ankle sprains (Verhagen et al, 2004). Advancing
of therapists’ development over time or through critical transitions our knowledge of the impairments in balance implicated in CAI
(student to practitioner; novice to experienced clinician). This study will help direct future rehabilitation. PARTICIPANTS: Eleven healthy
focuses on the learning and professional development of novice phys- volunteers (7 females, mean age = 28±6 (standard deviation, SD)
ical therapist graduates as they progressed through their first year years, height = 1.72±0.1 m) with no history of lower limb pathology
of clinical practice. PARTICIPANTS: A purposive sample of 12 new and 17 subjects with CAI (6 females, aged 27±7 years, height
graduates from 4 physical therapist professional education programs 1.76±0.1 m) were studied. The CAI subjects had at least 2 previous
participated in the study. Selection criteria included evidence of lateral ankle sprains, with at least one sprain in the last 2 years
promise as demonstrated by exceptional performance during clinical and a minimum of 3 weeks since the last sprain. Ethics approval
internships, engagement in extra-curricular professional activities, was obtained. METHODS: A system of markers was placed on
demonstration of characteristics of professionalism as defined in anatomical landmarks on the trunk and lower limb and data was
the American Physical Therapy Association’s Professionalism/Core acquired using a 3 dimensional motion analysis system (CODA
Values document, and cumulative GPA of 3.0 or higher. METHODS: MPX30). All subjects were asked to descend a single step (height
Investigators from 4 universities followed graduates throughout their = 0.14 m) and the mean performance in the 8 trials was averaged.
first year of practice. Data sources included: (1) semi-structured CAI subjects stepped down with the unaffected (or least affected)
interviews conducted at baseline and every 3 months for 1 year limb while uninjured subjects stepped down with the non-dominant
(3, 6, 9 and 12 months); (2) reflective journals completed twice limb. Kinematic data during single leg stance was analysed from
per month; and (3) review of artifacts such as academic and the limb not used in the stepping manoeuvre. ANALYSIS: The
clinical education records and resumes. An interview guide was kinematic data was sampled at 200Hz and CODA software was
developed and used by investigators for each interview. Interviews used to calculate steadiness, which was defined as the SD of
were audiotaped and transcribed verbatim. Guidelines for journal displacement of a trunk reference point as well as hip, knee and
writing were provided to participants. ANALYSIS: Data were ankle joint centres, during the stepping down task. Displacement
analyzed using a qualitative general inductive approach to analysis was measured in the anteroposterior (AP) and mediolateral (ML)
employing constant-comparison for within case and cross-case directions and greater standard deviations were considered indicative
analysis. RESULTS: Across the twelve cases and four universities, of less steadiness. Statistical significance was assessed using
five primary themes emerged: (1) Therapist learning was on-going independent sample t tests at p < 0.05. RESULTS: CAI subjects
throughout the year and accomplished through a variety of strategies were found to be less steady compared to uninjured subjects in
and via multiple sources; (2) Environmental factors that influenced the AP direction in the trunk (p = 0.03), hip (p = 0.01) and knee
learning and development included work place factors (culture of the (p = 0.01) but this was not significant in the ankle (p = 0.05). The
clinic, the practice community) and personal factors; (3) Professional AP steadiness was less in the CAI group for the trunk (49%),
role and identity development occurred in relation to self, PT/patient hip (53%), knee (20%) and ankle (100%). No difference was
relationships, and relationships with other colleagues, although there found in steadiness in the ML direction between the 2 groups
was individual variation in identity formation; (4) Recognition of the (p-value range = 0.17-0.98). CONCLUSIONS: CAI subjects show
vital importance of communication as an essential professional skill a consistent reduction in AP steadiness of the trunk and lower
continually grew and expanded over the year; (5) Perspectives varied limb on stair descent but no changes in ML steadiness. The
on the contribution of the professional education program to learning reduction in steadiness in CAI subjects was the greatest at the
and development during the first year of practice. CONCLUSIONS: ankle but this was not significant. IMPLICATIONS: Traditionally, CAI
For these promising novice therapists, interaction with patients, rehabilitation programmes have focused on exercises for balance
caregivers, peers and other professionals were important catalysts in the ML direction. This study suggests that it may also be
for learning and development during their early years of practice. beneficial to address trunk and lower limb steadiness in the
Mentorship and the workplace environment/experiences were critical AP direction. Future studies should evaluate whether altered AP
in shaping the nature and direction of growth. IMPLICATIONS: steadiness has any deleterious effects. KEYWORDS: Steadiness,
There is a need for continued longitudinal inquiry to fully understand balance. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
the forces that influence the early professional development of [email protected]
physical therapists. This study begins to address this gap in our ETHICS COMMITTEE: King’s College London Research Ethics
understanding of development during the early years of practice Committee
MEASUREMENT OF LOCAL LUNG VENTILATION DURING SHOULDER MUSCLE SIZE, COMPOSITION AND ACTIVITY
CHEST PHYSICAL THERAPY IN HEALTHY ADULTS BY MEANS FOLLOWING TREATMENT FOR BREAST CANCER
OF ELECTRICAL IMPEDANCE TOMOGRAPHY (PILOT STUDY)
Shamley D1 , Sriniganathan R1 , Watson M2 , Weatherall R3 ,
Wettstein M1 , Riedel T2 ,Radlinger L1 ; 1 Research Physiotherapy, Sugden E4 ; 1 Oxford Brookes University, Oxford, UK; 2 Department
University Hospital Bern, Switzerland; 2 Paediatric Intensive Care, of Radiology, Nuffield Orthopaedic Centre, Oxford, UK; 3 Centre
University Children’s Hospital Bern, Switzerland for Statistics in Medicine, Oxford, UK; 4 Department of Radiotherapy,
Churchill Hospital, Oxford, UK
PURPOSE: The aim of the study was to determine the distribution of
lung ventilation in different body positions and under the application PURPOSE: Despite the use of less extensive surgery and where
of Flutter® , PEP and CPAP in healthy adults. RELEVANCE: The possible the avoidance of radiotherapy to the axilla, there is still
knowledge of the distribution of lung ventilation is important for the morbidity affecting the shoulder. Muscle morbidity has been shown
for serratus anterior and lattissimus dorsi. Most soft tissue changes
respiratory chest physical therapy (CPT), because the efficiency
have been seen from the onset of radiotherapy (dose dependent) to
of mobilization of secretions is dependant on a good ventilation.
as late as 3 years after the start of radiotherapy. Current evidence
Electrical Impedance Tomography (EIT) provides a possibility to
of shoulder dysfunction is limited to goniometric measurements of
determine the distribution of ventilation in different body positions
glenohumeral movement and generally excludes scapula movements
during therapy. PARTICIPANTS: 5 healthy physiotherapists (3 m,
and muscle activity. Smooth scapulohumeral rhythm depends on the
2 f, 29.8 +/−5.8 years) familiar with CPT and the use of the
timed interaction of the muscles across the shoulder complex. A more
following respiratory aids: Flutter® , PEP and CPAP. METHODS: EIT
detailed understanding of the effects of treatment for breast cancer
measurements were performed during spontaneous breathing and
on the muscles of the shoulder is still needed. This study aimed to
with the use of three respiratory aids (Flutter® , PEP and CPAP)
provide some of this detail. RELEVANCE: Not every woman treated
in three different body positions (sitting upright, lying on the left
for breast cancer has access to an evidenced based rehabilitation
and lying on the right side). The sequence of respiratory aids
programme. The results of this study will form the basis of a DVD-
and body positions was randomized. CPAP and PEP pressures
based rehabilitation programme to be trialled in the UK and Africa.
were set to 15 mbar (similar to Flutter® -pressure). EIT sampling
PARTICIPANTS: 74 women treated for unilateral carcinoma of the
rate was 13 Hz. 3 measurements were performed for every body
breast in the last 6 years volunteered for the study. 54 of these
position and respiratory aid, with a total of 48 measurements of
women agreed to have an MRI scan. Exclusion factors were women
45 seconds each. ANALYSIS: Descriptive statistics and differences
with either, a history of shoulder pain or dysfunction, neurological
between respiratory aids (nonparametric: Friedman-Test) as well
conditions of the cervical spine or reconstruction surgery. METHODS:
as differences between sitting and lying position (nonparametric: All patients filled in a Shoulder Pain and Disability Index (SPADI).
Wilcoxon with Bonferroni correction) were calculated using SPSS. Bilateral EMG activity of four shoulder muscles was recorded during
RESULTS: In sitting position, there was no significant difference 3 repeat movements of scaption (n=74). Muscle cross sectional
(p = 0.516) of the ventilation of the right and left lung independent of area and signal intensity of these muscles (n=54) was determined
the used respiratory aid. Following analyzes focus on the right lung: from axial STIR images of MRI scans. Cross sectional area was
In lateral position ventilation of the dependent lung increased for 30.1 taken at spinal levels T2, T4 and T6. ANALYSIS: The relationship
±16.5% (p = 0.043) and decreased randomly 7.6 ±22.1% (p = 0.500) of both EMG activity and MRI with other factors was explored
for the independent lung during spontaneous respiration. During using multiple linear regression and stepwise methods. RESULTS:
CPAP therapy the ventilation of the dependent lung increased by All muscles were significantly less active on the affected side
48.4 ±12.2% (p = 0.043) and decreased for the independent lung by (p < 0.001). The longer the time since surgery the greater this effect
40.4 ±23.3% (p = 0.043). During Flutter® therapy the ventilation of the for pec major, serratus and rhomboid (p < 0.001). Low activity in
dependent lung decreased by 6.7 ±15.2% (p = 0.225) and increased trapezius and rhomboid were associated with a high SPADI score
for the independent lung by 14.4 ±11.4% (p = 0.080). During PEP (p < 0.001). All medical treatment protocols had an association with
therapy the ventilation of the dependent lung decreased by 2.8 the low performance of the muscles (p < 0.001) with no pattern
±18.0% (p = 0.500) and increased for the independent lung by 12.4 apparent. Pectoralis major and pectoralis minor on the affected
±14.4% (p = 0.225). CONCLUSIONS: The ventilation distribution side are smaller (p < 0.05). A smaller pectoralis major is associated
during spontaneous breathing corresponds to the literature. CPAP in- with a higher SPADI score (p < 0.001) and a smaller pectoralis
creases the ventilation in the dependent lung in lateral position, which minor is associated with a longer time since treatment (p < 0.001).
has already been shown by other authors. Surprisingly this effect can CONCLUSIONS: Muscle activity at the shoulder is affected by the
not be observed during PEP- and Flutter® -therapy. There is even treatment for breast cancer and is not confined to a particular
a trend to an increased ventilation of the independent lung. These surgical and radiotherapy protocol. These effects can in fact get
results must be confirmed in a larger study with calculated adequate worse over time and together with the changes in muscle size of
sample sizes. IMPLICATIONS: EIT is a simple non-invasive method the pec muscles are likely to lead to altered movement patterns and
to measure local ventilation. Respiratory chest physical therapy may pain reported by so many patients. IMPLICATIONS: Rehabilitation
be guided by EIT in future. CPAP with appropriate positioning can programmes and the training of health care professionals responsible
be used to improve local ventilation (e.g. atelectasis). Up to now it for delivering these programmes must address these findings. A
was assumed that Flutter® and PEP also increase ventilation of the DVD-based home programme is being developed and trialled in the
dependent lung. This assumption may be wrong, which will influence UK and Africa in order to ensure that as many women as possible
in the choice of the positioning during these therapies. KEYWORDS: have access to evidence based physiotherapy care. KEYWORDS:
Electrical impedance tomography (EIT), ventilation distribution, cancer; musculoskeletal; EBP. FUNDING ACKNOWLEDGEMENTS:
Flutter® , PEP, CPAP. FUNDING ACKNOWLEDGEMENTS: none. We would like to thank the Oxford Radcliffe Hospitals Charity fund
CONTACT: [email protected] for their generous support. CONTACT: [email protected]
ETHICS COMMITTEE: The study was approved by the Ethics ETHICS COMMITTEE: Applied and Qualitative Research Ethics
Committee of Canton Bern, Switzerland Committe. AQREC no. A02.064
Research Report Platform Presentation motor disabilities to those without disabilities. A secondary purpose
1236 Wednesday 6 June 12:05 is to identify barriers to and facilitators of a successful transition to
VCEC Meeting Room 16 young adulthood for persons with developmental motor disabilities.
WORK-RELATED MUSCULOSKELETAL DISORDERS AMONG RELEVANCE: Therapists often provide intensive intervention for
PHYSICAL THERAPISTS IN ISRAEL. PREVALENCE, children with cerebral palsy or spina bifida. Historically, little
PREDICTION AND PREVENTION attention has been paid to the outcome of these children as
they enter adulthood. Knowing the personal and environmental
Rozenfeld V1 , Ribak J2 , Carmeli E3 ; 1 Maccabi health services; 2 Tel
factors associated with a successful transition to emerging adulthood
Aviv University Environmental & Occupational Health department.,
(ages 20 to 30) can help direct successful intervention strategies
Sackler Faculty of Medicne; 3 Tel Aviv University Physical Therapy
in childhood, geared to helping therapists know how families
Department, Sackler Faculty of Medicne, Steyer School of Health
can effectively prepare for the eventual transition to adulthood.
professions
PARTICIPANTS: A volunteer sample of adults 20 to 30 years old
PURPOSE: Musculoskeletal disorders are a significant problem with motor disabilities (MD) (n=76) and without motor disabilities
among healthcare workers around the world. Physiotherapists (PT’s), (NMD) (n=72). Fifty-four adults with cerebral palsy (25 males) and
who commonly treat patients with these disorders, are also at risk 22 with spina bifida (10 males) participated in the group with MD.
of work-related musculoskeletal disorders (WRMSD’s) during their The group with MD had a mean IQ of 86.9 (SD 16.4) and the group
professional life, despite their knowledge of body mechanism and with NMD had a mean IQ of 104.5 (SD 8.9) as measured with the
injury prevention. The purpose of this study was to investigate the Kaufman’s Brief Intelligence Test. Mean age of participants was 25.0
prevalence of WRMSD’s among Israeli PT’s and their responses to years (SD 3.1) for the group with MD and 24.9 years (SD 3.3) for
injury. RELEVANCE: Investigation of the combined effect of all risk the group with NMD. Participants were selected if they reported they
and preventive factors will help to predict the potential incidence could read at the grade 7 level. METHODS: Participants completed
of WRMSD’s in different body areas. PARTICIPANTS: A 5-page eight reliable and valid questionnaires. They were also interviewed
Cromie modified, translated into Hebrew and validated questionnaire in their homes using a semi-structured interview. ANALYSIS:
was distributed to 182 PT’s who work in out-patients clinics Hierarchical regression analyses were done using SPSS. These
and rehabilitation centers, 127 PT’s answered. METHODS: The analyses explored predictors of success (defined as employment
Questions included the occupational history of the PT’s life and the status and psychosocial maturity), including personal (age, gender,
one-year prevalence of WRMSD’s in different body areas, job-related cognitive abilities, educational achievement, emotional health, coping
risk factors, injury prevention strategies and responses to injury, as style, gross motor functioning) and environmental (parents’ fostering
well as various demographic data. ANALYSIS: A Chi-square test of autonomy, family functioning, transportation availability) factors.
was used to find out the relationship between occupational fields and RESULTS: For persons with disabilities, being female, being more
symptoms in each body area, Spearman correlations were used to physically involved and not having independent transportation were
find the relationship between personal and professional risk factors factors that contributed to a less successful employment history
and symptoms in each body area, multiple regressions were used (36% of the variance explained). Age, depression, problem-focused
for a predictive model for injuries in each body area. RESULTS: coping, and fathers’ fostering of autonomy were factors that explained
Lifetime prevalence of WRMSD’s was 83%. 45% of PT’s have had 65% of the variance of participants’ scores on a measure of
it in the first five years of their career. The highest prevalence of self-reported psychosocial maturity. CONCLUSIONS: Both personal
WRMSD’s was in the following anatomical areas: lower back (80%), and environmental factors are associated with employment success
neck (59%), upper back (54%), and wrist/thumb (46%). Working in and perceived maturity during emerging adulthood. IMPLICATIONS:
rehabilitation centers was related to an increased prevalence of lower Therapists need to consider the emotional health of young adults and
back pain (p < 0.001, OR=8.0). Working in out-patients clinics was encourage use of problem-oriented coping skills. Pediatric therapists
related to an increased prevalence of thumb (p < 0.001, OR=6.0) and can use the results of this study as they discuss employment
wrist pain (p < 0.01, OR=3.1). The multi-system model was significant challenges with the children and families with whom they work. It
for all 10 body areas and predicts WRMSD’s with explained variance is also important for therapists to be familiar with the employment
between 10%-36%. CONCLUSIONS: Factors that turned out to be opportunities and supports for persons with motor disabilities in their
the main predictors of WRMSD’s include inadequate training in injury own communities. KEYWORDS: Transition to Adulthood, Cerebral
prevention, continuing to work when injured or hurt, not enough Palsy, Spina Bifida, Emerging Adulthood, Psychosocial Maturity,
rest breaks during the day and work scheduling. IMPLICATIONS: Employment, Success. FUNDING ACKNOWLEDGEMENTS: The
Specific strategies to reduce work-related injury should be developed study was funded by Alberta Heritage Foundation for Medical
and applied to the physiotherapy population in each occupational Research (AHFMR) and Canadian Institutes of Health Research
specialization as part of preventing WRMSD’s according to predictive (CIHR). Dr. Darrah was funded by a New Investigator Grant from
factors in each body area. KEYWORDS: occupational disorders, CIHR. CONTACT: [email protected]
prevention, risk factors. FUNDING ACKNOWLEDGEMENTS: This ETHICS COMMITTEE: Health Research Ethics Board, Edmonton,
work was unfunded. CONTACT: [email protected] AB, Canada and Conjoint Health Research Ethics Board, Calgary,
AB, Canada

VCEC Meeting Room 17 PP Crystal Pavilion A
PERSONS WITH DEVELOPMENTAL MOTOR DISABILITIES: INQUIRING ABOUT A HISTORY OF CHILDHOOD ABUSE:
PREDICTING SUCCESS DURING TRANSITION TO ADULTHOOD DISCLOSURE CAN ENHANCE CLIENT-CENTERED CARE
Darrah J1 , Magill-Evans J2 , Galambos N3 , Nickerson C1 ; Schachter C1 , Teram E2 , Stalker C2 , Lasiuk G4 , Danilkewich A3 ,
1 Department of Physical Therapy, University of Alberta, Edmonton,
Hovey A2 ; 1 School of Physical Therapy, University of Saskatchewan,
CANADA; 2 Department of Occupational Therapy, University Saskatoon, SK Canada; 2 Faculty of Social Work, Wilfrid Laurier
of Alberta, Edmonton, CANADA; 3 Department of Psychology, University, Waterloo, ON Canada; 3 College of Medicine, University
University of Alberta, Edmonton, CANADA of Saskatchewan, Saskatoon, SK Canada; 4 Faculty of Nursing,
PURPOSE: The main purpose is to identify factors that predict University of Alberta, Edmonton, AB Canada
employment status and psychosocial maturity in emerging adulthood PURPOSE: Within a broader study of the experiences of adult
and to compare the outcomes for young adults with developmental survivors of childhood sexual abuse with physical therapists and other
health professionals, we sought to examine whether asking about Research Report Platform Presentation
a history of childhood abuse during history-taking could facilitate 591 Wednesday 6 June 12:30
client-centered care and if so, how survivors thought it might do VCEC Meeting Rooms 19-20
so. RELEVANCE: The high prevalence rates of childhood sexual PREDIAGNOSTIC BODILY EXPERIENCES IN WOMEN WITH
abuse (1 in 3-5 femailes and 1 in 7-10 males) in the general FIBROMYALGIA, A CHALLENGE FOR PHYSIOTHERAPISTS?
population suggests that clinicians in all health disciplines work,
often unknowingly, with survivors. This is particularly relevant for Wanvik A1−4 ; 1 Sør-Trøndelag University College, Faculty of Health
physical therapists because childhood sexual abuse is implicated Education and Social Work Trondheim; 2 Norwegian University
in the many chronic pain syndromes in adulthood. PARTICIPANTS: of Technology and Science, Institute of Social Work and Health
46 female and 49 male survivors of childhood sexual abuse from Science Trondheim; 3 The Norwegian Fibromyalgia Association;
4 The Norwegian Physiotherapist Assosiation
6 Canadian provinces. METHODS: Employing a grounded theory
research approach, we conducted semi-structured interviews about PURPOSE: To investigate prediagnostic bodily experiences of
participants’ experiences with physical therapists and other health women with a recent fibromyalgia(FM) diagnosis.To learn as much
professionals (excluding mental health professionals) and their ideas as possible about how they understood and coped with theese
about practice that would be sensitive to their needs, including ways experiences in the years before they got FM. RELEVANCE:
of inquiring about abuse. ANALYSIS: Using the constant comparative Fibromyalgia is a condition that developes over years,with local
method (Glaser & Strauss, 1967), the data analysis began when the and widespread pain which is chronifying.Physiotherapists meet
data collection commenced and informed the ongoing interviewing theese patients while they are developing fibromyalgia, and they
process. The audiotaped interviews were transcribed and analyzed dont seem to be sufficiently aware of this health population as
independently by the researchers using NVivo 1.3. The researchers a risk group for developing fibromyalgia. PARTICIPANTS: Five
discussed their analyses to achieve a consensus about themes women; aged from 27 to 57 years with a recent fibromyalgia
seen in the interviews. The data interpretation was also shared diagnosis, participated.3 came from the Norwegian Fibromyalgia
with participants to ensure that it reflected their perspectives. Assosiation and 2 from a cooperating medical doctor. METHODS:
RESULTS: Most survivors stressed that the experience of childhood
A qualitative apprach was taken, using a life world intervju, and
abuse affected their health, their reactions to clinicians, and their
a retrospective design. The study is based on the understanding
ability to participate in and benefit from healthcare interventions.
of the body as a unity of body and self, according to the body
They advocated that all clinicians should have basic knowledge
phenomenology theory of Maurice Merleau-Ponty.The interviews
about the dynamics and long-term health effects of interpersonal
last from 45 to 65 minutes and they are transcribed. ANALYSIS:
violence. Furthermore, a clinician’s knowledge and skill in inquiring
The interviews were analysed according to Giorgis phenomenolgical
about abuse and sensitively responding to disclosure was crucial
scientific method, which has 4 steps. Reading through the transcripts
to survivors’ sense of safety, their willingness to share their past
several times,to familiarize, identifying units of meaning and sorting
experiences and discuss implications for treatment with the clinician.
them into codes, grouping the codes into categories and last,
Even for survivors who chose not to disclose, inquiry about past
identifying new patterns and meanings from the text. RESULTS:
abuse was seen as an indicator of a clinician who understands
The women suffered for many years before they got FM, they
that violence can affect the body and the therapeutic relationship.
sought many kinds of help for their plains without getting it, in
Participants emphasized that physical therapists must take into
the prediagnostic years. They all lived through very stressful life
account the implications of a positive history of interpersonal
violence for treatment and identified numerous ways of refining events in the years before the diagnosis,which put a lot of mental
client-centered care based on this information. CONCLUSIONS: A and physcial pressure on them. They ignored tiredness and pain
history of childhood abuse violence affects client health and health in their bodies for long periods of time, and put the needs of
care. Physical therapists’ inquiry about experiences of childhood other persons before their own needs. They did not seem to
abuse is an important part of understanding the health history identify with their own body, illustrated by expressions like; “its
and health care needs of all clients. IMPLICATIONS: These ok for me, but not for my body”. In very stressful periods their
findings suggest that physical therapy students and clinicians in all bodies felt strange and unreal, like they were performing in a
areas of practice should learn about childhood abuse and other play, and some felt themselves going outside their own bodies.
interpersonal violence, and ask adult clients specific questions They did not understand what was going on with their bodies.
about experiences of abuse and other forms of violence. In They felt unable to alter the situation and that they had pull
order to provide the most appropriate and client-centered care, themselves together and to stay in the situation until it was no
clinicians must also explore the implications of a positive history of longer possible. CONCLUSIONS: What they felt in their bodies
interpersonal violence to the client’s needs during examination and were not information they were in a position to make use of,it
treatment. KEYWORDS: interpersonal violence, client-centered care, did not make sense to them. They received little help from
disclosure. FUNDING ACKNOWLEDGEMENTS: This research has health workers to alter their illness behavior. There seemed to
been funded by: Physiotherapy Foundation of Canada, University of be a dichotomy between their conception of themself and of
Saskatchewan, Wilfrid Laurier University, Health Canada. CONTACT: their conception of their body. IMPLICATIONS: Physiotherapists
[email protected] should be able to identify this health population as a risk group
ETHICS COMMITTEE: Ethics approval for this project was received for developing fibromyalgia and to help theese women to gain
from the University of Saskatchewan Behavioral Research Ethics a stronger identification with their own bodies, and to healp
Board. them to a better understanding of the signs coming from their
body in the prediagnostic period. Further to help them develope
a less destructive illness behaviour,and and to gain a deeper
understanding of the unity of body and self. KEYWORDS: body-
subject, prediagnostic fibromyalgia, bodyphenomenology. FUNDING
ACKNOWLEDGEMENTS: This work is a part of my master thesis,
which I did at the Norwegian University of Science and Technology,
Faculty of Social work and health science, Trondheim, Norway in
2005. It was funded partly by the Sør-Trøndelag University College,
Faculty of Health Education and Social Work, Trondheim, Norway,
were I work as an assistant Professor at the Physiotherapy Program. I
also got funding resourses from the Norwegian Physiotherapy Assosi-
ation and by the Norwegian Fibromyalgia Assosiation. CONTACT: used more widely. KEYWORDS: therapeutic relationship, childhood
[email protected] abuse; client-centered care. FUNDING ACKNOWLEDGEMENTS:
ETHICS COMMITTEE: The medical committe for medical research This research has been funded by: Physiotherapy Foundation of
ethics, Mid-norway Canada, University of Saskatchewan, Wilfrid Laurier University, and
Health Canada. CONTACT: [email protected]
ETHICS COMMITTEE: Ethics approval for this research was
received from the University of Saskatchewan Behavioral Research
2213 Wednesday 6 June 12:50 Ethics Board.
BEFORE YOU TOUCH: DEVELOPING A RESEARCH-BASED Research Report Platform Presentation
HANDBOOK FOR CLINICIANS WORKING WITH MEN AND
WOMEN WHO HAVE EXPERIENCED CHILDHOOD ABUSE
Schachter C1 , Stalker C2 , Teram E2 , Lasiuk G3 , Danilkewich A4 ,
AN ANALYSIS OF PHYSICAL THERAPY PRACTICE RELATED
Hovey A2 ; 1 School of Physical Therapy, University of Saskatchewan,
TO OBESITY MANAGEMENT
Saskatoon, SK Canada; 2 Faculty of Social Work, Wilfrid Laurier
University, Waterloo, ON Canada; 3 Faculty of Nursing, University Williamson E, Hunt D; Florida Gulf Coast University
of Alberta, Edmonton, AB Canada; 4 College of Medicine, University
PURPOSE: Obesity has become a worldwide epidemic. Until
of Saskatchewan, Saskatoon, SK Canada
recently, the emphasis on evaluating overfatness and its clinical
PURPOSE: To create a research-based handbook to assist phys- implications has been focused in developed countries. However,
ical therapists, other health professionals and students to work lifestyle and technological changes in developing countries has
sensitively with men and women survivors of childhood sexual made obesity a worldwide concern. Physical therapists traditionally
abuse. RELEVANCE: The high prevalence of childhood sexual abuse have had little role in addressing issues related to obesity. In the
in the general population (1 in 3-5 females, 1 in 7-10 males) United States, the APTA’s Vision Statement 2020 addresses the
suggests that clinicians often unknowingly encounter survivors in issue of providing prevention services. Little evidence has been
their everyday practice. We sought to capture the experiential presented on how well physical therapists believe they are prepared
knowledge of survivors and clinicians to create a Handbook that is for this area of practice nor how frequently they are practicing these
highly relevant to both groups. PARTICIPANTS: 46 female and 49 skills. RELEVANCE: This study assists educators and clinicians in
male survivors of childhood sexual abuse and 200 physical therapists evaluating the preparedness of the profession to address the world
and other health professionals from across Canada. METHODS: health issue of obesity management. PARTICIPANTS: Members
To ensure the credibility and relevance of the research findings of the Florida Physical Therapy Association who had active e-
and to avoid the replication of traditional client-clinician power mail accounts were invited to participate. METHODS: A web-based
dynamics in both the research process and product, we combined survey instrument was developed to measure physical therapists’
grounded theory and action research methods. Survivors were current use and confidence in patient interview, examination and
interviewed about their experiences with physical therapists and other intervention skills specific to obesity management. IRB approval was
health care professionals (excluding mental health professionals) granted by the sponsoring institution and e-mails were sent to 2109
and asked for their ideas about practice that would be sensitive to physical therapists in the State of Florida, of which approximately
their needs. Using summarized analyses of the interviews, working 1600 appeared to be valid e-mail addresses. Those who elected to
groups composed of several men or women survivors and several participate returned the survey by electronic anonymous submission.
professionals (physical therapists, physicians or nurses) met on ANALYSIS: Descriptive statistics were generated for demographic
several occasions to develop guidelines for practicing in ways that data as well as participants’ responses to each of the Likert-scale skill
are sensitive to survivors and realistic for clinicians. Cumulative items (1 low, 5 high). A multiple regression analysis was conducted
information was shaped into the first draft of the Handbook, which to determine which of the demographic items were predictive of
was sent to interview and working group participants for review the confidence or skill use item groups. RESULTS: Sixty-percent
and feedback. The second draft of the Handbook was emailed to of the respondents received their education in the southest United
clinicians and counselors across Canada; feedback was incorporated States with the remainder representing all other regions of the
into the next draft. Feedback on the third draft was gathered country. Six percent were educated outside the United States. Mean
via focus groups of physical therapists, nurses, physicians and years of experience was 16.45, with an average of 0.94 post-
dentists in Ontario and Saskatchewan and incorporated into the final professional continuing education sessions on obesity management
version of the Handbook. ANALYSIS: At each phase of the project, issues. Confidence for interview and intervention skills was relatively
researchers discussed and agreed upon the interpretation of data high (m = 4.13, and m = 3.93 respectively). Skill usage for each of
among themselves and then with participants, to ensure that the the subset areas was consistently lower than confidence level, with
analysis was consistent with participants’ perspectives. RESULTS: usage of examination skills being the lowest (m = 1.33). Regression
The term ‘Sensitive Practice’ was coined to describe practices that coefficients demonstrated that prior nutrition coursework as well
would be sensitive to the needs of survivors. The hallmark of sensitive as being more highly educated were the strongest predictors for
practice is the facilitation of the survivor’s feeling of safety during confidence in the included skills (by subset). Negative coefficients
encounters with clinicians. The guiding principles that contribute to for the degree earned at entry-level were observed to be significant
safety include: respect, taking time, sharing control and information, for items related to use of skills. Years in practice was only
establishing rapport, attending to boundaries, and understanding the a predictor for confidence in interview skills (b = 0.263, t=2.76,
dynamics and long term effects of abuse. CONCLUSIONS: The p = 0.006) CONCLUSIONS: Participating PTs demonstrate poor to
Handbook on Sensitive Practice offers extensive practical, research- moderate confidence in interview, examination, and intervention skills
based suggestions for refining client-centered care of survivors of related to obesity management. Low levels of usage is observed in
childhood abuse. IMPLICATIONS: Since clinicians do not always these skills, with examination skills being used at a very minimum
know when they are working with survivors, Sensitive Practice level. IMPLICATIONS: Analysis of practice is necessary to better
needs to be regarded as universal procedures. The failure to understand how well the profession is meeting the needs of the
practice sensitively increases the risk of retraumatizing survivors obese client and what changes are necessary in the entry-level
and negatively affect their health. Research to identify effective and post-professional education. Broading the sample will provide
pedagogical methods for knowledge transfer of Sensitive Practice for a more representative group from which to draw conclusions.
to students and clinicians is required to ensure that it becomes Analysis of university curricula, paired with a better understanding of
current practice patterns, will allow for a clear view of the development Diagnosis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT:
needed in the profession. KEYWORDS: Obesity, practice patterns,. [email protected]
FUNDING ACKNOWLEDGEMENTS: None. ETHICS COMMITTEE: Nottingham Research Ethics 2, 1 Standard
ETHICS COMMITTEE: IRB Committee at Florida Gulf coast Court, Park Row, Nottingham NG1 6GN, England, UK
University
VCEC Meeting Rooms 19-20 AN INVESTIGATION INTO THE EFFICIENCY OF PATIENT
RECALL ABILITY IMMEDIATELY AFTER PHYSIOTHERAPY
THE PERCEPTIONS AND EXPERIENCES OF PATIENTS
TREATMENT IN AN OUTPATIENT SETTING
RECENTLY DIAGNOSED WITH FIBROMYALGIA SYNDROME
Cooney M, Norman L, O’Mahony C; Physiotherapy, School of
Diver C1,2 , Avis M1 , Freeman K1 ; 1 The University of Nottingham, Medicine, Trinity College, Dublin
Nottingham, UK; 2 Nottingham University Hospitals NHS Trust,
Nottingham, UK PURPOSE: This study aimed to establish the amount and type
of information currently being delivered to patients in a physio-
PURPOSE: To describe the perceptions and experiences of patients therapy outpatient setting. The proportion of the information that
on being recently being diagnosed with fibromyalgia syndrome. could be recalled immediately afterwards was then investigated.
RELEVANCE: Fibromyalgia syndrome (FMS) is a musculoskeletal RELEVANCE: Imparting information to patients forms an essential
condition of unknown aetiology characterised by chronic widespread part of physiotherapeutic management, as most conditions that
pain and poor sleep. It predominantly affects middle-aged women. physiotherapists treat require patients to actively participate in
There is no diagnostic test and diagnosis is criteria based and preventing pain and mechanical dysfunction. (Sluijs et al 1993a,
often contested. Previous studies have reported patient perceptions Henry et al 1999, Trede 2000). The effectiveness of this aspect of
of being diagnosed with fibromyalgia but this is in patients who intervention is therefore dependent on whether patients remember
have been in receipt of their diagnosis for some time (1-30 the advice they receive. Patients’ ability to recall advice has not
years). This study investigates this phenomenon within 2 months been investigated PARTICIPANTS: Patients who presented to the
of diagnosis. PARTICIPANTS: 23 patients (22 female, 1 male) with out-patients department of a large Dublin hospital with a back
a first diagnosis of FMS by a Consultant Rheumatologist were or neck complaint were approached, the study was explained
recruited from a Secondary Care Hospital. The patients are part verbally and in leaflet format. Patients were asked to give informed
of a larger longitudinal and on-going 2 year study. METHODS: consent as to whether they wished to participate. Inclusion criteria
Qualitative in-depth semi-structured interviews were used to identify required patients to be over 18 years, English speaking with no
the perceptions and experiences of patients recently diagnosed with known cognitive/memory defects. Patients attending their first or
FMS. An interview guide was formulated from previous research second treatment session were recruited, as Sluijs et al (1991)
on FMS and chronic illness. Patients were given of choice of found that there was a significant increase in the amount of
where the interview was conducted: their home, the hospital, the information physiotherapists gave during these sessions in relation
university or any other venue they suggested. The Fibromyalgia to the rest of the treatment period. METHODS: The study involved
Impact Questionnaire (FIQ) was performed at baseline to describe recording the information given by the physiotherapist treating the
the sample recruited. Interviews were tape recorded and hand written patient. Information was recorded under three headings advice,
notes made. ANALYSIS: The interviews were transcribed verbatim. exercises and information about the condition. Following treatment
They were analysed using qualitative content analysis. The data the patient was interviewed. The patient interview firstly obtained the
was coded using NVivo and then recurrent themes and meanings patient characteristics; age, sex, marital status, occupation, level of
were identified. RESULTS: ‘Being diagnosed’ was an important event education, previous visits to physiotherapy, chronicity of the condition
in the patient’s life. Four descriptive categories were grounded in and medication intake. A structured interview followed, where the
the data, labelled struggle for a diagnosis, meanings attached to subjects were asked to recall the information the physiotherapist had
the diagnosis, access to help and the future. For many patients given them, using a standardised set of questions. The questions
the receipt of a diagnosis was a significant event in a journey that were open-ended but referred to a certain topic therefore the
had usually begun some years previously with a visit to their GP. information gained on answering them was calssified as cued recall.
Whilst the diagnostic label legitimised the way they felt, it was also If the information was not recalled, a prompt was given from
interpreted as ‘uncertain’ and ‘incurable’ and frequently linked with a standardised list. The information recalled by this means was
previous life events. Provision of a diagnosis provided them access considered cued recall with prompting. ANALYSIS: The number and
to help and information that was previously unavailable and for some type of statements made by the physiotherapist were counted and
to consider the future and begin the process of acceptance and categorised. The percentage of statements recalled by patients was
adaptation. CONCLUSIONS: This study highlights the importance calculated and categorised as either cued recall or prompted recall.
of receiving a diagnosis to patients with an ‘invisible illness’ like RESULTS: An average of seven statements were made by each
FMS and the importance of validating both subjective and objective physiotherapist, mostly regarding treatment and exercises. The mean
findings. There are disadvantages of diagnosis associated with patient recall was 86%. Advice, treatment and exercises were equally
stigma and an uncertain illness trajectory. However, these are out- well recalled, and information on condition the least. Optimal recall
weighed by the advantages of being able to construct a new identity, occurred when 6-7 statements were delivered. CONCLUSIONS: At
acknowledgement and acceptance of the illness and the ability to least 14% of information was lost within the first few minutes post
consider adaptive coping strategies. IMPLICATIONS: Currently there treatment. While this is a small percentage it raises the question as
is a predominance of the “biological” in the biopsychosocial model, to how much is lost over a longer time frame and what effect this has
in the assessment and management of patients with FMS.Health on the effectiveness of intervention. It is necessary to repeat advice
care professionals should be made aware of the importance of given. IMPLICATIONS: Physiotherapists need to limit the amount of
an early diagnosis on the perceptions and experiences of patients information they give to patients, prioritise its content and consider
with FMS.In assessing and manageing patients with FMS they ways that they can enhance recall. KEYWORDS: patient education,
need to consider: the importance of being believed; the role of a cued recall, prompted recall. FUNDING ACKNOWLEDGEMENTS:
medical diagnosis; the significance of the language used and the unfunded. CONTACT: [email protected]
impact of diagnosis on identity and stigma. KEYWORDS: Qualitative ETHICS COMMITTEE: Dublin Federated Hospitals Joint Ethics
research; Semi-structured interviews; Fibromyalgia syndrome (FMS); Committee
OBESITY AS A LIFE EXPERIENCE CLASSIFICATION OF PERSONS WITH FIBROMYALGIA:
Rugseth G1 , Engelsrud G2 ; 1 Section for Health Science, University RELIABLE AND VALID SUBGROUPS BASED ON THE
of Oslo, Norway; 2 Section for Health Science, University of Oslo, MULTIDIMENSIONAL PAIN INVENTORY (MPI-D)
Norway Verra M1,2 , Angst F2 , Brioschi R3 , Lehmann S2 , Aeschlimann A2,4 ;
1 Physiotherapy Department, RehaClinic, Zurzach, Switzerland;
PURPOSE: The project explores what obese people experience 2 Research Department, RehaClinic, Zurzach, Switzerland; 3 Clinical
prior to and during their participation in treatment that is aimed at
changing lifestyle. Through a phenomenological perspective, obesity Psychology, RehaClinic, Zurzach, Switzerland; 4 Rheumatology
is in this project extended from being understood as a risk factor Department, RehaClinic, Zurzach, Switzerland
or a disease to being seen as a personal experience and as a PURPOSE: The aims of this study were to investigate if it was
phenomenon influenced by cultural discourse. RELEVANCE: There possible to replicate and describe the three cluster solution and
is a growing incidence and prevalence of overweight and obesity profiles found in other pain groups and describe cluster profiles
globally. Overweight and obesity are said to be risk factors for the based on self-reported Multidimensional Pain Inventory-scores for
development of diseases such as type 2 diabetes, hypertension, patients with fibromyalgia, describe characteristics of the cluster in
cardiovascular disease and cancer. Treatment programmes have relation to physical function, fear and depression, and coping at the
been developed worldwide to support people in their efforts to change same point in time and to validate the cluster solution by comparing
their lifestyle and lose weight. The main issues in these programmes clusters in physical function, fear and depression, and coping over
are reducing food intake and engaging people in a higher level time. RELEVANCE: Physical Therapists realise that the group of
of physical activity. It is evident that most people who lose weight persons with fibromyalgia is extremely heterogeneous with regard
during different treatment programmes regain it. This fact challenges to its etiology and responsiveness to interventions. The process of
the content of the treatment programmes. Physiotherapists play subclassification of fibromyalgia is a clinical reality but undertaken on
a central role in these treatment approaches. PARTICIPANTS: a individual clinical level. Classification of persons with fibromyalgia
12 obese persons attending a treatment programme. METHODS: into homogenous subgroups is an important objective in order to
The informants participated in a treatment programme inspired tailor interventions and to control for subgroup differences when
by cognitive behavior therapy. The programme had been running evaluating treatment outcome. PARTICIPANTS: Eighty-five persons
for several years and was organised as group meetings in a with fibromyalgia took part in the study. All persons were participants
hospital setting. Twelve obese persons were interviewed prior to in the in-house Zurzach pain management programmes with a
their participation in the treatment. Furthermore, eight of these cognitive-behavioural approach, including physical exercise, and had
informants were observed through 17 group meetings in one year. no other diagnosis which could interfere with these rehabilitation
ANALYSIS: Data has been analysed through a phenomenological activities. METHODS: The measures used were the Multidimensional
perspective RESULTS: An analysis of the interviews shows that Pain Inventory-German version (MPI-D), the Medical Outcomes
the experience of losing weight and regaining it is widespread Study Short Form 36-German version (SF-36), the Hospital Anxiety
among the participants. Data from observations in the treatment and Depression Scale-German version (HADS-D), and the Coping
group show that this is a common experience and that it is not Strategies Questionnaire-German version (CSQ-D). ANALYSIS:
communicated during the treatment – neither by the participants Cluster analysis was conducted for the total sample MPI-D subscale
nor the group leader. Further analyses illuminate that weight loss scores. RESULTS: The adaptive copers cluster represented 23% of
is an experience associated with ambiguity. To lose weight is for the the sample, dysfunctional 47% of the sample, and interpersonally
subject both strongly desired and connected to a sense of insecurity distressed 30% of the sample. The external validation of the cluster
and discomfort. They experienced that ambiguity is paid no attention solution showed that there were several significant differences
during the group meetings. Food, meals and exercise are discussed between clusters in physical function, fear and depression, and
and described during interviews in multiple and ambiguous ways. coping measures. There was also a significant interaction effect
In the treatment group these issues are mostly communicated as (cluster x time) in physical function (SF-36). Persons in the
nutrition, which affects weight and demands exercise. The weight dysfunctional cluster reported decreased physical function over time.
loss experience alters people’s relationships with others. This is CONCLUSIONS: These results support the presence of different
commonly understood as positive: people who lose weight are subgroups among persons with fibromyalgia. Future research will be
described as clever, good-looking and determined. The interviewees needed to validate these outcomes on persons in different settings.
also describe the negative and unwanted implications connected to IMPLICATIONS: This classification on psychosocial factors can be
this altering of relationships. CONCLUSIONS: Obesity is commonly seen as a complement to a classification based on medical condition.
treated as an objective phenomenon, as if it existed in itself and We hypothesize, that subsequent randomized trials will demonstrate
solely as a problem. From the obese person’s perspective, being that effect sizes increase when classification and matching are
obese is a complex experience, understood as both safe, desirable taken into account. KEYWORDS: fibromyalgia, subgroups, MPI-D.
and unwanted, as a solution as much as a problem, and as a choice FUNDING ACKNOWLEDGEMENTS: This work was funded by the
as much as a disease. IMPLICATIONS: Several key issues derived SPA Rehabilitation Foundation. CONTACT: [email protected]
from the data are given little or no attention from the professionals ETHICS COMMITTEE: The study was approved by the local re-
running the weight loss treatment. These results has implications search ethics committee (Health Department in Aarau, Switzerland).
for health professionals engaged in planning and running treatment
programmes for the obese. KEYWORDS: Obesity, phenomenology,
treatment. FUNDING ACKNOWLEDGEMENTS: The project is
funded by the Norwegian “Fond for etter- og videreutdanning av
fysioterapeuter”. CONTACT: [email protected]
ETHICS COMMITTEE: National Committees for Research Ethics in
Norway
PP Crystal Pavilion A VCEC Ballroom A
APROACH TO STUDY AND LEARNING STYLE ACROSS PATELLAR TENDON VERSUS HAMSTRING TENDON
AN UNDERGRADUATE PHYSIOTHERAPY PROGRAM: ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION:A
IMPLICATIONS FOR MOVING STUDENT LEARNING FORWARDS COMPARISON OF SHORT AND LONG TERM OUTCOMES
Isles R1,2 , Cantwell R2 ; 1 The University of Queensland, Brisbane, Keays S1 , Bullock-Saxton J2 , Keays A, Newcombe P, Bullock M;
Australia; 2 The University of Newcastle, Newcastle, Australia 1 Nambour Selangor Hospital; 2 University of Queensland, Brisbane,
Australia
PURPOSE: The aim was to measure physiotherapy students’ learn-
ing styles and approaches to study across an undergraduate program PURPOSE: This study aimed to compare the short and long term
to provide a profile of these Australian physiotherapy students outcomes of anterior cruciate ligament (ACL) reconstruction using
and determine whether it remained stable across the program. two different graft sources. RELEVANCE: The choice of graft material
Relationships between learning style, approach to study and learning used for ACL reconstruction remains controversial. Despite the need
outcomes as measured by GPA were also sought. RELEVANCE: for well controlled, long-term outcome studies comparing PT with
Entry-level physiotherapists are required by the profession to possess STG grafting, few studies have followed results for over five years
certain knowledge, skills and professional attributes but are also and no study has included an uninjured control group. This long-
expected to be independent thinkers and problem solvers. Student term, prospective study provides evidence based research in relation
learning is influenced by many factors. Personal factors include self- to the management of a very common sporting injury frequently
efficacy, motivation, preferred cognitive learning style and approach treated by physiotherapists. PARTICIPANTS: Sixty two ACL ruptured
to learning. External factors include the imposed expectations of the patients awaiting surgery were recruited from an orthopaedic clinic.
university through curriculum, teaching and assessment practices Thirty one patients underwent reconstruction using the PT as a
and of the profession via professional standards. PARTICIPANTS: A graft (PT Group)and 31 underwent reconstruction using the STG
cohort of undergraduate physiotherapy students from the University tendons(STG Group). All patients followed a controlled quadriceps
of Queensland were invited into the study in first year and emphasized physiotherapy program pre-operation and for six months
subsequently in 3rd and 4th years. Forty-seven students completed after surgery. A total of 30 uninjured subjects matched for age, gender
all data. METHODS: A longitudinal study included data collection and sporting involvement formed the control group. METHODS:
using Biggs’ Study Process Questionnaire and Kolb’s Learning Patients were assessed pre-surgery, at three weeks post-surgery
Style Inventory. Students provided information on gender, age, first (morbidity assessment only), at six months and six years post-
language and entry score. Course results were also obtained. surgery. Uninjured control subjects were assessed over the same
ANALYSIS: Learning preferences and demographic information time frame. Assessment at three time frames included: stability
were investigated for relationships with students GPA at each year testing (clinical stability and KT 1000 testing); isokinetic quadriceps
level and overall. Statistical analysis included descriptive statistics, and hamstring strength testing at 60 and 120 degrees per second;
ANOVA and multiple regression analysis. RESULTS: Students in first functional performance testing comprising three agility (shuttle run,
year were predominantly surface learners although this decreased side step and carioca)and two hop tests, and finally radiology.
across the program. Deep and achieving learning increased between ANALYSIS: Mixed model ANOVAs were performed in order to assess
third and fourth years. Dominant learning preference was Abstract any differences between the groups at each of the time frames as
Conceptualisation with a shift from Assimilator to Converger (more well as any differences over time periods. RESULTS: At three weeks
active than reflective) across the program. Success in the clinical post surgery there was a higher morbidity incidence in the PT Group.
(fourth) year was predicted by Achieving Approach, female gender At six months post-surgery there was significant loss of quadriceps
and speaking English as the first language. An Achieving Approach, strength in the PT Group at both speeds (p < 0.001) and of hamstring
female gender and younger age predicted cumulative GPA. Deep strength at the faster speed in the STG Group (p < 0.05). Fifty-six
learning did not predict higher GPA at any level. CONCLUSIONS: patients were assessed at six years post- operation: Two patients
The nature of the curriculum influenced students learning strategies. had injured their grafts and five had ruptured the contralateral ACL.
Predominantly science based first year courses were accompanied Six subjects had undergone meniscal surgery. Clinical stability was
by Surface approaches to learning while later, increasing professional restored to all, other than the two reinjured, patients. KT1000 side-
focus on theory and practice and clinical practice immersion saw to-side differences were the same for the PT (1.9mm) and STG
a preference for Active Experimentation and the success of an Groups (2.02mm) but were significantly greater than that of uninjured
instrumental Achieving approach to study. This bias towards the control subjects (p < 0.001). In the more demanding functional tests
Achieving approach in the clinical year may reflect both the (hop and triple hop index and carioca), the STG group performed
need to develop clinical and broader management skills and the similarly to the control group, whereas there was a significant
underlying competitiveness associated with future employment. difference (p < 0.05) between the PT and the control groups. The most
Future qualitative analysis of motivating factors and learning methods important finding was a significantly higher incidence of tibiofemoral
in a broader cohort would provide greater insight to the drivers osteoarthritis (OA) in the PT Group(p < 0.001). CONCLUSIONS: Both
of learning. IMPLICATIONS: Physiotherapy teachers and clinical types of surgery restored stability to the knee joint but neither graft
educators need to develop innovative methods to optimise (deep) restored stability equal to that of uninjured control knees. Hamstring
clinical reasoning skills but also to foster the development of grafting resulted in less morbidity in the early postoperative stage,
reflective (metacognitive) and professional skills throughout the greater quadriceps strength at six months post-surgery and improved
program. This must be done in innovative ways academic and function with a lower incidence of OA six years after surgery.
clinical settings. Students should have the opportunity for early IMPLICATIONS: Hamstring tendon grafting is possibly the preferred
clinical experiences and time for reflection in order to optimise option for anterior cruciate ligament reconstruction. KEYWORDS:
their knowledge and skill integration. KEYWORDS: Student learning; knee reconstruction outcome. FUNDING ACKNOWLEDGEMENTS:
styles. FUNDING ACKNOWLEDGEMENTS: Data collection was Nil. CONTACT: [email protected]
supported by research higher degree student allowance through ETHICS COMMITTEE: University of Queensland, Australia
the University of Queensland. There was no funding from grants.
ETHICS COMMITTEE: Ethics Committee of the School of Education
and Faculty of Social and Behavioural Sciences, the University of
Queensland.
VCEC Ballroom B & C VCEC Meeting Room 16
USING AN OUTCOMES-BASED PAY-FOR-PERFORMANCE DO THE REDUCTIONS IN ACTIVE KNEE EXTENSION RANGE
PROCESS IN OUTPATIENT THERAPY TO ENCOURAGE OF MOTION DURING SLUMP TESTING SHOW VARIATION
EVIDENCE-BASED TREATMENT: A REAL DATA SIMULATION FORM DAY TO DAY?
Hart D1 , Connolly J2 , Scott K3 , Werneke M4 ; 1 Focus On Reid D, Tucker N, McNair P; Physical Rehabilitation Research
Therapeutic Outcomes, Inc.; 2 Connolly Strategies & Initiatives; Centre, Auckland University of Technology, Auckland, New Zealand
3 Presbyterian Health Plan; 4 CentraState Medical Center
PURPOSE: The aim of this study was to investigate the variation in
PURPOSE: Our purpose was to test through a real data simulation active knee extension range of motion (ROM) during slump testing
whether use an outcomes-based risk-adjusted pay-for-performance within and across days. RELEVANCE: The slump test is commonly
(P4P) method used to reimburse therapists treating patients receiving used clinically to assess the interaction of neural tissue in the
outpatient therapy would reduce reimbursement or provide a financial spine and lower limbs. There is a paucity of literature that has
incentive to produce good patient outcomes while using the least investigated the reliability of the test from day to day. PARTICIPANTS:
number of treatment visits. RELEVANCE: The P4P concept is A convenience sample of 10 male and 10 female asymptomatic
rapidly influencing payers and legislators in the US, and payers in subjects aged between 20-49 years (mean age 30.1 yrs SD: 6.4)
other countries are exploring P4P methods to reimburse clinicians. were recruited to participate in the study. METHODS: A test retest
However, most P4P plans are based on process, not outcome, and repeated measures methodology was undertaken. During the testing
most plans were developed for physicians. PARTICIPANTS: Data procedure the subjects were positioned in a KinCom® Isokinetic
from 189,088 patients (50 yr, SD 16, min 18, max 102, 39% male) in dynamometer chair for ease of access. For each test the starting
Focus On Therapeutic Outcomes, Inc. data set from 552 outpatient position was 90º flexion at the knee joint and the ankle in full
clinics in 40 US states treated by 3,447 therapists (2000-2003) dorsiflexion. Knee extension ROM was tested in two slump positions,
were analyzed retrospectively: 94% orthopedic, 4% medical, 2% first with cervical spine flexion and secondly with cervical spine
neurological conditions. Project had formal IRB approval. METHODS: extension. In the first position, the subjects were asked to extend
Patients entered functional status (FS) data at intake and discharge their knee until they reached the point of their perceived maximal
(self-report surveys). Therapists entered administrative data at discomfort due to the stretch. At this point the maximum knee
discharge. Because this was a retrospective data analysis, the project extension angle was recorded. The subjects were then instructed to
did not affect customary treatment. ANALYSIS: Using a previously extend their cervical spine and extend their knee further if possible.
developed, valid P4P model, patients were partitioned into risk- Knee extension ROM was then recorded in this position. Subjects
adjusted cells by diagnostic group, condition severity, symptom acuity repeated this sequence three times on each day. The testing was
and age. Within each cell, patients were placed into one of 9 repeated with a separation of two days. ANALYSIS: To compare the
payment groups using above, predicted, and below predicted FS data within and across days, a 2-factor repeated measures ANOVA
change (discharge-intake) and visits, which allowed comparisons (trials and days) model was utilised. Typical error was calculated
of FS change (effectiveness) and visits (efficiency).We developed using the standard deviation of the difference in scores (Day 2-
P4P payment levels for each risk-adjusted group that collectively Day 1 data). The interclass correlation coefficient (ICC) for trial
were designed to encourage clinicians to produce good outcomes one and for the average of three trials across days were also
efficiently. Payment estimated using the P4P method was compared calculated. Data were plotted using Bland and Altman graphs. The
to payment using a fee-for-service (FFS) method. RESULTS: There alpha level was set at 0.05. RESULTS: The findings showed that
were 396 homogeneous risk-adjusted cells of patients used in the there was no statistically significant difference across days (p > 0.05).
P4P method. A 12% reduction in payment was estimated using High ICC values, low typical error, bias values close to zero, and a
the simulation had providers been reimbursed using a P4P method random scatter in the Bland and Altman plots indicated the variation
compared to a FFS method. Using the P4P method, payment in angles measured across days was relatively low. There was a
was shifted to patients who reported greater FS gains while using significant difference of a small magnitude within days (across trials)
fewer visits compared to patients who reported lower FS gains for both cervical spine positions (p < 0.05). The knee flexion angle
while using more visits. CONCLUSIONS: Results suggest use of a was greatest in the first trial compared with latter trials for both
method of payment for therapy that is based on a risk-adjusted P4P flexed and extended conditions (p < 0.05). There was no interaction
model using measures of effectiveness and efficiency could reduce effect (p > 0.05) across day and trial factors. CONCLUSIONS: The
reimbursement, but more importantly, payment based on results study demonstrated that knee extension ROM could reliably be
may realign resources to patients who benefit from efficient therapy measured from day to day, however, some viscoelastic and stretch
and away from patients who are not benefiting but are continuing tolerance responses may be occurring across trials within testing
to receive treatment. Strengths of the P4P methods include risk- on a single day. IMPLICATIONS: These finding indicates that a
adjusted outcomes from a large sample. Limitations include the need clinician should be consistent in using the slump test. If they do
for more diverse patients by diagnosis and more risk-adjustment one trial at day one, they should only do one trial at day two of
variables. IMPLICATIONS: Because 1) the P4P process is based on testing, similarly if they do three trials on day one, then they should
patient self-reported outcomes and number of treatment visits and 2) do three trials on subsequent days. KEYWORDS: Slump, Knee
is independent of treatment, practice guideline or provider, the P4P extension, Reliability, Stretch. FUNDING ACKNOWLEDGEMENTS:
method of reimbursement may encourage providers to use evidence- None. CONTACT: [email protected]
based practice to produce effective and efficient therapy. Findings ETHICS COMMITTEE: This work was approved by Auckland
suggest a P4P process may allow payers to realign resources to University of Technology (AUT) Ethics Committee (05/104)
patients benefiting from effective and efficient treatment. A similar
therapist payment method might be of value in countries with
a single payer system. KEYWORDS: pay-for-performance, func-
tional status, patient-reported outcomes, evidence-based practice.
FUNDING ACKNOWLEDGEMENTS: Department of Health and
Human Services, Centers for Medicare and Medicaid Services, Grant
#18-P-93066/9-01. CONTACT: [email protected]
ETHICS COMMITTEE: Institutional Review Board of Focus On
Therapeutic Outcomes, Inc.
Research Report Platform Presentation Development Cooperation of the Katholieke Universiteit Leuven,
659 Wednesday 6 June 13:45 Belgium. CONTACT: [email protected]
VCEC Meeting Room 17 ETHICS COMMITTEE: Study protocols were approved by the
EFFECT OF SIMULATOR TRAINING ON DRIVING AFTER Medical Ethics Committee of the University Hospitals Leuven,
STROKE: A RANDOMIZED CONTROLLED TRIAL Belgium.
Akinwuntan A1 , De Weerdt W2 , Feys H2 , Pauwels J2 , Baten G3 ,
Arno P3 , Kiekens C4 ; 1 Medical College of Georgia, Augusta GA, Research Report Platform Presentation
USA; 2 Katholieke Universiteit Leuven, Belgium; 3 CARA, Belgian 1302 Wednesday 6 June 13:45
Road Safety Institute, Brussels, Belgium; 4 University Hospital VCEC Meeting Room 18
Pellenberg, Belgium
RESPONSIBILITY FOR PREVENTION, TREATMENT AND
PURPOSE: The neurological deficits experienced after stroke affect MANAGEMENT OF MUSCULOSKELETAL DISORDERS –
the ability to perform most activities of daily living including driving, an A MATTER FOR THE MEDICAL PROFESSIONALS, EMPLOYERS
activity that many stroke survivors (>50%) wish to continue. Different OR THE INDIVIDUAL?
methods have been employed to train persons with stroke to resume Larsson M1−3 , Nordholm L4 ; 1 The Sahlgrenska Academy at
driving without convincing evidence of benefits from such training Göteborg University Inst. of Neuroscience and Physiology/Physical
programs. The authors investigated the effect of the most promising Therapy; 2 The Vårdal Institute; 3 Primary care in södra Bohuslän,
method (use of driving simulators) on driving training after stroke. SWEDEN; 4 University college of Borås, SWEDEN
RELEVANCE: An effective and safe training method of driving after
stroke will not only ensure more safe post-stroke drivers but improve PURPOSE: Musculoskeletal disorders are common and often seen
the quality of rehabilitation and further enhance the quality of life as a burden both to the individual and to society, but to whom
after stroke. PARTICIPANTS: Eighty-three persons with first-ever or what do people place responsibility for prevention, treatment or
stroke and in the subacute phase. METHODS: Subjects performed management of these disorders? Do people attribute responsibility
a 5-week 15-hour training program in which they were randomly to the medical professionals, to employers, to themselves or do they
consider the matter out of their hands? The purpose of this study was
allocated to either an experimental (simulator-based driving training)
to describe peoples generalized attitudes regarding responsibility
or control (driving-related cognitive tasks) group. Performance in
for musculoskeletal disorders and explore associations between
off-road evaluations and an on-road test were used to assess the
these attitudes and background variables such as gender, age,
driving ability of subjects pre- and post-training. Outcome of an
education, presence of musculoskeletal disorders, sick leave, phys-
official pre-driving assessment administered 6 to 9 months post
ical activity and visits to care-providers. RELEVANCE: People with
stroke was also considered. ANALYSIS: The differences between
musculoskeletal disorders frequently consult physical therapists. We
the experimental and control groups at pre-training, post-training and
believe that knowledge of people’s attitudes regarding responsibility
follow-up assessments as well as improvements from pre- to post-
for musculoskeletal disorders would be helpful to provide the most
training were tested using unpaired t-tests or Wilcoxon rank sum
efficient prevention, management and treatment of musculoskeletal
tests. Within-group improvements in each group at post-training were
disorders. PARTICIPANTS: A random sample of an adult (above
compared using paired t tests or Wilcoxon signed rank tests. The
18 years old) general population (in the southwest of Sweden) of
decisions of driving fitness (in three classes) based on the on-road
1770 persons, resulting in a response rate of 61% (n=1082) was
test during each assessment period were compared between groups
included in the study of generalized attitudes regarding responsibility
using chi-square statistics. Improvements in the tasks evaluated in for musculoskeletal disorders. Approximately 690 persons could be
the simulator immediately after 15 hours of training were investigated included in the multiple logistic regression analysis. METHODS: A
using Wilcoxon signed rank tests. Logistic regression analyses were cross-sectional postal survey design was used. The letter sent out to
performed to identify subgroups of subjects that benefited most the participants included an information letter, a questionnaire and a
from the training programs. RESULTS: Both groups significantly pre-paid reply envelope. The first part of the questionnaire was the
improved in a visual and many neuropsychological evaluations Attitude regarding Responsibility for Musculoskeletal disorders (ARM)
and in the on-road test after training. There were no significant instrument. Part two of the questionnaire included sociodemographic
differences between both groups in improvements from pre- to post- questions about age, gender and education as well as questions
training except in the “road sign recognition test” in which the about physical activity, musculoskeletal disorders, sick leave during
experimental subjects improved more. Significant improvements in the last 12 months and about visits to care-provider. ANALYSIS:
a three-class decision of driving fitness (“fit to drive,” “temporarily Descriptive statistics were used to describe participants’ generalized
unfit to drive,” and “unfit to drive”) were found in favor of the attitudes regarding responsibility for musculoskeletal disorders.
experimental group post-training. Significantly more experimental Multiple logistic regression analyses with stepwise backward removal
subjects (73%) than control subjects (42%) passed the follow- of covariates were used to investigate the associations between
up official pre-driving assessment and were legally allowed to attitudes regarding musculoskeletal disorders (as measured with
resume driving. Academic qualification and overall disability together ARM) and background variables. RESULTS: A majority of the partic-
determined subjects that benefited most from the simulator-based ipants had internal views regarding responsibility for musculoskeletal
driving training. CONCLUSIONS: Simulator-based driving training disorders, i.e. they thought that people should take responsibility
improved driving ability better than driving-related cognitive tasks, themselves. Many people also had attitudes which attributed
especially for well educated and less disabled persons with stroke. responsibility equally to themselves and to the medical professionals.
However, the findings of the study may have been modified as The main associations found were that lower education, not being
a result of the number of dropouts and the possibility of some physically active and being on sick leave for musculoskeletal
neurologic recovery unrelated to training. IMPLICATIONS: The disorders increased the odds of belonging to the group with the
outcome at follow-up demonstrates the long-term effect of simulator- most external attitude i.e. attributing responsibility to someone else.
based driving training and suggests the usefulness of implementing CONCLUSIONS: Most people do seem to have the attitude that they
such training program in the active rehabilitation phase after stroke. themselves should take responsibility for musculoskeletal disorders
However, patients with severe post-stroke deficits should be allowed although the associated background variables could be of interest
more time to physically recover before inclusion in such training and should be considered when planning prevention, treatment
programs. KEYWORDS: Cerebrovascular accident; Motor vehicles, and management of musculoskeletal disorders. Future work could
Driving simulators. FUNDING ACKNOWLEDGEMENTS: Supported address whether an active approach of agreement of provider
by Stichting Van Goethem Brichant and Interfaculty Office for and person concerning responsibility for musculoskeletal disorders
would affect outcome of treatment? IMPLICATIONS: Attitudes have as activity, participation and mood requires further examination.
implications for behaviour. If people think that they themselves IMPLICATIONS: A workbook based self-management intervention is
should be active in the prevention, treatment and mangemant a feasible method for individuals following stroke and can change their
of musculoskeletal disorders, they will be more responsive to levels of self efficacy. Self-management interventions could be used
suggestions from health professionals which emphasise self-care, to provide additional methods to facilitate the process of recovery and
and this in turn will have implications for societal health care influence activity, participation and mood KEYWORDS: stroke, self-
costs. KEYWORDS: Attitudes;Responsibility;Musculoskeletal disor- management, self-efficacy. FUNDING ACKNOWLEDGEMENTS:
ders. FUNDING ACKNOWLEDGEMENTS: This study was financially This work was unfunded. CONTACT: [email protected]
supported by The Vårdal institute, Göteborg university and The ETHICS COMMITTEE: London-Surrey Borders Research Ethics
local research council of Göteborg and South Bohuslän. CONTACT: Committee
[email protected]
ETHICS COMMITTEE: The study was approved by the Ethics
committee of Göteborg University.
THE PYRAMID MODEL: BRIDGING THE GAP BETWEEN
845 Wednesday 6 June 13:45 THEORY AND PRACTICE – A PEDAGOGIC APPROACH
Sjöberg N; Dept. of Physiotherapy, University College Øresund
A NEW SELF-MANAGEMENT INTERVENTION FOR STROKE: Copenhagen, Denmark
A SINGLE CASE STUDY APPROACH EMPLOYING A
RANDOMISED MULTIPLE AB BASIC DESIGN PURPOSE: In the educational system both lecturers and clinical
teachers experience the students’ frustrations about the discrepancy
Jones F1 , Partridge C2 ,Mandy A3 ; 1 St
George’s University
between theory and practice. The purpose of the study was to
of London and Kingston University, London, United Kingdom;
2 University of Kent, Canterbury, United Kingdom; 3 University of investigate how the newly qualified physiotherapists experience
their practice in relation to their understanding of the theoretical
Brighton, Sussex, United Kingdom
background acquired from the academic part of the education.
PURPOSE: Recovery after stroke is often stated to be most rapid in This knowledge was then discussed in relation to Aristotle’s ideas
the first few weeks. Factors influencing initial recovery are clearly about practical wisdom, phronesis and a model was created and
described in stroke literature but this often relates to changes in tried out on 3rd semester students. RELEVANCE: This study is
impairment. But what enables an individual to continue making important to both educators and students, because it presents a
progress in terms of activity and participation after discharge from model for physiotherapeutic phronesis which helps the students to
physiotherapy? Psychological factors such as self-efficacy have been identify and explain discrepancies between “what they are taught
strongly implemented in enhanced self-management in other chronic to do” and “what they actually do”. PARTICIPANTS: This first part
diseases with an associated effect on other health outcomes. This of the study is based on four qualitative semi-structured interviews
study aimed to test a stroke self-management intervention specifically of newly qualified bachelors in physiotherapy and the second part
designed to address the main sources of self-efficacy described on 3rd semester students. Inclusion of informants was strategic in
by Bandura. RELEVANCE: Despite considerable advances in acute relation to sex, educational institution and work place. METHODS:
care, stroke is still one of the most prevalent complex disabilities The study is a qualitative, hermeneutic study, based on interviews.
in the developed world. Interventions aimed at enhancing self- The interviews took place between half a year and one-and-half-
efficacy could provide an additional focus towards self-managing year after graduation; were tape-recorded and transcribed in extenso.
after discharge from conventional therapies. But the most feasible The discussion groups in 3rd semester was tape-recorded and
and effective intervention is not known. This study tests the effect transcribed likewise. The study was carried out according to existing
of a novel stroke self-management intervention on self-efficacy, ethical guidelines. ANALYSIS: The data was analyzed according
mood, activity and participation in a group of community dwelling to a Giorgi inspired editing-analysis-style. The material was coded
stroke survivors. PARTICIPANTS: Seven male and three female and then categorised and condensed. Communicative validation and
participants, with a mean age 61.5 years (s.d 8.15) maximum age analytical generalization according to Kvale, was used on the first
75 years, minimum age 46 years and an average of 24.2 weeks (s.d part of the study and the findings were analysed and discussed
18.29) post stroke. Seven participants had right sided hemiparesis in relation to Aristotle and his theories on ethics. On the basis of
and three had left sided hemiparesis, three had aphasia. Eight this, the “Pyramid-Model” was created, and the model was tried
participants lived with partners, and two lived alone. All lived in out on 3rd semester students in relation to the subject clinical
their own homes and none were employed at the time of the reasoning, and analyzed using editing-analysis-style. RESULTS: The
study. METHODS: We utilised a multiple participant, two phase newly qualified physiotherapists acts in a “phronetic way”, which is
(baseline followed by treatment) design. The intervention was a self- illustrated by a model of a pyramid. The corners of the pyramid
management workbook supported by three training sessions. The represent different aspects which influence the physiotherapeutic
workbook provided vignettes of stroke survivors with strong self- “best practice” (phronesis). The corners of the pyramid identified
efficacy, also practical solutions to common problems and a diary in this study are: physiotherapeutic technique, culture, ethics and
to record targets and mastery experiences. The primary outcome relation. The “best practice” or the “physiotherapeutic phronesis” is
was self-efficacy using a newly validated Stroke Self-efficacy Scale an imaginary point inside the pyramid, and the location of this point
(SSEQ), and secondary outcomes measured mood, activity and is defined by the unique situation; i.e. some times phronesis is much
participation. ANALYSIS: The intervention effect was evaluated with closer to another corner than the technique corner, because of the
a randomisation test, as the intervention points were randomly attraction from the others. This model was tried out on students and
determined within a preset range for each participant. Individual found useful in discussions on clinical reasoning and “what to do
participant scores were analysed using a weighted mean trend line. in real life”. CONCLUSIONS: The Pyramid model seems to be a
RESULTS: Statistical analysis of group effects showed a significant useful tool by contributing to the understanding of elements of clinical
change in self-efficacy (p < 0.01). A change was also demonstrated reasoning for 3rd semester students before their first clinical practice.
in activity, participation and mood for the majority of participants, but IMPLICATIONS: The Pyramid model might help the students to
this was not statistically significant. CONCLUSIONS: Self-efficacy reflect on why practice often looks otherwise than theory prompts. It
can change through the use of a targeted stroke self-management also helps them to identify elements that influences their practice
intervention, but the causal relationship with other variables such and hereby an opportunity to evaluate themselves. KEYWORDS:
Pyramid model, clinical practice, clinical reasoning. FUNDING activitation and decreased force production of the quadriceps femoris
ACKNOWLEDGEMENTS: Department of Physiotherapy, University muscle after total knee arthroplasty. Physical Therapy 83[4], 359-
College Øresund, Copenhagen, Denmark; Skodsborg School of 365. 2003. [2] Rutherford OM, Jones DA, Newham DJ. Clinical and
Physiotherapy, Skodsborg, Denmark. CONTACT: [email protected] experimental application of the percutaneous twitch superimposition
technique for the study of human muscle activation. Journal of
Neurology, Neurosurgery, and Psychiatry 1986[49], 1288-1291. 1986.
KEYWORDS: Hamstrings muscle activation, twitch interpolation,
anterior cruciate ligament. FUNDING ACKNOWLEDGEMENTS: This
VCEC Ballroom A
work was part of a PhD project that was done on a studentship
HAMSTRING MUSCLE ACTIVATION FOLLOWING AN ANTERIOR from King’s College London. No funding was received for this project.
CRUCIATE LIGAMENT RECONSTRUCTION: IMPLICATIONS CONTACT: [email protected]
FOR REHABILITATION ETHICS COMMITTEE: Guy’s Research Ethics Committee, King’s
Clifford A1 , Holder-Powell H2 ; 1 University of Limerick, Ireland; College London Research Ethics Committee and St Mary’s Local
2 London South Bank University, UK Research Ethics Committee
PURPOSE: A deficit in hamstring muscle strength is a common
sequel to an anterior cruciate ligament (ACL) reconstruction using
the Semitendinosus and Gracilis tendon graft. Muscle atrophy (loss Research Report Platform Presentation
of muscle tissue) and failure of volitional muscle activation are the
main causes of a reduction in hamstring muscle force production
VCEC Ballroom B & C
[1,2]. This study examined if a deficit in volitional hamstring activation
exists following an ACL-reconstruction. RELEVANCE: Information THE PROBLEM OF PRIORITIZING SCHOLARLY WRITING IN
regarding hamstring voluntary muscle activation in clients following THE WORKPLACE
an ACL-reconstruction may be a critical factor in assisting the Murray R, Newton M; Strathclyde University, Glasgow, UK
design and implementation of effective rehabilitation programmes.
PARTICIPANTS: Following ethical approval, a convenient sample of PURPOSE: Writing for publication requires a high level of skill,
subjects who underwent a unilateral ACL-reconstruction and four- the development of which appears to be configured, implicitly or
months of rehabilitation were selected to participate in the study. explicitly, within undergraduate and postgraduate curricula. However,
Eleven individuals (7 males) mean (±SE) age of 33.6 (±2.9) years physical therapists report problems in making time and space
volunteered to participate in the study. METHODS: The percutaneous for scholarly writing in the workplace. The purpose of this study
twitch superimposition method [2] was used to assess voluntarily was to assess the extent to which practices developed during
activation of the hamstrings from the ACL-reconstructed and a scholarly writing course were sustained in clinical workplaces.
contralateral uninjured legs. A pulse of supramaximal electrical stimuli RELEVANCE: Writing for scholarly purposes is the main way
was applied to the muscle while the participant performed a maximum that physical therapists communicate about their work. In order
voluntary contraction (MVC) of the hamstrings muscle. Hamstring to move physical therapy forward it is essential that both service
muscle force was assessed with subjects seated and stabilised in development and research be published. This study explored these
a dynamometer (KinCom 125AP, Chatanooga, Tennessee, USA) problems by following a group of participants in a Writing for
while the hamstrings were stimulated using a Digitimer stimulator Publication course, to assess the extent to which lessons learned
model DS7, which controlled the voltage (400volts), pulse width about making time and space for writing were implemented on
(200ms) and current amplitude. The pulse frequency (1Hz) and
return to their workplaces. PARTICIPANTS: Clinical professionals,
pulse delay (250ms) were programmed using the Digitimer D4030
including physical therapists, who had attended a course designed
programmer. The hamstring muscles were considered to be fully
to enable them to write for publication were identified. METHODS:
activated, if no additional force was generated by the supramaximal
One-to-one semi-structured interviews were conducted with 12 of
twitch of electrical stimulation. ANALYSIS: The amplitudes of the
the 14 course participants (4 males, 10 females), including six
twitch generated at rest and during three MVCs were measured
physical therapists. Interviews lasted approximately 45 minutes
and recorded. The hamstrings percentage muscle activation was
and were audio-recorded. ANALYSIS: Tapes were transcribed
calculated for both the ACL-reconstructed and uninjured limbs. The
verbatim. Themes were identified and checked by two independent
Wilcoxon signed ranks test (SPSS version 11.5) was used to compare
hamstring muscle activation in the ACL-reconstructed limb with the researchers. RESULTS: Analysis identified five potential barriers to
uninjured contralateral limb RESULTS: The mean ± standard error scholarly writing in the clinical workplace: 1. Participants’ clinical
(SE) hamstring muscle activation was calculated to be 89% ±0.8 in workplaces ‘did not facilitate writing’. 2. Some felt they had to
the ACL-reconstructed legs compared to 99% ±4.2 in the uninjured ‘sneak writing in’ and ‘not advertise’ their writing. 3. In spite of
legs, thus, the ACL-reconstructed hamstrings produced significantly management support for writing, other priorities were seen to have
less (11%) muscle activation (p = 0.04) compared to the uninjured more value. Participants were not comfortable prioritizing time for
contralateral side. CONCLUSIONS: A reduced ability to generate all scholarly writing in the workplace. 4. Participants reported that
of the available force in the hamstring muscles was identified, despite they used personal, rather than professional, time for scholarly
a maximal voluntary effort and four months of rehabilitation following writing. 5. Available space, such as clinic and open office, did
their ACL-reconstruction. It is recommended that future studies not provide an appropriate atmosphere for scholarly writing. A
examine the recovery of volitional activation deficits in the hamstrings strength of this study is that it provides detailed, individualized
following protocols involving methods like biofeedback, electrically information about physical therapists’ views on and experiences of
stimulation and muscle re-education. IMPLICATIONS: The results of scholarly writing. A weakness is that participants were self-selected.
this study have implications for the rehabilitation of clients following CONCLUSIONS: These findings show that while participants used
an ACL-reconstruction, as deficits in muscle activation are thought strategies learned on the course for other professional tasks, such
to contribute towards a slow and suboptimal recovery [1]. Thus, it as report writing, they were unable to prioritize scholarly writing in
is suggested that rehabilitation programmes for clients following an their workplaces. IMPLICATIONS: The implications of this study are
ACL-reconstruction include exercises to reduce volitional activation that making time and space for scholarly writing in the workplace is
deficits in the hamstring muscles, as traditional exercise programmes problematic for clinicians. Other mechanisms for helping clinicians
may be inadequate for the recovery of voluntary muscle activation. to prioritize scholarly writing in the workplace should be devel-
References: [1] Mizner RL, Stevens JE, Snyder-Mackler L. Voluntary oped. KEYWORDS: Publishing, workplace, prioritizing. FUNDING
ACKNOWLEDGEMENTS: Funded by the Nuffield Foundation (UK). Research Report Platform Presentation
CONTACT: [email protected] 1090 Wednesday 6 June 14:05
ETHICS COMMITTEE: National Health Service (NHS) Central VCEC Meeting Room 17
Office for Research Ethics Committees (COREC) and University of TRAINING IN FITNESS CENTERS WITH STROKE: LONG-TERM
Strathclyde Ethics Committee IMPACT ON MOTOR, FUNCTIONAL PERFORMANCE AND
QUALITY OF LIFE
Research Report Platform Presentation Teixeira-Salmela L, Goulart F, Faria C, Britto R, Parreira V;
1159 Wednesday 6 June 14:05 Universidade Federal de MInas Gerais, Belo Horizonte, Brazil
PURPOSE: To investigate motor, functional performance and quality
THE INTRA- AND INTERTESTER RELIABILITY OF THE of life measures after a training program in fitness centers followed
MOVEMENT CONTROL TESTS OF THE LUMBAR SPINE
by one-year of detraining with community-dwelling chronic stroke
Luomajoki H1,2 , Kool J3 , Airaksinen O2 , de Bruin E4,5 ; survivors. RELEVANCE: Despite clear evidence of physiological
1 Physiotherapie Reinach, 5734 Reinach, Switzerland; 2 University of
declines during detraining, research is still not clear about the
Kuopio, Kuopio, Finland; 3 Rehabilitation Clinic Valens, Switzerland; relationship between declines in functional performance (FP) and
4 University hospital of Zürich, Switzerland; 5 ETH Zürich, Switzerland
quality of life (QL), since these measures involve more complex
PURPOSE: To assess the reliability of the observation of move- processes. PARTICIPANTS: Thirty participants (17 men and 13
ment control in patients with non specific low back pain (LBP). women), mean age of 56.40 ±10.9 years (34 to 83) and mean
RELEVANCE: Non-specific LBP is a tremendous problem in our time since onset of stroke of 3.8 ±3.4 years (1 to 14) took
societies. It is a heterogenic condition. Subgroups need to be part in a combined program of muscle strengthening and physical
diagnosed much more clearly. Functional stability of the spine conditioning. The training was performed at a fitness center and
can be examined through movement palpation but the reliability consisted of 30 sessions with evaluations at baseline and after
is poor. Another diagnostic tool is the observation of the control training. Twenty two participants (57.7±12 years) were re-assessed
of active movements of the spine described by Sahrman and after a one-year follow-up of detraining, defined as the period of one
by O’Sullivan. A test battery consisting of 10 movements were year after the interruption of the program. METHODS: Measures
developed, where the observer rates the control to be correct or of motor performance included assessment of muscle strength,
not correct. PARTICIPANTS: 40 patients currently in physiotherapy spasticity, and symmetry. Muscle strength was evaluated by the
treatment were included; 27 patients with non specific low back pain total work produced by the flexors/extensors of the trunk, hip,
and 13 patients without back pain but in treatment due to another knee and ankle; spasticity by the modified Ashworth scale; and
musculoskeletal problem. The patients did not know the tests before. symmetry by the percentage of weight distribution on each lower
A standard instruction was given to all patients. Average age of the limb in a standing position and during the sit-to-stand movement.
patients was 52 years. METHODS: Patient perfoming 10 tests for Functional performance measures included timed measures of gait
movement control of the lumbar spine adapted after Sahrmann and speed and stair climbing, whereas, quality of life was investigated
O’Sullivan were videoed in a standardized manner. 4 physiotherapists by the Nottingham Health Profile, whose psychometric properties
trained in this specific assessment, blinded to each other and to the of its Brazilian version were previously investigated. The training
patients rated the performance seen in the videos either correct or not program consisted of supervised exercise sessions and followed
correct. ANALYSIS: Kappa statistics were calculated to measure the a protocol previously employed with chronic stroke survivors and
reliability between the raters and raters to themselves. Kappa values each training session included: a 5 to 10-minute warm-up consisting
below 0.4 are considered as poor, between 0.4-0.6 as moderate and of calisthenics and range of motion exercises and stretching;
above 0.6 as substancial. Significance of the results and percentual 30 to 40-minute of aerobic exercises, consisting of walking plus
agreement were calculated as well. RESULTS: The kappa values for
cycling, each at a target heart rate of at least 70 to 75% of
intertester reliability ranged between 0.24-0.71 (P < 0.001). 6 tests
the maximal heart rate based on age; strength training, using
were above 0.6 which means a substancial reliability. The intratester
resistance equipments; a cool-down period, consisting of 5 to 10
reliability was between 0.51-0.96 (P < 0.001), all tests but one were
minutes of muscular relaxation and stretching exercises. ANALYSIS:
above 0.6. The percentual agreement between the raters was above
Descriptive statistics and tests for normality and homogeneity of
80% for all but one test and the intra-rater agreement was by
variance were carried-out for all outcome variables, using SPSS
all tests above 80%. CONCLUSIONS: Our research strenghtens
the findings from earlier studies that the inspectory findings of the for Windows (version 13.0). Repeated measures ANOVA, with pre-
movement control ability of the spine have a good to substancial planned contrasts, were used to determine whether significant
reliability. The reliability might be even better if the raters also differences existed between baseline, post-training and follow-up
knew the anamnesis of the patients videoed. Further studies are measures, at a significance level of a<005. RESULTS: The findings
needed to assess the reproducibility of the tests and to assess the showed significant improvements in all outcome measures after
validity of the tests. IMPLICATIONS: Diagnosis of movement control training, except for the motor performance measures of spasticity
dysfunction has good intra-rater reliability in 9/10 tests and good and symmetry. The gains observed in strength measures returned
inter-rater reliability in 6/10 tests. KEYWORDS: Movement control to baseline after one year of detraining. However, the gains in
tests, Low back pain, movement impairment syndromes. FUNDING all measures of functional performance remained unchanged. In
ACKNOWLEDGEMENTS: None. CONTACT: [email protected] addition, QL showed the greatest improvement after training and the
ETHICS COMMITTEE: Ethics commitee of the Canton Aargau, gains persisted during follow-up. CONCLUSIONS: The maintenance
Switzerland of gains in FP and QL with detraining suggested that these
measures may be influenced by variables other than muscle strength.
IMPLICATIONS: Participation in the exercise program appeared
to improve perception of QL and functional abilities with chronic
stroke and may thus be of value in maintaining certain aspects of
independence in their lives. KEYWORDS: Stroke, detraining, quality
of life. FUNDING ACKNOWLEDGEMENTS: Brazilian Government
Agencies (CNPq/FAPEMIG). CONTACT: [email protected]
ETHICS COMMITTEE: Ethics Committee Board of the Universidade
Federal de Minas Gerais
DOES AN EXTENDED STROKE UNIT SERVICE WITH EARLY DIAGNOSING UNILATERAL NEGLECT: HYPOTHESIS
SUPPORTED DISCHARGE HAVE ANY EFFECT ON BALANCE GENERATION AND PATTERN RECOGNITION IN
OR WALKING SPEED? PHYSIOTHERAPISTS’ CLINICAL REASONING
Askim T1,2 , Mørkved S2,1 , Indredavik B3,4 ; 1 Department of Plummer-Damato P1 , Morris M2 , Denisenko S3 ; 1 University of
Community Medicine and General Practice, Faculty of Medicine, California Los Angeles, Los Angeles, USA; 2 University of Melbourne,
Norwegian University of Science and Technology, Trondheim, Melbourne, Australia; 3 La Trobe University, Melbourne, Australia
Norway; 2 Clinical Services, University Hospital of Trondheim,
Norway; 3 Stroke Unit, University Hospital of Trondheim, Norway; PURPOSE: To identify the clinical reasoning processes used by
4 Department of Neuroscience, Faculty of Medicine, Norwegian physiotherapists in the assessment of unilateral neglect (ULN)
University of Science and Technology, Trondheim, Norway and to ascertain whether therapists generate hypotheses about
the different types of neglect. RELEVANCE: Understanding clinical
PURPOSE: Effective stroke unit care with early mobilisation improves decision making processes is important in identifying how particular
functional outcome after stroke, however increased risk of falling is behavioural symptoms are recognised, interpreted, and classified
a major problem among persons with stroke and impaired balance in clinical practice. PARTICIPANTS: The participants were 14
is one of the main reasons for falling. A new kind of service has physiotherapists recruited from the Victorian branch of the Neurology
been developed during the last decade that offers Early Supported Special Interest Group of the Australian Physiotherapy Association.
Discharge (ESD). In the present study the aims were to evaluate METHODS: Participants observed a 27-minute videotaped assess-
the effect of an extended stroke unit service with ESD on balance ment of an experienced physiotherapist assessing a patient with
and walking speed, and to explore the association between initial leg
left ULN following stroke. The participants were not told that the
paresis, initial movement ability and balance one year after a stroke.
patient had ULN. At predetermined intervals, the videotape was
RELEVANCE: Functional disability after stroke is costly to the health
paused and the participants documented their thoughts pertaining
care system. This study seeks more knowledge about improvement
to the case at that point in time. There were 5 segments of the
of function after stroke. PARTICIPANTS: Sixty-two patients admitted
assessment: initial interview, sensory, motor function, balance and
to the Stroke Unit at Trondheim University Hospital, fulfilling the
gait, and standardised tests for neglect. ANALYSIS: A transcript of
inclusion criteria, were included in the trial. METHODS: A randomized
responses was prepared for each participant. Each transcript was
controlled design was used, comparing the ESD with ordinary stroke
read by two researchers independently several times and patterns
unit service. The outcome measures were Berg Balance Scale (BBS)
in the participants’ thinking were noted. Data were then displayed
and walking speed at one, six, twenty-six and fifty-two weeks after the
in a matrix to facilitate comparison across participants for each
stroke. On the multiple regression analysis BBS was dichotomised
into good balance (BBS 45) versus poor balance (BBS < 45). segment of the assessment. The data for each section of the
The ESD service consisted of stroke unit treatment combined with video were then examined for evidence of hypothesis generation.
a home-based program including follow up care co-ordinated by a Only hypotheses pertaining to ULN were analysed. RESULTS:
mobile stroke team that offers early supported discharge and works in Physiotherapists used both hypothetico-deductive reasoning and
close co-operation with the primary health care system during the first pattern recognition in their thinking related to ULN. A hypothetico-
four weeks after discharge. The intervention placed emphasize on deductive clinical reasoning approach, which is characterised by
task spesific exercise therapy in the patients’ home. ANALYSIS: In all specific testing to confirm a hypothesis, was evident amongst
analysis between groups Mann–Whitney U-test was used for ordinal therapists who, after forming a hypothesis about neglect, thought
data, t-test for ratio data, and c2 tests for nominal data. Multiple about strategies to test their hypothesis. Pattern recognition, which
logistic regression was used to analyse the association between initial does not involve explicit testing of a hypothesis, was evident in
leg paresis, initial movement ability and balance fifty-two weeks after a small group of clinicians who evaluated their early hypotheses
stroke allowing adjustments for potential confounders as age, sex, of ULN through observation of the patient’s non-verbal behaviour
treatment group and number of days from onset of symptoms to during the interview; they did not wait for the hypothesis to be
hospital admission. RESULTS: 23 patients in each group completed formally tested. This clinical reasoning behaviour is consistent with
all assessments on BBS. The differences in change between the models of pattern recognition in which clinicians use knowledge
two groups showed a trend toward greater improvement in the ESD from prior experience (i.e. recognise a pattern of symptoms)
group compared to the ordinary service group from one week follow to make a diagnosis. Hypotheses concerning specific types of
up to six weeks follow up (p = 0.065) and from one week follow up to neglect were infrequently generated. Physiotherapists concentrated
twenty-six weeks follow up (p = 0.142) on the BBS, but no differences on verifying the presence of neglect and quantifying the severity
in change between the two groups on fast walking speed. All patients of the syndrome, rather than differentially diagnosing the specific
with initial severe leg paresis suffered from poor balance one year types. CONCLUSIONS: Physiotherapists collect a large amount of
after the stroke. The odds ratio for poor balance was 42.1 (95% data through observation and they use this information to formulate
confidence interval; 3.5–513.9) among patients with no initial walking and evaluate clinical hypotheses about neglect. Existing knowledge
ability. CONCLUSIONS: Our results do not conclusively indicate and previous experience may influence whether a therapist uses a
that ESD has an effect on balance. We found a strong association pattern recognition or hypothesis testing model of clinical reasoning.
between initial severe leg paresis, initial inability to walk and poor The lack of hypothesis generation for different types of ULN suggests
balance after one year. IMPLICATIONS: Further research should that clinicians do not typically distinguish between the different types
emphasize task specific exercise therapy with a higher intensity of neglect in routine clinical assessment. IMPLICATIONS: Failure
in addition to ESD to enhance further improvement on balance to explicitly identify the nature of ULN implies that the primary
and walking speed in order to facilitate an active life for persons factors contributing to a person’s functional limitations may not always
with stroke. KEYWORDS: stroke, balance, rehabilitation. FUNDING be addressed specifically in treatment. Education in the different
ACKNOWLEDGEMENTS: This study has received financial support types of ULN may help clinicians to refine their neglect-related
from The Norwegian Fund for Post-graduate Training in Physio- hypotheses. KEYWORDS: clinical reasoning, diagnosis, unilateral
therapy and from Clinical Services, St. Olavs Hospital, Trondheim neglect. FUNDING ACKNOWLEDGEMENTS: This research was not
University Hospital, Norway. CONTACT: [email protected] funded.
ETHICS COMMITTEE: Regional Committee for Medical Research ETHICS COMMITTEE: La Trobe University Faculty Human Research
Ethics in Norway, REK Ethics Committee.
DOCUMENTING THE PROCESS AND INITIAL OUTCOMES FROM DETERMINANTS OF SELF-EFFICACY IN THE REHABILITATION
INTERPROFESSIONAL CLINICAL PLACEMENT EXPERIENCES OF PATIENTS WITH AN ANTERIOR CRUCIATE LIGAMENT
INJURY
Asseraf-Pasin L1 , Birlean C1 , Redden K1 , Takahashi S2 , Shore B1 ;
1 McGill University; 2 Shriners Hospital for Children Thomeé P1 , Währborg P, Börjesson M, Thomeé R, Eriksson B,
Karlsson J; 1 Dept of Orthopaedics, Lundberg Laboratory, Gröna
PURPOSE: Little is known about students’ interprofessional attitudes Stråket 12, Sahlgrenska University Hospital, 41345 Göteborg,
in the context of interprofessional clinical education (Hind, Norman, Sweden
Cooper, Gill, Hilton, Judd & Jones, 2003). The purpose of this
study was to understand (primarily from the students’ perspective) PURPOSE: The purpose of this study was to explore several
the planning, process, and outcomes from an interprofessional (IP) independent measures (both physical and psychological) believed
clinical placement. An IP education program was developed by an to affect perceived self-efficacy in the rehabilitation of patients
IP team in a Spina-Bifida pediatric clinic because administration with an anterior cruciate ligament (ACL) injury. RELEVANCE: We
pushed for the team to meaningfully integrate students doing clinical hypothesise that self-efficacy may be determined by important factors
placements. RELEVANCE: This presentation will explain how an IP to consider in rehabilitation such as coping with pain and locus of
clinical placement was organized, developed, evaluated, and used control, as well as previous experience of injuries/illness, quality of
to inform subsequent IP clinical placements. PARTICIPANTS: Five life, symptoms and physical function. PARTICIPANTS: A total of 116
students (2 physiotherapy, 2 nursing, 1 occupational therapy), three patients with a mean age of 31 years (18-55) were consecutively
preceptors (1 physiotherapist, 1 nurse, 1 occupational therapist), included in the study. Forty-five patients had an ACL-deficient knee
and one clinical nurse specialist (IPE program director) participated and 71 patients had undergone an ACL reconstruction. They were
in this study. All students who were involved in the placement rehabilitated for at least three to six months and able to read and
participated. The three preceptors most directly involved with the understand the Swedish language. The Human Research Ethics
students were invited to participate, and the IPE program director Committee at the Faculty of Medicine, Göteborg University, Sweden,
was a key informant and crucial to understanding program planning. approved the study. Written informed consent was obtained and the
METHODS: The program was observed qualitatively by (a) regular rights of subjects were protected. METHODS: For this explorative
communication with the program director, (b) notes from the descriptive study the Knee Self-Efficacy Scale (K-SES) was used
preceptor meetings throughout the program, (c) a student-journaling as the dependent measure. K-SES is a new valid and reliable
activity, and (d) open-ended follow-up forms asking students instrument, with good responsiveness to perceived self-efficacy. The
about their understanding of own and other professional roles, dependent and 39 independent measures were documented at one
and interprofessional education and practice. Three standardized visit; 12 months post injury/reconstruction. ANALYSIS: The K-SES
questionnaires (Entry Level Interprofessional Questionnaire (Pollard score was transformed to normal scores by the transformation by
et al., 2004), Interdisciplinary Education Perception Scale (Hawk Blom. All correlations between the K-SES and the independent
et al., 2002), Attitudes towards Health Professionals Questionnaire measures with a p-value of 0.1 were used in a regression
(Lindqvist et al., 2005)) were administered to students before and model to identify the determinants of the K-SES. RESULTS: Forty
after the clinical placement. ANALYSIS: Descriptive statistics create per cent of the variance in the complete K-SES was explained
pre-post profiles of the five students and summarize student-ratings by the Lysholm score, KOOS-Sport/Recreation, Internal Locus of
of usefulness and level of interest on key components of the Control and Locus of Control by Chance. Forty-one per cent
clinical placement. Transcripts of open-ended questionnaire items, of the variance in patients’ present perceived self-efficacy was
observations, preceptor notes, and student-journaling activities were explained by the same independent measures. When it came to the
inductively analyzed through open coding (Strauss, & Corbin, 1998). perceived self-efficacy of future capability 38% of the variance was
RESULTS: Students held positive attitudes toward interprofessional explained by the Lysholm score, KOOS-Sport/Recreation, Tegner-
education and practice. Students reported learning about own and Present level and Internal Locus of Control. CONCLUSIONS: Self-
other professional roles from the IP clinical placement. The key reported symptoms/functions and Internal Locus of Control were thus
challenge reported by students and preceptors was creating a the most important determinants of self-efficacy for patients with an
balanced schedule between time spent on clinical competencies ACL injury. In order to strengthen self-efficacy, these determinants
and interprofessionalism. CONCLUSIONS: Success of this program should be considered by the clinicians involved in the rehabilitation.
indicates that interprofessional education helps clarify professional IMPLICATIONS: The results from the present study are new and
roles for students, and that learning together enhances clinical place- important to consider for the physical therapist when planning and
ment experiences. In the words of one student: “I think each student executing the rehabilitation program for patients with an ACL injury.
should experience an IP clinical placement at least once during their The present study demonstrates that self-efficacy was closely related
program. Ideally, this would be in the second year when they have a to self-reported symptoms and functions, as well as to Internal Locus
good understanding of their own profession but can still benefit from of Control. In addition, perceived self-efficacy of future capability
learning about others. Learning in school about the roles of HCPs appears to be influenced by the present physical activity level. The
is not the same as working and interacting with them. You learn rehabilitation of a patient who is physically fit and determined to
more and gain a greater respect when you work interprofessionally resume his/her prior activity may be more successful because of
within a team. This is a good way to promote IPP in the future; it that patient’s strong self-efficacy. As a result, the strategies may have
is the best way to attain interprofessional care!” IMPLICATIONS: to be different when dealing with a patient who is less physically fit
This presentation will generate discussion around the need to and has poorer self-efficacy. KEYWORDS: anterior cruciate ligament
increase IP in clinical placements in order to prepare physiotherapists injury, rehabilitation, K-SES, self-efficacy, determinants. FUNDING
for practice in health care systems that are increasingly support- ACKNOWLEDGEMENTS: This study was supported by a grant
ing IP patient and family-centered practice. KEYWORDS: Pro- from the Swedish National Centre for Research in Sports and the
cess/Outcomes/Interprofessionalism/Clinical Placement. FUNDING Local Research and Development Council of Göteborg and southern
ACKNOWLEDGEMENTS: The McGill Educational Initiative on Bohuslän. CONTACT: [email protected]
Interprofessional Collaboration: Partnership for Patient and Family- ETHICS COMMITTEE: The Human Research Ethics Committee at
Centred Practice. CONTACT: [email protected] the Faculty of Medicine, Göteborg University, Sweden, approved the
ETHICS COMMITTEE: McGill University, Faculty of Medicine study.
REDUCED BONE DENSITY AND BONE STRENGTH INDEX IN WORK ABILITY AND WORK STRESS AMONG SOCIAL
THE HEMIPARETIC RADIUS IN INDIVIDUALS WITH CHRONIC SERVICES AND HEALTH CARE PROFESSIONAL TEACHERS IN
STROKE FINLAND
Pang M1−3 , Ashe M2,3 , Eng J2,3 ; 1 Hong Kong Polytechnic University, Jaakkola-Hesso S1 , Nygard C2 , Savinainen M2 ; 1 Satakunta
Hong Kong, China; 2 University of British Columbia, Vancouver, University of Applied Sciences; 2 Tampere School of Public Health,
Canada; 3 GF Strong Rehabilitation Centre, Vancouver, Canada University of Tampere Finland
PURPOSE: This primary purposes of this study were to (1) compare PURPOSE: The aim of this study was to describe work ability and
bone status in the radius between the paretic and non-paretic work stress in a group of teachers in a cross-sectional study in
side following chronic stroke, and (2) to determine the relationship autumn 2005 in social services and health care professional teachers
in Finland. RELEVANCE: Applied Sciences has been developed to
between volumetric bone mineral density of the radius and stroke
many different sectors in Finland during last ten years. Employees
impairments. RELEVANCE: Individuals with stroke often sustain
have been required knowledge to many different fields to be able to
residual physical impairments in the upper extremity, such as muscle
work in this area. With increasing age and demands of work, such
weakness, spasticity and reduced motor control. These factors may
as teaching in the different environments and the individual physical
contribute to secondary bone loss and increase the risk of upper
demands, work stress increasing among the professional teachers.
extremity fractures. Indeed, wrist fracture is the second most common
Based on different studies the teachers stress and the work load have
type of wrist fracture among people with stroke. Understanding how been the main reasons to burn out. PARTICIPANTS: A total of 1200
stroke influences bone health will provide important information in teachers were the target group for this study. The questionnaire was
devising effective strategies for preventing or treating bone loss in sent to the teachers using Internet. The participants answered to the
this population. PARTICIPANTS: A convenience sample of 63 older guestions anonymously. The participants were either senior lectures
adults (50 years of age or older) with chronic stroke (stroke onset or full-time teachers. In all 419 of teachers answered to WAI. Mean
1 year or more) were recruited from the community. METHODS: age was 50.2 years of all, female (50.4 years) and male (48.1 years).
Peripheral quantitative computed tomography (pQCT) was used In all 478 of teachers answered to QPSNordic. In this study The
to obtain a cross-sectional image of the radius at the 30% site subjects were divided for two age groups <45 and>45 and gender
(measured from the distal endplate) on both sides. The outcomes groups. METHODS: The WAI and QPSNordic34+ were used as a
variables were total bone mineral content (mg/mm), total bone method. ANALYSIS: The statistical analyses were carried out using
mineral density (mg/mm3 ), cortical thickness (mm), and polar stress- SPSS package. The statistical significance was tested with the t-test.
strain index (mm3 )(a bone strength index). In addition, Fugl-Meyer RESULTS: The WAI was classified as good work ability in all groups.
Motor Assessment was performed to assess motor impairment. In general men and younger subjects had higher WAI compared
The amount of use scale of the Motor Activity Log was used to the others. In average every fourth of teachers perceived high
to measure how frequent the participant used the paretic arm in stress. There were differences between women and men in mastery
daily functional activities. Hand-held dynamometry was used to of work and in job demands. Women perceived higher mastery
evaluate isometric muscle strength of shoulder flexion, shoulder of work and job demands than men. There were no differences
abduction, elbow flexion, elbow extension and hand grip. A composite between full time lectures and senior lectures in psychological
muscle strength score was calculated by summing the force value variables. CONCLUSIONS: The results of study are parallel with
obtained from each muscle group (in Newtons). Spasticity at the earlier studies concerning WAI among different age groups. Although
wrist was measured by Modified Ashworth Scale. ANALYSIS: the teachers perceived high mastery of work they perceived rather
Descriptive analysis was performed to yield the mean and standard high stress level. It is important to notice that the superior support
deviation of each outcome variable. Paired t-tests were performed was rather low among the teachers and the combination of high
to compare the pQCT variables between the paretic and non- demand with low control has negative effect on well-being. An
paretic side. Multiple regression analysis was performed to predict interesting finding is that there are not much differences between
total bone mineral density from basic demographics and stroke senior lecturer and full time lecturer. IMPLICATIONS: This study
impairments. A significance level of 0.05 was set for all statistical will develop occupational physiotherapist‘s skills in assessing loading
tests. RESULTS: Total bone mineral content, total bone mineral factors in work. KEYWORDS: Work ability, WAI, QPS-index, stress,
density and cortical thickness, and polar stress-strain index on teacher. FUNDING ACKNOWLEDGEMENTS: This study is not
the paretic side were significantly lower than those on the non- funded. CONTACT: first name.last name@samk.fi
paretic side (p < 0.05). Multiple regression analysis revealed that ETHICS COMMITTEE: University of Tampere and all the participant
schools in the study
the composite muscle strength score is a significant predictor of
total volumetric bone mineral density, accounting for approximately
11% of its variance. CONCLUSIONS: The bone status on the Research Report Platform Presentation
hemiparetic side was compromised. Decreased muscle strength is 1595 Wednesday 6 June 14:25
a major determinant of bone density in the radius. IMPLICATIONS: VCEC Meeting Rooms 19-20
Strengthening exercises may be an important strategy to preserve
FACTORS THAT INFLUENCE FUNCTIONAL INDEPENDENCE
or improve bone density of the upper extremity in individuals with
POST STROKE
stroke. KEYWORDS: stroke, bone density, osteoporosis, muscle
strength. FUNDING ACKNOWLEDGEMENTS: Natural Sciences and Mamabolo V, Mudzi W, Stewart A; University of the Witwatersrand,
Engineering Research Council of Canada (Marco Pang). Heart and Johannesburg, South Africa
Stroke Foundation of Canada (Janice Eng); Canadian Institutes for PURPOSE: The influence of demographic, physical and environ-
Health Research (Maureen Ashe, Janice Eng); The Michael Smith mental factors on patients who have had a stroke has not been
Foundation for Health Research (Maureen Ashe, Janice Eng); British well established. The objectives of this study were to establish the
Columbia Medical Services Foundation (Maureen Ashe). degree of functional independence of patients who have had a
ETHICS COMMITTEE: University of British Columbia research stroke and to establish factors that influence functional independence
ethics committee. GF Strong Rehabilitation Centre research ethics post stroke. RELEVANCE: Information about factors that influence
committee patient’s functional independence post stroke could be used to plan
the patient’s length of hospital stay, the frequency of outpatient visits conducted using a hermeneutic approach. Data was collected from
to the physiotherapy department for rehabilitation; and to also provide each participant on two occasions by observing them undertaking
patients and their caregivers with information on the possible pattern their usual daily patient care activities, and interviewing them about
of recovery based on the identified factors. PARTICIPANTS: Patients their decision making. A process of participant checking was used
were sought from four stroke outpatient public health facilities in to confirm that the collected data was reflective of the decision
the Gauteng province of South Africa. A sample of convenience making of the participants. ANALYSIS: Data analysis involved an in-
(68 patients) was derived from patients who were attending a depth, iterative process of reading and interpretation of the research
stroke class at these facilities. Patients who had aphasia were texts to identify the nature and processes of decision making.
only included if they had a caregiver who could respond to the Texts for analysis were constructed from the collected data in the
questionnaire on their behalf. The following were excluded from the form of field-notes from the observation, and interview transcripts.
study: patients who were dependent in activities of daily living before The texts were interpreted, guided by hermeneutic devices: the
the stroke, those who had more than one stroke, institutionalised hermeneutic circle and fusion of horizons. Credibility of the research
or hospitalised patients, patients who were not willing to participate was enhanced by the adoption of a critical, reflexive approach
in the study were also excluded for ethical reasons. METHODS: by the researcher during data collection, text construction and
This was a quantitative research using a descriptive cross sectional interpretation. RESULTS: Decision making in CP is essentially a
study design. The Barthel Index was used to establish the degree sequential process focussing on making decisions about problems,
of functional independence on discharge from the hospital and at then making concurrent and inter-related decisions about interaction
the time of data collection (more than six weeks post stroke); and and intervention, and finally making decisions about evaluation.
a self designed questionnaire was used to establish demographic, Decision making was dependent upon the attributes of the decision
physical and environmental factors. Intra and inter rater reliability and decision making situation. Where decision making was perceived
tests were done to validate the questionnaire. The questionnaire to be simple the decision making process was conducted rapidly with
was interviewer administered. ANALYSIS: Data were summarised limited awareness or conscious recognition of progressing through a
using frequency distributions, percentages and cross tabulations. series of decision making stages. Where decisions were more difficult
Furthermore, after dichotomising the Barthel Index, the influence more conscious attention and deliberation was involved at key points.
of the observed factors was studied using a logistic regression In decision making about problems, practitioners aim to develop a
within a 95% confidence interval. Odds ratios were also calculated. picture of patient’s problems in sufficient depth to allow them to
RESULTS: Ninety three percent of the patients were functionally progress to making decisions about intervention. Decision making
independent post discharge. Younger patients had the highest about intervention uses concurrent lines of reasoning to consider
likelihood of improved functional independence (p = 0.003); married intervention options, evaluate risk versus benefit, and incorporate
patients recovered functional independence faster than those who perceptions of practitioner self-efficacy. Decision making about
were single (p = 0.05). The following factors also improved chances evaluation occurs during and about the decision making process
of being functionally independent: bowel continence (p = 0.003); par- and informs future decisions. CONCLUSIONS: This research has
ticipating in community (p = 0.02) and household (p = 0.01) activities. revealed that clinical decision making in CP is a complex process
Having a caregiver decreased the chances of regaining functional that is adaptable and flexible according to decision attributes and
independence (p = 0.04). CONCLUSIONS: Factors that influence foci. IMPLICATIONS: The nature of decision making in CP revealed
functional independence post stroke are: age, marital status, bowel in this research provides a basis for educating beginning practitioners
continence, caregiver availability, participating in household and to increase their preparedness for the reality of clinical practice.
community ativities. IMPLICATIONS: The patient’s marital status as This research also provides a basis for pursuing research that
well as availability and the role of the caregiver should be established. aims to promote quality decision making. KEYWORDS: Decision
It is also necessary to encourage patients and to teach the caregivers making, clinical reasoning. FUNDING ACKNOWLEDGEMENTS:
to encourage them to participate in household and community ac- Australian Physiotherapy Research Foundation (PRF) and Charles
tivities post stroke. KEYWORDS: Stroke, Functional independence. Sturt University. CONTACT: [email protected]
FUNDING ACKNOWLEDGEMENTS: Medical Research Council of ETHICS COMMITTEE: The University of Sydney ethics committee
South Africa and Physiotherapy department of the University of the and the ethics committees of the hospitals involved.
Witwatersrand. CONTACT: [email protected]
ETHICS COMMITTEE: Human Research Ethics Committee (Medi-
cal). Approval number: M050449
BEYOND PROFFESIONAL BARRIERS: INTERDISCIPLINARY
1310 Wednesday 6 June 14:45 EDUCATION IN MEDICAL AND HEALTH CARE SCIENCES
Younis A1,2 ; 1 St. George’s University of London, London:
THE NATURE OF CLINICAL DECISION MAKING IN UK; 2 Faculty of Health and Social Care Sciences, Kingston
CARDIOPULMONARY PHYSIOTHERAPY University,London: UK
Smith M1,2 , Higgs J2 , Ellis E2 ; 1 Charles Sturt University; 2 The
PURPOSE: Collaborative learning in healthcare education has, in
University of Sydney
recent years, achieved much attention. Indeed in 1988, the World
PURPOSE: In the field of cardiopulmonary physiotherapy (CP), Health Organisation (WHO) published the document: ‘Learning
decision making has received limited research attention. The aim together to work together’ the pupose of which was to facilitate
of this research was to develop an understanding of the nature of Inter-Professional Education (IPE). The need for closer working
decision making in acute care CP. RELEVANCE: This study was between health and social care professions has, since then, been
undertaken to inform the education of CP practitioners in the process continually reinforced at both national and international policy level
of clinical decision making. PARTICIPANTS: Fourteen participants (Department of Health 1989, 1996, 1997, 1998). At St George’s,
who were engaged in the practice of CP in three experience University of London and Kingston University UK, we have a well-
categories (novice, intermediate and more experienced) took part established inter-professional educational programme aimed at level
in the study. Participants were recruited from three Australian 1. The purpose of this paper is to evaluate the effectiveness of our
metropolitan hospitals. Participants practised across a range of acute Inter-Professional Education (IPE) programme according to students’
care clinical areas (e.g. intensive care, post-abdominal surgery and perceptions. RELEVANCE: Primarily, it is hoped that IPE helps foster
respiratory medicine). METHODS: A qualitative research study was improved teamwork among multi-disciplinary professionals, breaks
down unhelpful stereotypical attitudes and facilitates future joint in isometric muscle strength (MVC), voluntary activation, function
working. Additionally, education in health and social care sciences (Hughston Clinic Questionnaire) and surface electromyogram (EMG)
is costly. This study, therefore, identifies students’ perceptions parameters were examined. Median frequency (Hz) and amplitude
regarding the effectiveness of IPE and informs us directly of their (mV) of rectus femoris using Fast Fourier Transform were calculated
views of the IPE programme in order to help ensure that the during 5-s isometric contractions at 100%, 75%, 50% and 25% of
objectives of the course are being met and that better ways of MVC. ANALYSIS: Statistical analysis was performed using Statistical
delivering IPE may be identified. PARTICIPANTS: 208 students from Package for the Social Sciences (SPSS 10.0). Comparisons between
six different disciplines at St Georges University London and the variables were analyzed by one way analysis of variance (ANOVA),
Faculty of Health and Social Care Sciences at Kingston University and Bonferroni post hoc tests assessed any test, limb or group
participated in a Common Foundation Programme (CFP) which differences. Association between variables was measured by linear
was designed within our Faculty to address the needs of health regression. RESULTS: One month after surgery, a significant
care in the UK. METHODS: Students’ perceptions were assessed correlation (p < 0.01) was found between activation level (%) and
through the completion of a questionnaire. Full ethical approval was MVC of injured knee extensors. By three months, most patients
given by the Faculty of Health and Social Care Sciences ethics had achieved full activation but still had muscle weakness. At
committee. ANALYSIS: Non-parametric ANOVA, Kruskal-Wallis test one and three months post surgery and for all levels of MVC
and cross tabulation were used to determine the differences between contraction, the median frequencies of the injured limbs were
disciplines, as well as frequency distribution, minimum and maximum, significantly lower (p < 0.05) compared to the SC group as were those
range, mean and standard deviation (SD). The data was analysed of the RC group. There was a significant lowering of the median
using the Statistical Package for Social Sciences (SPSS) version frequencies of the uninjured limbs compared to the SC group at
13. Significance was accepted at P < 0.05. RESULTS: In general the 75 and 100% of MVC. The EMG amplitude of the uninjured and
majority (n=169, 81.4%) of the participants enjoyed the experience injured limbs mirrored those of the SC and RC groups, respectively.
of IPE. There was no statistical significance difference between Regression analysis showed the functional questionnaire and level
disciplines (p > 0.05) regarding; students’ opinions of the suitability of activation of the knee extensors can predict knee function one
of each topic for IPE delivery, level of interaction between disciplines year after surgery. CONCLUSIONS: Muscle activation patterns
in each topic, and suitability of teaching methods. However, there was altered following ACL injury and repair and contribute to subsequent
a statistically significant difference for lecturer availability: p = 0.001 changes in muscle fibre properties during detraining and subsequent
and for suitability of examples given during delivery: p = 0.009 retraining. IMPLICATIONS: These neuromuscular adaptations after
CONCLUSIONS: Overall, the students have been very positive about knee surgery provide a basis to develop specific muscle strength
the experience. However, there are some areas of concern which training that includes recruitment of large, fast contracting muscle
should be addressed in the future design of any Inter-Professional fibres. In addition, combination of functional scores and level of
Education modules. These include: more interactive teaching activation predicts functional performance beyond the rehabilitation
methods and joint projects, and making sure case studies are phase and can inform rehabilitation regimes specific to the individual.
relevant across disciplines in order to facilitate the passage BEYOND These data further our understanding of the persistent knee extensor
PROFFESIONAL BARRIERS IMPLICATIONS: The implication of weakness evident after ACLR. KEYWORDS: ACLR, muscle strength,
this study concerns the improvement in methods of interdisciplinary function, motor unit recruitment, EMG, median frequency. FUNDING
education in medical and health care sciences, with the intention ACKNOWLEDGEMENTS: This work was supported by the School
of promoting holistic approaches to patient care. KEYWORDS: Inter- of Health & Biosicience, University of East London. CONTACT:
professional, Education, Collaboration, Learning, Stereotypes, Team- [email protected]
work, Roles. FUNDING ACKNOWLEDGEMENTS: N/A. CONTACT: ETHICS COMMITTEE: University of East London Ethics committee
[email protected] and East London & City Health Authority Ethical Committee.
ETHICS COMMITTEE: Full ethical approval was given by the Faculty
of Health and Social Care Sciences ethics committee of Kingston
University, UK.
VCEC Ballroom B & C
Research Report Platform Presentation STROKE AND HEALTH-RELATED KNOLWEGE, BELIEFS,
2455 Wednesday 6 June 14:45 AND BEHAVIORS OF CHINESE CANADIANS: STATUS AND
VCEC Ballroom A IMPLICATIONS FOR PHYSICAL THERAPISTS
CHANGES IN MUSCLE STRENGTH AND FUNCTION AFTER Wang S1 , Li Z2 , Jongbloed L1 , Dean E1 ; 1 School of Rehabilitation
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Sciences, University of British Columbia, Vancouver, Canada;
Drechsler W, Cramp M, Scott O; University of East London, 2 School of Communication and Culture, Royal Roads University,
London, UK Victoria, Canada

PURPOSE: Despite post operative rehabilitation, studies report PURPOSE: Stroke is a leading cause of death in Chinese Canadians
quadriceps weakness early (Morrissey et al. 2000) and later (CCs); the fastest growing group of immigrants. The needs of CCs
(Mikkelsen et al. 2000) after anterior cruciate ligament reconstruction in relation to health and stroke education are not well documented.
(ACLR). The underlying reasons for this persistent muscle weakness We examined stoke-related health knowledge, behaviors and beliefs
are unresolved and strategies that control motor unit recruitment of CCs in reference to European Canadians (ECs), and the effect
remain unknown. Surface electromyographic (EMG) signal has of acculturation of the CCs on these variables. RELEVANCE:
been used to estimate motor unit recruitment patterns and median Canada is a cultural mosaic. Health white papers in recent years
frequency of muscle (Stulen & De Luca 1981). This study monitored have identified the need for culturally sensitive and responsive
neuromuscular changes in quadriceps femoris muscle at one and health care (Romanow Report 2002; Kirby Report 2002). Immigrants
three months after ACLR. RELEVANCE: Rehabilitation programmes from Confucian-heritage countries are a growing proportion of
may be optimised by identifying and considering recruitment control immigrants to countries worldwide. An understanding of the needs
strategies employed during submaximal and maximal contractions of this unique group will help promote the ideals of culturally
following surgery. PARTICIPANTS: Thirty one patients (28M, 6F) sensitive and responsive health care. PARTICIPANTS: Convenience
recovering from ACLR (mean (SD), age 30(8) years were tested samples of CCs (n=103) and ECs (n=103) from the Lower Mainland
one and three months after surgery. Physically inactive (RC) and of British Columbia, Canada. METHODS: An ethically-approved,
sports participants (SC) acted as controls. METHODS: Changes cross-sectional, descriptive study was conducted. The questionnaire
was primarily based on closed-ended questions from established to examine the performance of 10 active movement control tests.
tools and consisted of four parts: stroke-related knowledge, health Each test is rated whether correct ot incorrect. The reliability of
behaviors, health beliefs, and demographic information. Stroke- the tests has been shown in earlier studies. ANALYSIS: The effect
related knowledge was assessed with open-ended questions.The size (d) between the groups were calculated where d < 0.20 is
back-translation method was used to translate the questionnaire considered small, 0.2-0.5 medium and over 0.8 large effect size.
into Chinese. Traditional and simplified Chinese versions were T-tests for the significance of the difference between the groups
used. ANALYSIS: Descriptive statistics were used to describe were calculated, where P values <0.01 are considered showing high
subject characteristics, frequencies to compare behaviors and significant results. RESULTS: The effect size d was 0.79 between
beliefs, and chi-square tests and correlations to compare differences the groups by a p < 0.001 which means a large effect size by a very
between groups, and sub-groups of the CCs based on median clear significance for the result. LBP patients scored in average 3.0/10
split of years in Canada. The p value was 0.05. RESULTS: tests incorrectly whereas persons not suffering from LBP scored 1.4
Demographically, the groups were comparable with the exception of / 10 tests incorrectly (8.6/10 correct). CONCLUSIONS: There is a
income (p < 0.05). Compared with ECs, CCs were less awareness clear difference between the sampled populations with and without
of stroke risks, warning signs, and emergency response. Preferred low back pain in the active movement control tests. This might be an
health information sources were media, family and friends for the important outcome measure in the effectivity studies of LBP and an
CCs, and health professionals for the ECs (p < 0.05). With respect to important detail to try to improve by treating LBP patients. Further
dietary habits, both groups consumed fewer than the recommended studies are needed to examine the construct validity of the active
number of servings of the major food groups (Health Canada movement control tests as a specific assessement tool for a specific
2006). CCs are less likely to smoke and drink alcohol than ECs subgroup of LBP. IMPLICATIONS: Active movement control tests
(p < 0.05) and are more sedentary (p < 0.05). The level of exercise are a promising tool to be used in examination and treatment of
for most respondents was less than that recommended (American LBP patients. KEYWORDS: Active movement control tests, LBP,
College of Sports Medicine 2005). Compared with ECs, the health Cross sectional study. FUNDING ACKNOWLEDGEMENTS: None.
beliefs of CCs with respect to diet were more consistent with CONTACT: [email protected]
established guidelines, yet fewer appreciated the importance of ETHICS COMMITTEE: Ethics committee of canton Aaragau in
regular exercise and normal weight (p < 0.05). CCs reported more Switzerland
stress from all causes than ECs (p < 0.05). Years in Canada had little
relationship to stroke-related knowledge and behaviors reported by Research Report Platform Presentation
CCs. Having lived more years in Canada however was associated
with greater belief about negative health effects of smoking and
alcohol (p < 0.05). CONCLUSIONS: Improved knowledge translation
strategies are needed for ECs, and in particular CCs. Our ADAPTING THE CO-OP TREATMENT APPROACH FOR ADULTS
findings related to diet and exercise of Asian immigrants concur WITH STROKE: PHASE ONE, EXPERT OPINION
with other studies. Hofestede’s theoretical dimensions of culture McEwen S1 , Polatajko H1 , Ryan J2 , Birkenmeier R3 , Huijbregts M2 ;
helped explain differences in stroke-related knowledge, behaviors, 1 University of Toronto; 2 Baycrest Centre for Geriatric Care;
and beliefs between groups, and identified distinct strategies for 3 Washington University School of Medicine
delivering health education to CCs. IMPLICATIONS: By enhancing
their understanding of differences and similarities between these PURPOSE: The purpose of this multi-phased project is to determine
groups, physical therapists may enhance the cultural sensitivity of the adaptability of the CO-OP approach for use with adults with
their interventions and overall management. KEYWORDS: Chinese stroke. The Phase 1 research questions were: 1. What is the
Canadians, culturally sensitive health care, health behaviors, health perspective of expert stroke rehabilitation clinicians regarding the
beliefs, health knowledge, health knowledge translation, responsitive utility of the CO-OP approach for use with adults with stroke?
health care. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: 2. What adaptations do they recommend? RELEVANCE: There is
[email protected] little evidence on how best to improve participation outcomes for
ETHICS COMMITTEE: University of British Columbia, Canada, people with stroke. The Cognitive Orientation to daily Occupational
Ethics Review Board Performance (CO-OP) treatment approach was designed for the
treatment of children with motor-based performance deficits, and a
body of research has demonstrated its ability to improve activity and
Research Report Platform Presentation participation. CO-OP is an integrated approach to skill acquisition that
1198 Wednesday 6 June 14:45 includes elements critical for the generalization and transfer of skills
VCEC Meeting Room 16 from rehabilitation programs to real life. Skill acquisition is viewed
ACTIVE MOVEMENT CONTROL TESTS OF THE LOW BACK from a learning perspective and emphasis is on integrating activities
AMONG PATIENTS WITH LBP AND NO LBP in the larger context of life participation. It is hypothesized that once
adapted, CO-OP will be more effective in improving participation
Luomajoki H1,2 , Kool J3 , Airaksinen O2 , de Bruin E4,5 ;
1 Physiotherapie Reinach, 5734 Reinach, Switzerland; 2 University post stroke compared to current approaches. PARTICIPANTS:
(Phase one) Five expert occupational therapists (OTs) and three
of Kuopio. Finland; 3 Rehabilitation Clinic, Valens, Switzerland;
4 University hospital of Zürich. Switzerland; 5 ETH Zürich Switzerland expert physical therapists (PTs) with an average of 16 years
work experience were recruited. Theoretical sampling was used to
PURPOSE: Validation of active movement control tests by comparing ensure a mix of expertise, discipline, work setting, and experience.
the test performance score between patients with and without low METHODS: A multi-phased study to adapt CO-OP for use in stroke
back pain (LBP). RELEVANCE: Movement impairment syndroms is currently underway, using a combination of expert opinion, single
are a promising possible subgroup among patients with low back case experimental design, and process evaluation. This Phase 1
pain. Active movement control tests are based on those originally used expert opinion. In a workshop format, stroke rehabilitation
described by Sahrmann and by O’Sullivan. The tests are a reliable clinicians were introduced to the CO-OP approach. Subsequently,
tool for the diagnosis in this syndrom. PARTICIPANTS: We examined they participated in a focus group to discuss the potential applicability
242 persons (mean age 46 years in both groups) with a battery of of the approach for adults with stroke, and to elicit recommendations
10 tests on the ability to control the active movements of the low for adaptations. Demographic information was collected, and the
back. 121 persons were currently suffering of LBP and further 121 focus group was audiotaped and transcribed verbatim. ANALYSIS:
persons did not have currently or in the last 3 months any LBP. The transcription was analyzed line by line by three of the authors,
METHODS: A cross sectional study with a standardized protocol looking for evidence of the participant’s perspective on the utility of the
approach for adults with stroke, as well as specific recommendations participants, along with 14 predictor variables. Mean change was
for its adaptation. They initially worked independently, and then reported along with group and individual change indices of effect size
discussed their findings to reach consensus. RESULTS: CO-OP (ES) and reliable change proportion (RCP). Standard model building
was perceived as a novel, promising, and exciting approach for methods identified predictive variables associated with pain and
stroke rehabilitation. Challenges to implementing the approach in disability outcomes at discharge for simple and multiple regression
adults with stroke may include using the approach in people models. The study included 2624 participant records from three
with executive functioning impairments, and potential differences in health regions. Initial pain and disability scores were moderately low,
the way adults and children learn motor skills. Recommendations but substantial improvement was observed on all three measures
include training implications, timing, and methods to introduce with ESs ranging from 0.9–1.1 and RCPs from 43.2% to 61.5%.
the approach to clients. Therapists articulated a range of stroke Regression analysis found several individual predictors, but only
rehabilitation beliefs and attitudes, particularly around client-centred age remained significant in multiple models. ANALYSIS: PEARS
goal-setting, that may facilitate or hinder the future adoption of this participants reported substantial reduction of pain and disability
approach. CONCLUSIONS: A group of expert stroke rehabilitation at discharge supported by large ES and moderate RCP values.
therapists consider the CO-OP approach as novel and promising However, models did not identify as many variables predictive of
for use with adults with stroke and specific recommendations disability as was expected. This may be due to data loss from low
for adaptations have been made. IMPLICATIONS: The CO-OP outcome completion and model specification error. These findings
approach has potential to provide therapists with a successful, demonstrate success of the secondary prevention component of
structured, and integrated approach to stroke rehabilitation. Further PEARS, and provide guidance for improvement of program evaluation
work is underway to examine the adaptations required from the methods. RESULTS: CONCLUSIONS: IMPLICATIONS: Strategies
client’s perspective, and a controlled trial is planned. KEYWORDS: to increase outcome completion are necessary for PEARS and other
stroke rehabilitation, learning, physiotherapy practice. FUNDING PT programs that use standardized pain and disability outcome
ACKNOWLEDGEMENTS: This project has received funding from the measures. Doing so can enhance interpretation of clinical effec-
Physiotherapy Foundation of Canada and the James S. McDonnell tiveness and development of robust prediction models which could
Foundation. CONTACT: [email protected] further guide development and implementation of primary prevention
ETHICS COMMITTEE: Baycrest Centre for Geriatric Care and strategies. KEYWORDS: muscloskeletal injury, occupational health,
University of Toronto Health Sciences II outcome evaluation. FUNDING ACKNOWLEDGEMENTS: Funding
for this study was provided by the Occupational Health and Safety
Agency for Healthcare (OHSAH). The first author was funded in a
Strategic Training Program in Rehabilitation Research from the CIHR
2654 Wednesday 6 June 14:45 Institute of Musculoskeletal Health and Arthritis.
PAIN AND DISABILITY OUTCOMES FROM A PREVENTION
AND EARLY ACTIVE RETURN-TO-WORK SAFELY (PEARS)
PROGRAM 1801 Wednesday 6 June 14:45
Kozlowski A1,3 , Yassi A2,3 ; 1 School of Rehabilitation Sciences,
FAMILY MEDIATED EXERCISES (FAME) FOLLOWING STROKE –
University of British Columbia, Vancouver, Canada; 2 Department
A SURVEY OF THE VIEWS OF ‘FAMILY MEMBERS/FRIENDS’
of Health Care and Epidemiology, University of British Columbia,
Vancouver, Canada; 3 Occupational Health and Safety Agency Galvin R1 , Stokes E1 , Cusack T2 ; 1 School of Medicine, Trinity
for Healthcare, Vancouver, Canada Centre for Health Sciences, James’s St, Dublin 8; 2 School of
Physiotherapy and Performance Science, College of Life Sciences,
PURPOSE: Healthcare workers (HCWs) are at high risk of
Unviersity College Dublin
musculoskeletal injuries (MSIs). Pain and disability are associated
with MSIs. The Prevention and Early Active Return-to-work Safely PURPOSE: The primary aim of this project is to determine
(PEARS) program was developed to address rising incidence of whether ‘family mediated exercise intervention’ (FAME) in addition
MSIs in HCWs, and consequences of MSI such as time loss, to routine physiotherapy improves muscle strength and function in
claim costs, and pain and disability. The PEARS program combined the lower limb in persons with stroke. In effect, the nominated ‘family
primary and secondary prevention strategies under a culture of member/friend’ of the person with stroke receives training from the
participatory health and safety managed jointly by healthcare unions physiotherapist and then helps the person with stroke to complete a
and management. Successful reduction of MSI incidence was series of exercises each day. RELEVANCE: One major component of
reported previously. The purpose of this study was to (1) report on stroke rehabilitation is exercise intervention. It has been suggested
secondary prevention outcomes of pain and disability, and (2) develop that the dose of physiotherapy intervention that occurs post stroke
prediction models for pain and disability outcome at discharge. is, at best, ‘homeopathic’ (Pomeroy & Tallis 2002). De Weert and
RELEVANCE: Physical therapy (PT) is integral to both primary Feys (2002) report that: ‘Physiotherapists need to develop strategies
and secondary prevention components of PEARS. Integration of PT whereby patients and caregivers take full responsibility for the bulk of
intervention with workplace components can facilitate optimal and therapy – for instance, training of balance, strength and endurance,
safe recovery and return to function. Measurement of clinical and repetition of simple tasks, group therapy, fitness-related training and
other outcomes can support clinical decision making and program family involvement.’ However, the penetration from science in to
planning. PARTICIPANTS: PEARS is a prevention and voluntary clinical practice is relatively non-existent. PARTICIPANTS: In order
early-intervention program for HCWs with, or at risk of MSI. All to explore the views of family/friends of people with stroke on their
HCWs with an MSI incident are referred to PEARS, and offered perceived role in the delivery of exercises (FAME) by them under
PT, ergonomic workplace assessment, work practice modification, the supervision of a physiotherapist, a self-report questionnaire
and if necessary, integrated return-to-work planning with modified was administered.‘Family members/friends’ (n=100) of people with
hours and/or duties to facilitate early and safe recovery. HCWs stroke who were actively receiving inpatient physiotherapy in a
can also be referred by self, physician, union, or management selection of Dublin hospitals were invited to participate in the
representatives. The program typically lasts a maximum of seven study. METHODS: The self-report questionnaire was designed by
weeks. METHODS: Pain and disability scores were captured for the the authors and reviewed by five senior physiotherapists (PT’s)
Visual Analogue Discomfort Scale (VADS), the Oswestry Disability in neurology/age related healthcare. The Survey Review Board in
Index (ODI), and the Disabilities of the Arm, Shoulder and Hand St. James’s Hospital, Dublin, also reviewed the questionniare. The
(DASH) questionnaire at initial and discharge visits for PEARS questionnaire contained four sections that documented demographic
details of the participant, frequency of participants involvement in adoption of a critical, reflexive approach by the researcher during
their ‘family member/friends’ physiotherapy, the views of participants data collection, text construction and interpretation. RESULTS: The
on the delivery of exercises by them with and without the supervision findings of this research resulted in the development of a model
of a PT and reasons that limit or could potentially enhance of factors influencing clinical decision making in cardiopulmonary
participants participation in physiotherapy. ANALYSIS: Descriptive physiotherapy. At the core of this model is the dependence of
statistics (mean, mode, mean) were primarily used to consider decision making upon the nature of the decision task, particularly
the responses of the participants. In addition, chi-squared tests as related to the uncertainty and difficulty of the task. This
were carried out to determine if male and female respondents core process of decision making was influenced by the physical,
differed significantly in their responses to particular questions. organisational and socio-professional factors that constituted the
RESULTS: Ninety-one respondents reported that they would be complex, variable and uncertain contexts of cardiopulmonary deci-
available to help their ‘family member/friend’ with a stroke with sion making. Cardiopulmonary decision making is also influenced by
his/her exercises. However only 36% reported that they had been practitioner factors including clinical experience, frames of reference
invited to attend physiotherapy sessions by the PT since their and particular decision making capabilities. Cardiopulmonary phys-
‘family member/friend’ commenced physiotherapy. The majority of iotherapy practitioners develop cognitive, metacognitive, emotional
respondents were willing to help deliver exercises in the hospital and social capabilities that enable them to make decisions in
and in the home setting (range 86%-99%) unsupervised following the complex contexts of acute care settings. With increasing
suitable training by the PT. Commitment to work was documented as experience cardiopulmonary physiotherapists demonstrate more
the primary that limited respondents’ participation in physiotherapy advanced capabilities for making optimal decisions in the contexts
(24%). CONCLUSIONS: Family members of people with stroke of acute care cardiopulmonary physiotherapy decision making.
are willing to participate in physiotherapy. Suitable training by CONCLUSIONS: This research has revealed that clinical decision
the physiotherapist is necessary in order to optimise participation. making in cardiopulmonary physiotherapy is influenced by multiple,
Strategies that may enhance participation in physiotherapy should complex interacting factors. Understanding, critiquing and improving
be implemented. IMPLICATIONS: The application of these findings clinical decision making requires consideration of each of these
in the rehabilitation setting will enable the optimal involvement and factors. IMPLICATIONS: The model developed in this research offers
active participation of willing ‘family members/friends’ of people with a conceptual framework for cardiopulmonary physiotherapy teaching,
a stroke in their individually prescribed rehabilitation programmes. practice and research and has the potential to enhance the quality
KEYWORDS: Stroke, physiotherapy, family involvement. FUNDING of decision making in acute care settings. KEYWORDS: Clinical
ACKNOWLEDGEMENTS: This project was in receipt of a gift cheque reasoning, decision making. FUNDING ACKNOWLEDGEMENTS:
from the ‘Friends of the Royal Hospital Donnybrook’. CONTACT: This work was supported financially by the Australian Physiotherapy
[email protected] Research Foundation (PRF) and Charles Sturt University. CONTACT:
ETHICS COMMITTEE: Research Ethics Committee, Trinity College [email protected]
Dublin. ETHICS COMMITTEE: The University of Sydney and ethics
committees of the hospitals involved
1312 Wednesday 6 June 15:05 Research Report Platform Presentation
PP Crystal Pavilion A 2763 Wednesday 6 June 15:05
A MODEL OF FACTORS INFLUENCING CARDIOPULMONARY VCEC Ballroom A
PHYSIOTHERAPY DECISION MAKING IN VIVO KINEMATICS OF ANTERIOR CRUCIATE LIGAMENT
Smith M1,2 ,Higgs J2 ,
Ellis E2 ; 1 Charles Sturt University; 2 The DEFICIENT KNEES DURING BILATERAL SQUATTING USING A
University of Sydney SINGLE-PLANE SHAPE-MATCHING TECHNIQUE
Gamada K1 , Yamaguchi S2 , Banks S3 , Moriya H2 ; 1 Department
PURPOSE: Quality decision making is an essential element of good
of Physical Therapy, Hiroshima International University,
clinical practice. A description of factors influencing cardiopulmonary
Higashi-Hiroshima Japan; 2 Department of Orthopaedic Surgery,
decision making is not evident in the research literature. The aim
Graduate School of Medicine, Chiba University, Chiba, Japan;
of this study was to identify factors that influence decision making 3 Department of Mechanical and Aerospace Engineering, University
in acute care hospital settings by cardiopulmonary physiotherapists
of Florida, Gainesville, USA
with varying levels of clinical experience. RELEVANCE: This study
was undertaken to inform clinical decision making by physiother- PURPOSE: Rupture of the anterior cruciate ligament (ACL) often
apists as it relates to their everyday practice and to inform the leads to early osteoarthritis (OA). The nature of pathomechanics in
education of beginning physiotherapy practitioners. PARTICIPANTS: knees with ACL-deficiency (ACLD) during in vivo, dynamic activities
Fourteen participants engaged in the practice of cardiopulmonary has not been clearly understood. The goals of this in vivo study
physiotherapy in three experience categories (novice, intermediate were to demonstrate the pathological kinematics of ACLD and
and more experienced) took part in the study. Participants were determine the roles of the 2 bundles of the ACL during squatting.
recruited from three Australian metropolitan hospitals and practised RELEVANCE: Knowledge of the pathological kinematics of ACLD
across a range of acute care clinical areas (e.g. intensive care, during squatting will provide important implications for the use of
post-abdominal surgery and respiratory medicine). METHODS: A closed kinetic chain exercises for knees with ACLD and ACL-
qualitative research study was conducted using a hermeneutic reconstruction. PARTICIPANTS: Five patients with unilateral ACLD
approach. Data was collected from each participant on two occasions participated in this IRB-approved, prospective study. Combined
by observing them undertaking their usual daily patient care activities, ligament injuries, radiographic OA, underage patients were excluded.
and interviewing them about their decision making. A process of A mean interval from injury to the testing was 144 months (range:
participant checking was used to check that the collected data was 3-300 months). METHODS: A shape-matching technique (Banks,
reflective of the decision making of the participants. ANALYSIS: 1996) using single-plane lateral fluoroscopy and CT-based patient-
Data analysis involved an in-depth, iterative process of reading specific knee models were used for kinematic analysis of bilateral
and interpretation of the research texts. Texts for analysis were squatting. Patients performed 2 sets (ACLD and contralateral knees)
constructed from the collected data in the form of field-notes from of 3 cycles of bilateral squatting under fluoroscopic surveillance at
the observation and interview transcripts. The texts were interpreted, 15 Hz in a wide and open stance technique to avoid overlapping
guided by hermeneutic devices: the hermeneutic circle and fusion of the contralateral knees. They also underwent CT scan at 0.5mm
of horizons. Credibility of the research was enhanced by the slice pitch, from which geometric bone models of the femur and tibia
were created. ANALYSIS: A custom program (KneeTrack) produced PARTICIPANTS: 102 first-generation ICs and 102 ECs, recruited via
by a co-author (SB) were used for the shape-matching procedure convenience sampling from community centers across the Lower
to obtain 6 degrees-of-freedom knee kinematics, whose estimated Mainland of British Columbia, Canada, participated. METHODS:
errors were 1.5mm in sagittal translations and 1.5 degrees in 3 A descriptive, comparative study, based on a structured self-
rotations (Fregly, 2005). Cardan/Euler angle convention (Tupling and administered questionnaire, was conducted. Based on established
Pierrynowski, 1987) was used for quantitative analyses. Two-way tools, the questions focused on health knowledge, beliefs, behaviors
repeated measure ANOVA was used for kinematics comparisons and sociodemographic information. The back-translation method was
and p < 0.05 were used for the level of significance. RESULTS: used to translate the questionnaire into Punjabi. ANALYSIS: De-
Both ACLD and contralateral knees demonstrated increasing tibial scriptive statistics described subject characteristics, and IHD-related
internal rotation with knee flexion between 0º and 100º in which the knowledge, behaviors, and beliefs. Chi-square tests and independent
rotation angles between the 2 groups were not statistically significant. t-tests examined group differences. Within-group differences were
The ACLD knees showed continuing tibial internal rotation at 120º examned for gender and age for both groups; and for ICs based
and 130º, while the contralateral knees’ rotation remained constant on median split of the number of years lived in Canada. The p
after 100º. The contralateral normal knees showed significantly more value was 0.05. RESULTS: ICs had less knowledge of IHD risks
external rotation at 120º and 130º. There was significant tibial anterior (p < 0.05), and were less likely to exercise or eat healthfully compared
translation at all flexion angles between 0º and 130º. The medial with ECs (p < 0.05). Barriers and motivating factors identified by
anteroposterior contact points were relatively constant throughout the two groups reflected their cultural orientations, e.g., focus on
the flexion range, and those of the ACLD knees were located more relation to others than self. Duration of residence in Canada for
posteriorly at 0º, 10º, and 100º. The lateral anteroposterior contact IC immigrants had no effect on knowledge, physical activity, and
points moved more dynamically from anterior to posterior, and those health beliefs, although leisure-time activity and dietary practices
of the ACLD knees were located more posteriorly at 0º, 10º, 20º, improved with increased time of residency in Canada (p < 0.05).
120º and 130º. CONCLUSIONS: In ACLD knees, the tibia translated CONCLUSIONS: Differences between the East Indian and Canadian
anteriorly throughout the flexion range, perhaps due to the deficient cultures with respect to health beliefs and behaviors can be explained
posterolateral bundle of the ACL. The tibial internal rotation of the based on cultural theory. Although the findings support that ICs
ACLD knees was larger in deep flexion, which may be due to the have less healthy lifestyles compared with ECs, there was no
deficiency of the anteromedial bundle of the ACL based on the evidence to support these worsened over time in Canada. The
knowledge of in vitro biomechanics. IMPLICATIONS: A closed kinetic urban environment may have a role in lifestyle practices given
chain exercise, e.g. squatting, may not be a safe activity for ACLD high rates of IHD mortality among urban dwelling East Indian
knees. This information should be implemented in future exercise compared with migrant ICs. The present study supports that IC
prescription for rehabilitation of ACL injury. KEYWORDS: ACL cultural values augment the effect of the Canadian environment in
deficient knee, pathokinematics, in vivo knee kinematics. FUNDING influencing health behaviors. IMPLICATIONS: Insights are provided
ACKNOWLEDGEMENTS: No funding for this study was received by into ways health education targeted toward these two groups can
any of the authors. CONTACT: [email protected] be conceptualized, designed, and disseminated. Physical therapists
ETHICS COMMITTEE: Approved by the Ethics Committee at Faculty practicing in culturally diverse settings need to consider the role
of Medicine, Chiba University of culture on clients’ health knowledge, behaviors, and beliefs.
KEYWORDS: IndoCanadians, culturally sensitive health care, health
behaviors, health beliefs, health knowledge, responsitive health
care. FUNDING ACKNOWLEDGEMENTS: Ann Colins Whitmore
2661 Wednesday 6 June 15:05 Memorial Foundation and the Physiotherapy Foundation of Canada.
VCEC Ballroom B & C CONTACT: [email protected]
HEALTH KNOWLEDGE, BELIEFS, AND BEHAVIORS OF ETHICS COMMITTEE: The Ethics Review Board of the University of
INDOCANADIANS WITH SPECIAL REFERENCE TO HEART British Columbia, Canada.
DISEASE: IMPLICATIONS FOR PHYSICAL THERAPISTS
Rodrigues G1 , Jongbloed L2 , Li Z3 , Dean E2 ; 1 Back in Motion Research Report Platform Presentation
Rehabiltation Inc., Surrey, British Columbia, Canada; 2 School of 2404 Wednesday 6 June 15:05
Rehabilitation Sciences, University of British Columbia, Vancouver, VCEC Meeting Room 16
Canada; 3 School of Communication and Culture, Royal Roads
University, Victoria, Canada THE RELIABLE IDENTIFICATION OF A SUBGROUP OF
“HYPERVIGILANT” PATIENTS WITH NON-SPECIFIC LOW BACK
PURPOSE: Mortality from ischemic heart disease (IHD) of East PAIN USING A CLINICAL EXAMINATION
Indians who emigrate to the West, is due to lifestyle as well
McCarthy C1 , Gittins M2 , Roberts C2 , Oldham J2 ; 1 Warwick
as hereditary. Prevention strategies targeted towards this group
Medical School, University of Warwick; 2 University of Manchester
requires an understanding of factors that influence health behaviors
that predispose IHD. This study examined IHD-related knowledge, PURPOSE: Non-Specific Low Back Pain (NSLBP) accounts for over
beliefs and behaviors of IndoCanadians (ICs) and European 85% of all Low Back Pain diagnoses. Homogenous subgroups of pa-
Canadians (ECs) to elucidate the role of culture on health behaviors. tient presentation may exist within this heterogeneous condition. This
RELEVANCE: South Asians comprise one of the largest non- study evaluated a typical physiotherapy clinical examination’s item
European immigrant groups in Canada as well as other cultures. reliability and ability to identify homogenous subgroups of patients
Health white papers have identified the need for culturally sensitive with NSLBP. RELEVANCE: There is a body of evidence suggesting
and responsive healthcare. Although IHD is the leading cause of that targeting treatment to subgroups of patients with NSLBP is more
death in Canada, the cross-cultural effectiveness of health education effective than not adopting this strategy of management. Importantly,
strategies warrants elucidation. We argue that health education valid subgroups of NSLBP are yet to be fully established. This work
content and delivery warrant being adapted to the individual, based evaluated the contribution that a typical physiotherapy examination
on cultural considerations. An understanding of the needs of this made to identifying subgroups of NSLBP. PARTICIPANTS: Three
unique group will promote the ideals of culturally sensitive and hundred and one patients with NSLBP, referred from primary and
responsive healthcare for minority groups. With the association secondary care, were examined by 54 physiotherapists. The study
between lifestyle conditions and affluence, preventing and managing was undertaken in 27 physiotherapy departments across the UK. The
these conditions through effective health education is a physical sample of patients demonstrated moderate disability and pain. The
therapy priority across cultural groups including the dominant culture. physiotherapists were experienced (average years since qualification,
13yrs) and the majority had post-graduate qualifications. METHODS: received from the University of Manitoba Health Research Ethics
Patients were examined by physiotherapists using a standardised Board. ANALYSIS: Structural equation modeling was used to test
clinical examination, developed using a Delphi consensus technique. two models of physical function. The first model used confirmatory
Each patient was examined by two physiotherapists, to allow an inter- factor analysis to test a model with three latent variables of pain,
tester reliability study to be conducted. Only the items with acceptable mobility, and self care. The second model used structural regression
reliability were then entered into the next stage of analysis. Data to test the associations among these latent variables. All analyses
were then analysed for the presence of distinct subgroups using were performed using LISREL software. RESULTS: The mobility
k-means cluster analysis. Clusters identified by the first rater were latent variable included walking, stairs, and other aspects of physical
then compared with the clusters identified by the second rater in activity. Self care included items of activities of daily living, strength,
a cross validation technique. ANALYSIS: Clinical examination items and dexterity – measures of strength and hand dexterity were
were analysed for agreement using kappa coefficients and weighted significantly associated with self care rather than mobility. The three-
kappa coefficients for ordinal data. 95% C.I.s were calculated. K- factor model provided a good fit to the data. A structural regression
means cluster analysis was conducted to examine for between 2 model in which pain has a direct effect on mobility and an indirect
and 5 potential clusters. Agreement in the numbers of clusters effect on self care provided a good fit to the data. CONCLUSIONS:
identified in rater one and rater two’s data was assessed using kappa Mobility, pain, and self care describe dimensions of physical function
coefficients. RESULTS: The inter-tester reliability of the majority of one month after stroke. The effect of pain on self care appears to
items was moderate to substantial (52% of items with kappa > 0.40). be indirect, through mobility. Future work will evaluate change in
A k-means cluster analysis of the two data sets revealed substantial these dimensions of physical function over time. Validation of the
agreement on the presence of two subgroups (k = 0.63). One group model in other chronic disease populations is an important next
(n=47, 16%) had higher fear avoidance beliefs related to physical step. IMPLICATIONS: Modeling physical function post stroke may
activity, sensory pain, anxiety and disability. They were more likely assist physiotherapists in understanding the components of physical
to be provoked by, and avoidant of, pain provocative tests. They function and assist in determining goals with the client, improving
were also more likely to be judged as having central sensitisation physical function and health related quality of life. KEYWORDS:
and a dominant psychosocial component to their pain presentation. physical function, stroke, structural equation modeling. FUNDING
Tests that highly predicted membership of the hypervigilant group ACKNOWLEDGEMENTS: Original study funded by the Canadian
included the presence of allodynia whilst a negative straight leg raise Stroke Network. CONTACT: [email protected]
reduced the probability of membership of this group significantly. ETHICS COMMITTEE: University of Manitoba Health Research
CONCLUSIONS: The identification of a group of hypervigilant Ethics Board
NSLBP patients should allow the development of effective interven-
tions, targeted specifically towards this group. A valid, standardised
clinical examination does make a contribution to the diagnostic
management of NSLBP. However, considerable numbers of tests and 3099 Wednesday 6 June 15:05
questions did not contribute to the discrimination of any subgroups of VCEC Meeting Room 18
NSLBP. IMPLICATIONS: There is a strong need for the development THE INFLUENCE OF INJURED WORKERS’ PERCEPTIONS OF
of a discriminatory, examination instrument that will allow us to FUNCTION ON THEIR WORK STATUS AFTER SUSTAINING
further identify valid subgroups of NSLBP. KEYWORDS: Low Back A WORK-RELATED UPPER EXTREMITY MUSCULOSKELETAL
Pain, Diagnosis, Reliability. FUNDING ACKNOWLEDGEMENTS: INJURY
This work was funded by a Post Doctoral Fellowship from the UK Switzer-McIntyre S1 , Jaglal S1,2 , Hogg-Johnson S3,4 , Irvine-
NHS Research Capacity Generation Agency. Many thanks go to the Doran D5 , Holness D6,7 ; 1 University of Toronto, Faculty of Medicine,
many patients and clinicians involved in the study. Department of Physical Therapy; 2 Toronto Rehabilitation Institute;
ETHICS COMMITTEE: South East MREC 3 University of Toronto, Department of Public Health Science; 4 Intitute
for Work and Health; 5 Unviersity of Toronto, Faculty of Nursing;

6 University of Toronto, Faculty of Medicine, Department of Medicine;
7 St. Michael’s Hospital, Occupational & Environmental Health Unit
VCEC Meeting Room 17 PURPOSE: The purpose of this research was to describe the
A STRUCTURAL EQUATION MODEL OF PHYSICAL FUNCTION characteristics of Ontario Workplace Safety and Insurance Board
POST STROKE (WSIB) claimants, who sustain an upper extremity injury, in order
to identify patterns and determine if a worker’s perceived level of
Barclay-Goddard R1,2 , Lix L2 , Wood-Dauphinee S3 , Mayo N3 ;
1 Department of Physical Therapy, School of Medical Rehabilitation, function affects their work status. RELEVANCE: The study builds
on the concept that returning to work is a multifactorial process
University of Manitoba, Winnipeg, Canada; 2 Department of
involving a number of physical and psychosocial factors that are
Community Health Sciences, University of Manitoba, Winnipeg,
influenced by the injured worker, the health care professionals, the
Canada; 3 Division of Clinical Epidemiology and School of Physical
employer, and the WSIB. What has not evolved in the literature to
and Occupational Therapy, McGill University, Montreal, Canada
date is how an individual’s perception of their function influences
PURPOSE: To describe the dimensions of physical function at one work status. PARTICIPANTS: Subjects sustained a work-related
month post stroke and their associations. RELEVANCE: Physical musculoskeletal upper extremity injury. The mean age of the study
function is widely recognized as an important component of health sample is 40.2 years, 68 of the 106 participants were male. Of
related quality of life (HRQL). Improvements in client HRQL may the participants 42.5% were on full work duties, 22.6% on modified
be achieved by understanding the way in which physical function work and 34.9% not at work. METHODS: A consecutive sampling
is conceptualized by individuals post stroke. PARTICIPANTS: 678 design. Workers were interviewed by telephone at approximately six-
persons with stroke participated as part of a one-year study entitled weeks post-accident. The primary measures included; self perception
“Understanding Quality of Life Post-Stroke: A Study of Individuals of function, the Disability Arm Shoulder and Hand Questionnaire,
and their Caregivers”, funded by the Canadian Stroke Network. The select questions from the Job Content Questionnaire and open-
mean age was 67.3 (14.8) years, 45.1% of the participants were ended questions regarding perceptions of ability to work. ANALYSIS:
female and 49.5% had a right sided lesion. METHODS: Self report Univariate analysis followed by bivariate analysis was used to identify
data were from generic and stroke-specific instruments of HRQL trends, quantify impact and discern associations between work status
including the SF-36, EuroQuol, Health Utilities Index, Stroke Impact and all variables. Content analysis was used to systematically and
Scale and the Preference Based Stroke Index. Ethics approval was objectively determine the presence of patterns within the qualitiative
data. RESULTS: As hypothesized, an individual’s perception of their pre-post pilot study conducted in preparation for a randomized trial
function is related to their work status (p < 0.0001), as is their with a wait list control. Seven participants and two facilitators formed
perception of disability (p < 0.0001). Both an individual’s perception the main Thunder Bay group and four participants connected by
of function and disability are strongly associated with work status at videoconference from two remote locations. The primary outcomes
baseline, however for this sample of workers, perceived function (OR were: participant perceptions, attendance rate, Goal Attainment
2.1, 95% CI 1.4 3.2) appears to have a slightly stronger relationship Scaling, Reintegration to Normal Living Index (RNL), Activity-specific
than the DASH (OR 0.56, 95% CI 0.3 1.04). Those individuals who Balance Confidence Scale (ABC), Geriatric Depression Scale (GDS),
perceived their level of function to be close to pre-accident level were Berg Balance Scale and the Six-minute Walk Test (6MWT). Data
much more likely to be at work. The qualitative data supports the were collected pre- and post-program, and at three-month follow-
overall findings, those individuals who felt valued, had modified work up. Focus groups and in-depth interviews were conducted following
programs in place, access to health care and perceived their level of the program. ANALYSIS: Data analysis was conducted using
function to be close to or at their pre-accident level were much more SPSS Version 14, and included descriptive statistics, comparison
likely to be at work. CONCLUSIONS: While the factors that influence of Thunder Bay to the remote group and comparisons of pre-
work status are multidimensional; perception of function appears to post outcomes for the group as a whole. Thematic analysis of
be one of the factors to consider in the overall equation. Future work the focus group and interview data was conducted. RESULTS:
in this area is required to provide more insight into the predictive Two participants dropped out, one from each group. Attendance
value of self-perception of function over time on work status. rates were 83.3% overall, 89.8% for the Thunder Bay group and
IMPLICATIONS: When an individual’s perception of their recovery 70.4% for the remote group. Goal Attainment Scaling increased
is probed duirng a physical therapy assessment it appears that for all participants by an average of 2.2 on the five point scale.
questions related to how long they feel it will take to return to activity Improvements were seen on the GDS, ABC and the 6MWT. Findings
and whether or not they are ready to return to their pre-accident job from the focus group and interviews revealed the program provided
are good indiciators of their liklihood to return to work. The value both people with stroke and care partners with greater awareness
of a simple clinical question, which is used in everyday practice; and acceptance of stroke, increased social support and improved
“What is your level of function today as compared to before your ability to cope. In addition, they reported a decrease in their perceived
injury” has been validated. KEYWORDS: return to work, workplace loneliness when they were able to share with others in a similar
health, optimizing function. FUNDING ACKNOWLEDGEMENTS: situation, even if they were in a different community. All participants
Workplace Safety and Insurance Board of Ontarion, Work & Health reported that videoconferencing decreased their sense of isolation.
Scholarship; William T. McEachern Fellowship; University of Toronto, CONCLUSIONS: Telehealth is a feasible method to disseminate
Institute of Medical Science Merit Award; University of Toronto Open programs to rural and remote areas. IMPLICATIONS: Results from
Scholarship; University of Toronto, Department of Physical Therapy. this pilot study have been used to inform a larger randomized
CONTACT: [email protected] controlled trial to evaluate the effectiveness of this program delivery.
ETHICS COMMITTEE: University of Toronto, Research Ethics Board KEYWORDS: stroke, community integration, telehealth. FUNDING
as well as the Workplace Safety and Insurance Board of Ontario ACKNOWLEDGEMENTS: Heart and Stroke Foundation of Ontario.
Research Ethics Board CONTACT: [email protected]
ETHICS COMMITTEE: Baycrest Centre Research Ethic Board;
St. Joseph’s Care Group Board Ethics commmittee; Thunder Bay
Regional Health Sciences Centre RET
TELEHEALTH DELIVERY OF MOST, A STROKE SELF-
MANAGEMENT PROGRAM TO REMOTE AREAS IN NORTHERN 2164 Wednesday 6 June 15:25
ONTARIO: RESULTS OF THE PILOT EVALUATION PP Crystal Pavilion A
Huijbregts M1,2 , Taylor D3 , Cameron J2 , Kagan A4 , McEwen S2 , FACTORS THAT INFLUENCE THE DECISION MAKING OF
Streiner D1 ; 1 Baycrest, Toronto, Canada; 2 University of Toronto, CLINICIANS IN CHOOSING A BALANCE ASSESSMENT METHOD
Toronto, Canada; 3 St. Joseph’s Care Group, Thunder Bay, Canada; McGinnis P1,2 , Hack L2 , Nixon-Cave K2 , Michlovitz S2 ; 1 Richard
4 Aphasia Institute, Toronto, Canada
Stockton College of NJ, Pomona, NJ, USA; 2 Temple University,
Philadelphia, PA, USA
PURPOSE: Moving on after Stroke (MOST) is a multi-modal psycho-
educational and exercise program based on self-management PURPOSE: The aims of this descriptive study were to 1) understand
principles for persons with stroke and their care partners. It the selection and utilization of balance assessment methods from
is associated with improved community reintegration and health the perspective of the clinician, 2) ascertain what therapists studied
behaviours changes. Previous telehealth delivery of MOST used knew about available options and explore why they selected the
videoconferencing with one facilitator-in-training and all study methods used, and 3) determine whether practice choices matched
participants in one location and the second facilitator at a distant site, recommendations from the literature. RELEVANCE: Evidence-
and identified a need to disseminate the program to more isolated based practice is a key component of APTA’s Vision Statement.
communities. The purpose of this current study was to explore The literature provides a variety of balance assessment methods
the feasibility of videoconference delivery to remote communities in therapists could utilize during examination of patients with balance
preparation for a randomized controlled trial. RELEVANCE: Many deficits. However, little is known about how or why therapists
individuals have difficulty resuming a satisfying life after stroke. For select assessment approaches for specific patients. PARTICIPANTS:
those living in remote areas the problem is exacerbated by lack Eleven therapists were selected via purposeful sampling in order
of programming, scarce healthcare resource and isolation. Small to explore a range of factors proposed to influence assessment
numbers of people limit opportunities for peer-support, and cost- decisions (6 from outpatient, 5 from inpatient rehab settings).
efficient delivery of programs. The use of telehealth to improve Participants included 8 females and 3 males; clinical experience
access and to reduce the discrepancy in services was an important ranged from 4-18 years. METHODS: Qualitative methods permitted
recommendation of the recent Canadian government Romanow in depth exploration of decision making. Data sources included
report. PARTICIPANTS: People with stroke in Northwestern Ontario repeated interviews, analysis of balance assessment methods used,
three to eighteen months post stroke were invited by mail and and expert opinion. Credibility of the findings was established
screened for eligibility. On average, the 11 participants were 72 by use of low inference data, member check, and triangulation
years old and 11.5 months post stroke. METHODS: This was a among participants and data sources. ANALYSIS: Qualitative data
analysis software was utilized during a process of open and professionals involved in GHIs across the globe. METHODS: The
axial coding, followed by thematic analysis. Inter rater reliability research design consisted of three phases: Phase 1: Identification
of the coding scheme with an outside reader yielded 0.79 kappa and recruitment of key informants; Phase 2: Telephone interviews;
coefficient, or substantial agreement. RESULTS: The following and Phase 3: Data analysis using a qualitative software program
themes emerged from the data. Therapists used practical knowledge (NVivo). ANALYSIS: A SWOT (Strengths, Weaknesses, Opportu-
drawn from experience to guide assessment decisions. Observation nities, and Threats) Analysis was used to categorize transcribed
of patients’ movement was the primary assessment and diagnostic data into sub-themes according to the framework. RESULTS:
tool. The perceived value of information gathered from various Strengths of Canadian PTs included their educational background
assessment approaches mattered more than testing time when and training, professional adaptability, communication and teaching
selecting approaches for specific patients. The primary advantage skills. Weaknesses included a lack of field experience and unrealistic
of using quantitative balance tests was providing numeric data for expectations. Informants identified Opportunities in direct education
documentation purposes. Among participants studied, the influence and curriculum development, rehabilitation service development, and
of the literature in guiding assessment decisions was limited. A advocacy for the profession and clients. However, Threats that limited
Three Stage Model of Balance Assessment Decision Making was these opportunities included limited resources, cultural and language
derived from the data, depicting both the decision making process, barriers, and local health care systems. CONCLUSIONS: The
and reasons influencing therapists’ choices. Participants studied were Strengths and Opportunities appear to outweigh the Weaknesses
aware of a broad range of balance assessment methods, and most and Threats highlighting the potential for Canadian PTs to expand
frequently used gait observation, Berg Balance Test, and ratings of their involvement in GHIs. In addition to direct clinical service
Normal, Good, Fair, or Poor. At times, therapists used quantitative provision, Canadian PTs can undertake larger roles in education,
balance tests in a manner consistent with recommendations from advocacy, and program implementation. These results however
the literature, but they also used them for a variety of other highlight that there is a need for ongoing research regarding these
purposes. Participants also used a wide range of assessment potential opportunities. IMPLICATIONS: The results suggest that
approaches based on observation and description of movement Canadian PTs are well positioned to partners with expanding physical
that were not supported by research literature or expert panel therapy education programs in developing nations, and to promote
recommendations. CONCLUSIONS: Previous models of assessment the enlargement of rehabilitation programs that maximize use of local
decision making have described the process therapists use during resources and ensure sustainability. At the macro level, opportunities
patient examination. Current findings also provide insight into the for advocacy in policy-making exist both in developing nations,
reasons influencing assessment decisions. In the complex and in particular for rehabilitation programs inclusive of persons with
busy nature of clinical practice, therapists gathered data that they disabilities; and in Canada, where PTs can focus on increasing
considered meaningful during patient examination. IMPLICATIONS: governmental support for GHIs with a rehabilitation focus. In order to
If the goal of the profession is to foster integrating research enhance the role of the PT, we highlight the benefits of incorporating
evidence into clinical practice, then the practical knowledge and global health themes into entry-level physical therapy curricula
perceived values of therapists must be combined with findings and clinical internships. KEYWORDS: Global Health Initiatives,
from the literature. Deeper understanding of factors influencing SWOT analysis. FUNDING ACKNOWLEDGEMENTS: Physiotherapy
assessment decisions will increase insight into the practice of Foundation of Canada.
physical therapy. KEYWORDS: Decision-making; Balance; Examina- ETHICS COMMITTEE: Health Sciences I Research Ethics Board at
tion; Evidence-based practice. FUNDING ACKNOWLEDGEMENTS: the University of Toronto
ETHICS COMMITTEE: Temple University- Office for Human Subjects
Protections Institutional Review Board
THE EFFECTS OF GRADED ACTIVITY FOR LOW BACK PAIN ON
3225 Wednesday 6 June 15:25 PAIN-RELATED FEARS AND THEIR INFLUENCE ON RETURN
VCEC Ballroom B & C TO WORK
THE ROLE OF THE CANADIAN PHYSICAL THERAPIST IN Staal B1,2 , Hlobil H2,3 , Koke A4 , Twisk J5 , Tjabe S2,3 , van
GLOBAL HEALTH: A SWOT ANALYSIS Mechelen W2,6 ; 1 Department of Epidemiology, Maastricht
Alappat C1 , Siu G1 , Penfold A1 , McGovern B1 , McFarland J1 , University; 2 Department of Social Medicine, Institute for Research
Raman S2 ; 1 University of Toronto, Toronto, Canada; 2 University in Extramural Medicine, VUmc Amsterdam; 3 KLM Health, Safety
of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Environment, Schiphol; 4 Pain management and Research
Center, University Hospital Maastricht; 5 Department of Clinical
PURPOSE: The purpose of this study was to assess the current
Epidemiology and Biostatistics, Institute for Research in Extramural
and future roles of Canadian physical therapists (PTs) in global
Medicine, VUmc Amsterdam; 6 Body@work, Research Center
health initiatives (GHIs). The results of the study were used to
Physical Activity, Work and Health, TNO-VU Amsterdam
generate a series of recommendations that may be used to guide
the global health activities of Canadian PTs. RELEVANCE: The role PURPOSE: The purposes of this analysis were: (1) to study the
of rehabilitation is poorly defined in developing nations. Canadian effects of a graded activity intervention for low back pain on
PTs may be well-positioned to use their professional skills and pain-related fears (given the earlier found positive results of this
knowledge to contribute to the development of rehabilitation in intervention with regard to return to work), and (2) to investigate
GHIs. This study provides recommendations in practice, policy whether reductions in pain-related fears due to the graded activity
and education to enhance the work of Canadian PTs in GHIs. intervention may cause a more rapid return to work. RELEVANCE:
PARTICIPANTS: Twenty-five internal and external sources were The graded activity intervention, which can be described as a
interviewed. Internal informants were PTs purposively selected behaviourally-oriented physical exercise programme, has been found
from a group of members of the International Health Division effective for low back pain in occupational health care, in terms of
(IHD) of the Canadian Physiotherapy Association (CPA). External return to work. Positive effects on (cognitive)-behavioural outcomes,
informants were also purposively selected through a list generated such as pain-related fears are also expected in view of the
within the executive committee of the IHD in order to maximize operant conditioning behavioural background of the intervention.
diversity of experiences and perspectives. The list of external In order to improve and refine knowledge about the working
informants included non-Canadian PTs as well as other health care mechanisms of the graded activity intervention, it is important to
know what characteristics of the intervention influence return to mean age (60.5±8.2 y) who had sustained a stroke (CVA group)
work. PARTICIPANTS: Eligible sick-listed workers with low back in the right (RHL: n=21) or left (LHL: n=13) cerebral hemisphere
pain, who were employed by an airline company. They were and 34 age-matched (59.3±10.5y) healthy persons (CTL group)
randomly assigned to a graded activity group (n=67) or a usual were administered the KVIQ-20. Patients with severe communication
care group (n=67). METHODS: The effects of graded activity were or perceptual impairments were excluded. METHODS: The KVIQ-
studied in a randomised controlled trial in a Dutch occupational 20 assesses on a 5-point ordinal scale the clarity of the image
care setting, and compared with usual care. Measurements were (visual: V subscale) and the intensity of the sensations (kinesthetic:
taken at baseline, and after 3, 6, and 12 months follow-up. Primary K subscale) that the subjects are able to imagine from the first-
outcomes of this study were return to work, functional status and person perspective. The questionnaire includes movements from the
pain. Secondary outcomes consisted amongst others of measures for limbs, trunk, head and shoulders. ANALYSIS: Total scores from
pain-related fears (i.e. fear-avoidance beliefs about physical activity the V and K subscales were averaged for each group and sub-
and work, and fear of movement/(re-)injury). ANALYSIS: In order groups; total V and K subscores were also averaged for each side
to meet our first purpose, analysis of covariance was applied to for items involving movements of the upper (UL) and lower limbs
analyse the differences in improvement between the two groups (LL). Statistical analyses were made using 2x2 and 3x2 ANOVAs with
regarding pain-related fears. To meet our second purpose variables repeated measures followed by the post-hoc Bonferroni procedure.
indicating a reduction in pain-related fears were added to a basic The statistical level of significance was set at 0.05. RESULTS: In both
Cox regression model which described the relationship between groups, the V subscores (CVA: 37.6±7.7; CTL: 37.3±8.2) were larger
treatment allocation and return to work over a 12-month follow- (p = 0.000) than the K subscores (CVA: 33.5±9.6; CTL: 32.7±8.5)
up period. If our hypothesis is correct, adding reductions in pain- and there was no group difference. Likewise, V subscores remained
related fears to the model should lead to a reduction in the hazard larger than K subscores when comparing sub-groups of patients
ratio for return to work. RESULTS: The differences in improvement (RHL and LHL). For the UL, in the CVA group, the V subscores
between the two groups were statistically significant, and in favour of were smaller (p = 0.001) when imagining movements on the affected
the graded activity group for fear-avoidance beliefs about physical side (10.9 ±2.3)than for those on the unaffected side (11.9±2.4).
activity and work and fear of movement/(re-)injury at 3 months For the LL, however, the K subscores were smaller (p = 0.05) when
follow-up. After adding the reductions in pain-related fears over 3 imagining movements on the affected side (13.29±4.4) compared to
months as separate variables to the basic Cox regression model, those on the unaffected side (14.4±4.1). In the CTL group, there was
the hazard ratio for return to work did not decrease contrary to no side difference for UL and LL. CONCLUSIONS: Irrespective of the
our hypothesis. CONCLUSIONS: The graded activity group showed side of the cerebral lesion, patients demonstrated a level of motor
positive effects for reductions in pain-related fears, compared to imagery ability similar to age-matched healthy subjects and both
usual care. Reduction in pain-related fear was not found to play groups demonstrated better visual than kinesthetic imagery. However,
an intermediate role between graded activity and return to work. in contrast to healthy individuals, patients had more difficulty
IMPLICATIONS: Physiotherapists who treat low back pain patients when imagining movements on their affected side. IMPLICATIONS:
and wish to improve return to work and pain-related fears may Patients without severe communication and perceptual impairments
consider a graded activity intervention. No recommendations can are able to imagine movements and thus they could benefit from
be provided regarding the working mechanisms of this intervention mental practice training. However, the level of ability between sides
and, subsequently, which elements of the intervention need special can be different. KEYWORDS: Stroke, motor imagery questionnaire,
attention. KEYWORDS: low back pain, pain-related fears, return to mental practice. FUNDING ACKNOWLEDGEMENTS: This work was
work. FUNDING ACKNOWLEDGEMENTS: The study was funded supported by the Quebec Provincial Rehabilitation Research Network
by the Dutch Health Insurance Executive Council (CVZ). CONTACT: (FRSQ) and the CIHR. CONTACT: [email protected]
[email protected] ETHICS COMMITTEE: The etics committee of the «Institut de
ETHICS COMMITTEE: The study was approved by the medical réadqaptation en déficience physique de Québec»
ethical commitee of the VU university medical center in Amsterdam,
the Netherlands
1852 Wednesday 6 June 15:25 THE PROGNOSTIC VALUE OF WORKERS’ EXPECTATIONS
VCEC Meeting Room 17 FOR RECOVERY IN PREDICTING TIMELY RETURN TO WORK
MOTOR IMAGERY ABILITY AFTER STROKE Battié M1 , Gross D1,2 ; 1 Department of Physical Therapy, University
Malouin F1,2 , Doyon J3 , Durand A4 , Richards C1,2 ; 1 Department of of Alberta, Canada; 2 Workers’ Compensation Board Alberta/Millard
Rehabilitation, Laval University, Quebec City, Qc., Canada; 2 Center Health, Canada
for Interdisciplinary Research in Rehabilitation and Social Integration
PURPOSE: There has long been an interest in identifying indi-
(CIRRIS); 3 Department of Psychology and Unité de neuroimagerie
viduals reporting work-related injuries who are at high risk for
fonctionnelle, Institut universitaire de gériatrie, University of Montreal;
4 Institut de réadaptation en déficience physique de Québec prolonged disability. However, previous research has demonstrated
that predicting successful return to work is a complicated and
PURPOSE: Motor imagery ability is a prerequisite to benefit challenging task involving multiple factors. We expanded on recent
from mental practice and this ability can be lost after a stroke. work that has attempted to broaden the scope of contextual
The Kinesthetic and Visual Imagery Questionnaire (KVIQ-20), a factors influencing work disability by examining injured worker’s
questionnaire adapted for testing motor imagery in persons with expectations of recovery. In particular, we sought to determine
stroke, provides a reliable tool to determine whether this ability is whether perceptions of physical capacity to resume and sustain
intact or reduced after stroke. Study objectives were to investigate regualr work activities, have prognostic value for timely, successful
1) the effects of a stroke on motor imagery ability as measured return to work. RELEVANCE: While the majority of claimants with
by the KVIQ-20; 2) the influence of the side of the hemispheric ‘soft tissue injuries’ return to work quickly, a small portion remains off
lesion and 3) whether the ability to imagine movements on the work for prolonged periods and goes on to long-term disability. Return
affected and unaffected sides is comparable. RELEVANCE: Except to function, including return to work, is often an important goal of
for a few case reports of patients with focalized brain lesions, very physical therapy for such individuals. The identification of prognostic
little is known about the effects of cerebral lesions on the ability factors for prolonged work disability, including potentially modifiable
to engage in motor imagery. PARTICIPANTS: Thirty four persons, psychosocial factors, could be important in the development of more
effective care strategies. PARTICIPANTS: Study participants were 38 subjects had suffered a right Cerebrovascular accident (CVA),
work injury claimants entering the primary rehabilitation centre of the 26 suffered a left CVA. Ethical approval was received from Lothian
Workers’ Compensation Board of Alberta, Canada for rehabilitation or Research Ethics Committee. METHODS: Subjects were randomly
assessment between April 2001 and March 2002. All had open claims allocated to one of three groups: a control (CON), a PP or WP
for back injury or clearly objective trauma-related injuries (such as group in a single blind randomised controlled trial of a four week
fractures, dislocations or amputations) and were on total temporary programme of functional tasks. A research physiotherapist visited
disability. METHODS: We conducted a prospective cohort study. A participants in their own home three times during the four weeks
measure of patient expectations for recovery and resumption of work to teach subjects either PP or WP exercises targeted at mobility
was added to data routinely collected at initial (baseline) assessment and lower limb function. CON subjects were given information about
at the rehabilitation centre. Data on a variety of possible confounding stroke. Baseline outcome measures were taken on two occasions
factors were also gathered, including age, gender, occupational prior to the intervention phase and meaned (base). The baseline was
loading category, Pain Disability Index, numeric pain rating, and compared to outcomes taken at the end of intervention (OM3) and a
time from date of injury to date of baseline measures, among 48 hour retention test (OM4). Outcome measures included the Motor
others. Time in days from baseline measurements to suspension Assessment Scale (MAS), Timed Up and Go over 2 m (TUG2m),
of total temporary disability status in the following year served as gait speed and a step test. ANALYSIS: Data were plotted to examine
a proxy outcome measure of timely return to work and functional distribution of data and descriptive data determined. Box and whisker
recovery. ANALYSIS: Cox proportional hazards regression analysis plots were derived and formal statistical testing using ANCOVA was
was used for univariate and multivariable analyses. Initially, analyses conducted. RESULTS: ANCOVA showed no statistically significant
were performed on the entire dataset, then seperately for back differences for any of the measures at OM3 compared to baseline
versus objective injury subgroups. RESULTS: The entire sample or between OM3 and OM4. MAS: Base-OM3 p = 0.799; OM3-OM4
consisted of 536 claimants, including 317 back injury claimants p =0.281; TUG2m: Base- OM3 p = 0.652; OM3-OM4 p =0.545;
and 219 objective injury claimants. Better recovery expectations Gait speed: Base- OM3 p = 0.719; OM3-OM4 p =0.859; Step Test:
were crudely associated with faster suspension of disability benefits Base- OM3 p = 0.677; OM3-OM4 p =0.788. Despite no statistically
(HRR=0.91 (95% CI, 0.83-0.99), which diminished somewhat in the significant findings, clinically relevant improvements were found. This
multivariable analysis controlling for Pain Disability Index score, and was most notable in the Step test with an increase in median
other identified confounding factors (HRR=0.93 (95% CI, 0.85-1.02)). score from 0 (baseline) to 3 (OM3) reducing to 2 (OM4) for WP
The prognostic value of worker’s expectations of recovery and return and increased median score from 2 (baseline) to 4 maintained at
to work tended to be higher among back injury claimants than (OM3 and OM4) for PP. MAS scores also improved by 3 points
among those with clearly defined trauma and resultant pathology. from baseline to OM3, which was maintained at OM4 in the WP
CONCLUSIONS: Reocvery expectations have a modest effect on group. CONCLUSIONS: While no statistically significant changes
timely return to work, which appears somewhat greater in claimants were found there were some clinically relevant improvements. Post-
with back problems than clear trauma. IMPLICATIONS: Physical study power calculations based on velocity data showed the study
therapists should be aware that recovery expectations, particularly to be underpowered and a sample of 175 per group required to give
related to perceptions of physical capacity to resume and sustain 80% power to detect mean differences between the groups of 0.2
work activities, may influence timely return to work. Thus, it standard deviations at the 5% significance level. IMPLICATIONS:
could be helpful to specifically identify and address such percep- Valuable data to inform future trials has been provided. Future studies
tions during the rehabilitation process, particularly in back injury with a larger sample are required to determine the efficacy of PP
claimants. KEYWORDS: Recovery expectations; Workers’ Compen- or WP strategies in chronic stroke. KEYWORDS: whole practice;
sation; return-to-work; occupational rehabilitation, prospective cohort part practice; chronic stroke. FUNDING ACKNOWLEDGEMENTS:
study. FUNDING ACKNOWLEDGEMENTS: Funding was recieved This work was funded by the Primary Care Research Fund,
from the Workers’ Compensation Board of Alberta. CONTACT: Chief Scientist Office, Scotland (grant 00B/3/19/F26). CONTACT:
http://www.uofaweb.ualberta.ca/rehabmed/MicheleCritesBattie.cfm [email protected]
ETHICS COMMITTEE: Ethics approval was obtained from the ETHICS COMMITTEE: Lothian Research Ethics COmmittee
University of Alberta’s Health Research Ethics Board.
Poster Displays, Wednesday 6 June
2857 Wednesday 6 June 15:25 Research Report Poster Display
VCEC Meeting Rooms 19-20 02-06 Wednesday 6 June 09:00
AN INVESTIGATION INTO A HOME-BASED MOBILITY VCEC Exhibit Hall B & C
REHABILITATION PROGRAMME FOR LATE-STAGE STROKE. A CHANGE IN THE LEVEL OF SKILL FOR MANUAL BREATHING
PILOT RANDOMISED CONTROLLED TRIAL ASSIST TECHNIQUE IN THE PRACTICAL WORKSHOP
Baer G1 , Durward B2 , Weller D3 ; 1 Dept of Physiotherapy, Queen Masuda M1 , Yoshino T2 , Ihashi K3 , Momose K4 , Harada T5 , Ito N1 ;
Margaret University College, Edinburgh, Scotland, UK; 2 Faculty 1 Department of Physical Therapy, Nippon Engineering College,
of Health and Social Sciences, Galsgow Caledonian University, Tokyo, Japan; 2 Department of Physical Therapy, Ibaraki Prefectural
Glasgow, UK; 3 Dept of General Practice, University of Edinburgh, University, Inashiki, Japan; 3 Department of Physical Therapy,
Edinburgh UK Yamagata Prefectural college of health and medical sciences,
Yamagata, Japan; 4 Department of Physical Therapy, Shinsyu
PURPOSE: This study investigated the efficacy of different task
University, Matsumoto, Japan; 5 Department of Rehabilitation
specific exercise practice regimes (whole practice – WP or part
Medicine, Iida City Hospital, Iida, Japan
practice – PP) of functional tasks in a population of chronic
stroke subjects. This abstract reports results related to mobility. PURPOSE: The purpose of this study was to evaluate change in
RELEVANCE: The underlying theoretical rationale was based on the skillful level of the manual breathing assist technique (MBAT) in
Motor Learning theory, suggesting that whole practice of tasks is practical workshop and to obtain the benefits of the 5-day workshop
superior to part practice of components of tasks in neurologically which is currently being implemented and the indications about
normal subjects. A number of authors have advocated the superiority how to impart the future skills. RELEVANCE: The research by
of WP over PP in a clinical setting. PARTICIPANTS: 64 chronic stroke Takahashi et al. points out MBAT as the most commonly used
were recruited for the study, (31 male, 33 female). Mean age was 72.9 method during implementation of respiratory physical therapy in
years (+ 9.0), mean time since stroke was 30.3 months (+ 28.8). Japan, however pain and discomfort during implementation of the
Poster Displays, Wednesday 6 June S547
skills have been reported. In order to produce the effects of with relevant keywords and Medical Sub Headings (MeSH). The
MBAT, it is indicated that accumulation of training experiences methodological quality of study we considered is randomization or
above a certain level and acquisition of clinically applicable skills randomized cross-over study design. ANALYSIS: For continuous
are necessary. PARTICIPANTS: The subjects were 24 physical variables, post-intervention net difference between groups were
therapists participating in the 612th Workshop hosted by the compared and a weighted or standardised mean difference (WMD
Japanese Physical Therapy Association. Skill measurement was or SMD) and 95% confidence intervals (CI) were calculated. For
incorporated in the contents of the workshop, and we obtained each outcome, a test of heterogeneity was carried out to determine
the subjects’ consent for participation in the measurement before whether a random or fixed effect was applied. Dichotomous outcomes
they began to take the workshop. METHODS: Qualitative evaluation were expressed as odds ratios (OR) and 95% CI. RESULTS:
of skills and measurement of tidal volume were performed in a Fourteen studies published from 2000 to 2006 with 727 participants
female physical therapist as a subject. After each participant carried were included. The majority of studies included patients with both
out the MBAT 8 times, tidal volume change during implementation primary and secondary HF, NYHA II or III, age over 50-year-old
of the respiratory assistance method and qualitative evaluation and predominant male patients. The home-based intervention was
of the respiratory assistance method were done with VAS. The performed from 6-week to 9-month, low-to-moderate intensity of
respiromonitor AE-300 (Minato Medical Science Co.) was used in aerobic training with reported adherence around 70%. Home-based
tidal volume measurement. The number of the qualitative evaluation exercise significantly increased 6MWT (WMD random effect model)
items of skills was 9 items, “overall impression”, “comfort”, “contact by 37.9 meters (95% CI 4.9 to 70.8), peak VO2 (WMD random effect
sites”, “palm contact condition”, “tenderness of touch”, “direction of model) by 2.62 ml/kg/min (95% CI 1.25 to 3.99). QOL measured by
assistance”, “strength of assistance”, and “range of assistance”. The Minnesota Heart Failure Questionnire was not statistically significant
right edge of VAS as “a level possible to continue the MBAT (good)” with −1.35 points by training (WMD random effect model, 95% CI
and the left edge as “a level not possible to continue the MBAT −6.66 to 3.96). Hospitalizations for cardiac events with OR 0.62
(bad)”.Early measurement was performed in the afternoon of the first (95% CI 0.24 to 1.60), non-cardiac events with OR 1.57 (95% CI
day. Final evaluation was done in the afternoon of the fourth day of 0.52 to 4.75), and mortality with OR 0.95 (95% CI 0.32 to 2.82)
the workshop. ANALYSIS: For the increased tidal volume and the were found during the study period. CONCLUSIONS: Home-based
qualitative evaluation of skills, a paired t-test was used in order to find exercise training is effective to improve exercise capacity in HF
a significant difference between the early measurement and the final patients, QOL is maintained or improved after training. The meta-
measurement. In addition, Pearson’s correlation coefficient was used analysis was done on the trials in stable, mild to moderate HF
in order to find items correlated with “comfort” of VAS. RESULTS: For patients aged over 50-year-old and may not represent the total
the increased tidal, the average early-stage volume was 296±150 population of patients with HF. Further research is needed to
ml, and the average final-stage volume was 406±122 ml, showing a investigate the most effective dose of training and appropriate
significant increase compared to the early stage volume (P < 0.01). monitoring strategy to improve the adherence of home-based model.
For the qualitative evaluation of skills, the final stage evaluation IMPLICATIONS: In the multidiscipline case management teamwork,
showed a significant increase in all items compared to the early PT can assist HF patients to improve their exercise capacity,
stage evaluation (p < 0.01). Evaluation items correlated most highly QOL, and symptoms through the home-based training. Home-based
with “comfort” among the qualitative evaluation items were “palm cardiac rehabilitation is more cost-saving than hospital-based, PT
contact condition” (p = 0.769) and “timing of assistance” (p = 0.737). should devote more to home-based cardiac rehabilitation in the era
CONCLUSIONS: In the 5-day practical workshop, the original aim of of health care cost shortage. KEYWORDS: Heart failure, Exercise
skills – increased tidal volume could be achieved, and simultaneously training, Home-based. FUNDING ACKNOWLEDGEMENTS: This
more “comfortable” skills could be acquired. IMPLICATIONS: We study was unfund. We acknowledged the master student Tzu-An
need to study whether we can aim at shortening of hours to impart Chen in our labaratory for the articles search and identification.
skills centering on “palm contact condition” and “timing of assistance” CONTACT: [email protected]
through teaching of the practical skills. KEYWORDS: manual
breathing assist techniques(MBAT), practical workshop, Qualitative
evaluation. FUNDING ACKNOWLEDGEMENTS: We wish to thank
Yumiko Someya for technical support. 03-14 Wednesday 6 June 09:00
INCREASING THE NUMBER OF MINORITY PHYSICAL
Research Report Poster Display THERAPY STUDENTS TO REDUCE HEALTH DISPARITIES IN
02-10 Wednesday 6 June 09:00 NORTH CAROLINA
Radwan H, Rainey Y, Cowie R; Winston Salem State University
THE EFFECTS OF HOME-BASED EXERCISE ON EXERCISE
PERFORMANCE AND QUALITY OF LIFE IN PATIENTS WITH PURPOSE: The purpose of this study was to demonstrate a
CHRONIC HEART FAILURE: A META-ANALYSIS series of initiatives to increase the number of enrolled minority
students in PT education programs in the state of NC and US.
Chien C1 , Wu Y; 1 School and Graduate of Physical Therapy,
RELEVANCE: The actual and perceived quality of care for an
Medical College, National Taiwan University, Taipei, Taiwan
individual is largely dependent on the availability of health care
PURPOSE: A lot of evidence demonstrated that supervised exercise professionals whose backgrounds are as diverse as the populations
training improves exercise capacity and quality of life (QOL) in they serve. Statistics show that in all health professions, minority
patients with chronic heart failure (HF), however, relatively little populations including African American, Native American, Asian
research related to the effects of home-based training. This study and Hispanic/ Latino persons remain under-represented relative to
was to perform a meta-analysis to assess the effects of home- the ethnic demographics of the United States (US) and the state
based exercise training on exercise capacity and QOL in patients of North Carolina (NC). In 2005, the number of minority physical
with HF. RELEVANCE: The home-based training model can benefit therapists in the US was about 11.2% (APTA PT Fact Sheet, ‘05) as
more patients if the evidence supports the effectiveness and safety. compared to 33.8% of combined minority populations in 2005 (US
PARTICIPANTS: Randomized controlled trials related to home- Census Bureau, ‘05). On the other hand, the number of minority
based cardiac rehabilitation or exercise training in patients with physical therapists in NC is approximately 6% as compared to
HF were considered in this meta-analysis. The evaluated outcome the 32.0% minority population statewide (US Census Bureau, ’05).
measures included exercise performance and QOL. METHODS: There is a shortage of minority graduate students in all physical
Electronic databases were searched for English language articles therapy programs. The percentage of all minority students enrolled
in PT education programs nationally is 15.6% (APTA, ’05). The Two for each semester where the clinical examinations are
relatively few Historically Black Colleges and Universities (HBCUs) conducted. ANALYSIS: Focus group interviews are transscribed and
with accredited PT programs can play a major role in increasing subsequently schematised. All observations are written down and
the number of minority physical therapists. WSSU is an HBCU subsequently analysed and schematised by developing hypotheses
with such a program. PARTICIPANTS: This abstract presents data and questions regarding the participants‘performance.These empiri
from five years of student admission and progression data leading are compared with the competencies theory and the directive
towards PT professional practice at WSSU. METHODS: A series requirements stating which competencies must be tested during
of department and university initiatives were designed to prepare clinical training. Data analysis is undertaken in an interdisciplinary
students from all ethnic backgrounds to deliver PT services to diverse group consisting of 1 theory-based teacher, 1 clinical trainer and
populations within a variety of practice settings. These initiatives 1 physiotherapy and occupational therapy student. Workshops are
include: preadmission counseling and assistance to increase the held together with students, theoreticians and clinical trainers with
overall number and quality of applicants; carefully executed, objective the goal providing ongoing information and inspiration in support of
admission policies and a variety of financial incentives to increase the analysis process. RESULTS: The examination with its starting
the number of highly qualified enrollees; curricular innovations to point in a realistic practice situation with a patient lives up to
enhance academic and clinical success, build self-confidence, and directive requirements. Practice competencies are documented as a
maximize retention of all students; assistance toward early success snapshot on the examination day, whilst interdisciplinary and social
on the PT Licensing Examination including continuous evaluation of competencies in practice and the student‘s practical development
academic and clinical skills; hiring and retaining a mission-driven and can not be evaluated over time. The demands on students in clinical
diverse faculty, staff and administration to support these initiatives. examinations are different in practice, and examination difficulty and
ANALYSIS: Five years of admission data were collected, tabulated marking criteria are unclear to the students. There is a demand
and analyzed using descriptive techniques and compared to the state for more written work as well as for two sensors per clinical
and national statistical data. RESULTS: The initiatives listed above examination. CONCLUSIONS: Methods of teaching and learning
allowed the WSSU program to exceed the current national average must be developed. Clinical examinations must be developed to
of 15.6% by steeply increasing the number of minority enrollees from ensure the correct assessment of the required competencies. The
33.2% in 2000 (N=6) to 55.6% in 2004 (N=18). While this number report findings point to a combination of different types of exam
dropped to 28.5% in 2005 (N=20), it rebounded to 37.5% in 2006 forms containing both formative and substantive evaluations together
(N=24). CONCLUSIONS: Initiatives such as those developed by the with self-evaluation directly targeted at the competencies requiring
faculty, staff and administration of WSSU should be implemented evaluation. IMPLICATIONS: Methods of teaching and learning and
and consistently applied in order to increase the number of minority the clinical exams must be developed to ensure that they are
students in PT education programs. IMPLICATIONS: This continued testing the required competencies. KEYWORDS: clinical educa-
effort to enroll more minority PT students will help decrease the health tion,evaluation,competencies. FUNDING ACKNOWLEDGEMENTS:
disparities and provide for an increased quality of physical therapy This research report was funded by The Danish Ministry of Education
care for underserved populations throughout NC and the nation. and CVSU-Fýn. CONTACT: [email protected]
KEYWORDS: Health Disparities, Minority PT Students, Admission
and Progression Initiatives. FUNDING ACKNOWLEDGEMENTS:
N/A. CONTACT: [email protected]
ETHICS COMMITTEE: Department Accreditation Committee. 05-02 Wednesday 6 June 09:00
LEARNING STYLE, LEARNING STRATEGY, AND LOCUS OF
CONTROL: A DESCRIPTION OF STUDENTS IN A DISTANCE
03-22 Wednesday 6 June 09:00 PHD PROGRAM
Hill C, Nof L, Hellman M; Nova Southeastern University
THE DEVELOPMENT AND QUALITY ASSESSMENT OF
EXAMINATIONS WITHIN THE CLINICAL PART OF THE PURPOSE: Exceedingly high attrition rates (40–50%) have been
PHYSIOTHERAPY EDUCATION reported in the United States with the growth of distance education.
The purpose of this study was to describe, in a cross-sectional
Højvang A; CVSU-Fyn. Odense. Denmark
study that identifies learning style and motivation, the students who
PURPOSE: To develop and control the quality of clinical teaching, are in a one-of-a-kind distance PhD program at Nova Southeastern
so that it reflects, documents and evaluates the professional and University; a program with an impressive 3.5% attrition rate.
social competencies which the students must develop and learn RELEVANCE: The factors that help reduce attrition from online
in the course of their clinical training RELEVANCE: Examination programs have not yet been clearly identified. This study attempted
structure has an important regulatory function with regard to student to discover those factors by considering learning styles and their
motivation and learning. The primary objective is to ensure a clear contribution to student retention. PARTICIPANTS: All students who
connection between teaching and clinical trials and that the clinical were matriculating in the PhD, PT program as of January, 2005,
examinations test the students in the required competencies as set were included in the study. METHODS: A three-part online survey
out by the directive and curriculum. The second objective is to ensure was sent to all seventy-four students in the program. The first part
that quality control is developed across disciplines and considers of the survey contained demographic information; the second part
both theory and practice, and to develop new evaluation models was the Kolb Learning Style (LSI) Inventory, and the third part
that meet the above demands. PARTICIPANTS: 6 clinical teachers was the Nowicki-Strickland Locus of Control (LOC). ANALYSIS: For
from 6 selected enrolled locations and 6 randomly selected students. the qualitative questions, answers were grouped into themes by
The enrolled clinical locations have been selected to ensure as each author and then compared for agreement. Descriptive statistics
great a variety as possible regarding the type of client, scope and were used to categorize respondents based on the Kolb LSI and
review methods in the 4.th, 5.th and 6.th semesters. METHODS: the Nowicki-Strickland LOC. Chi Square was used to determine
Practical discourse analysis-an anthropological research method with if there were any between-group differences. RESULTS: Thirty-
an initial focus group interview comprised of clinical teachers; field one surveys were returned, for a 40% response rate. Wanting to
studies observing the clinical examinations followed by individual perform research, furthering the career, and convenience of online
interviews with the observed participants, with the goal of testing education were identified as the predominant motivating factors
hypotheses and explaining why the participants performed as they keeping students in the program. Family issues, financial implications,
did. Six clinical examination observations have been conducted. and volume of course work were identified as the predominant
de-motivating factors that made it difficult for students to stay in were from Japan (45% and 41%) and the USA (26% and 64%).
the program. For the Kolb LSI, there was no significant difference Therefore, detailed analyses of Japanese and the USA data were
between the NSU students and the norms for the general population performed and revealed that compared to the USA, Japanese PT
in terms of learning style. For the Nowicki-Strickland LOC, the vast schools have (1)a greater coefficient of variation in CPPT IH (73%
majority of students (74%)fell in the high internal motivation category. versus 40%), (2)significant less CPPT CI experience in most of
Only 23% fell into the average internal/external motivation category, cardiopulmonary diseases(p < 0.05), but significant greater CPPT
and 3.2% fell in the high external motivation category, similar to instruction by PT CI(p < 0.05), and (3)significant fewer IH in many
those in a study by Terrell (2002). The norms across the general areas of CPPT(p < 0.05). Other important findings include a signifi-
population were 33%, 52%, and 15% respectively. There was a cant (1)inverse relationship between the overall PT IH and the ratio of
significant difference (p = 0.000) between the general population and CPPT IH in both Japan and the USA (p < 0.05),(2)greater number of
the NSU students. CONCLUSIONS: Though significance was found clinical affiliation hours in the USA compared to Japan (p < 0.001),and
in comparing the general population with the NSU students, the (3)greater percentage of time spent in CPPT disease management
populations are too different to draw conclusions from this statistic. and clinical case studies in the USA(p < 0.001). CONCLUSIONS: The
It is the authors’ opinion that the answer lies in the nature of survey results from Japan, the USA, and other countries indicate
the students who attend the program and the profession’s move that there is substantial diversity in PTEI among countries. The less
to a doctoral entry level degree. Longitudinal studies that include than optimal response rate is surprising considering the methods
successful completion of the dissertation process may provide used to administer the survey. The results of this study are the
additional insight into what makes students succeed in a distance first to compare and contrast PTEI around the globe which may be
education environment at the doctoral level. IMPLICATIONS: Those helpful to improve PT education and the development of worldwide
who score as highly internally motivated should do well in a PT practice. The specific analyses between Japan and the USA have
physical therapy online learning environment, while those who score revealed significant differences in the approach to CPPT education.
as highly externally motivated may be better suited to traditional IMPLICATIONS: Further investigation of these differences and a
learning. This should be discussed with potential students before more comprehensive and complete examination of international
they commit time and resources to physical therapy distance learning PTEI is needed. KEYWORDS: Education, Cardiopulmonary Physical
programs. Faculty may need to maintain a high degree of contact Therapy, World Perspective. FUNDING ACKNOWLEDGEMENTS:
with those students. KEYWORDS: distance education. FUNDING We gratefully acknowledge the funding support of Japanese Pfizer
ACKNOWLEDGEMENTS: The project was funded by the Health Research Foundation. CONTACT: [email protected]
Professions Division of Nova Southeastern University.
ETHICS COMMITTEE: Internal Review Board, Nova Southeastern
University. Research Report Poster Display
08-02 Wednesday 6 June 09:00
A HONG KONG SURVEY OF THE USE AND PERCEIVED
06-18 Wednesday 6 June 09:00 EFFECTIVENESS OF TENS AND OTHER MODALITIES FOR THE
VCEC Exhibit Hall B & C TREATMENT OF PAIN
EDUCATIONAL ISSUES IN PHYSICAL THERAPY-A WORLD Scudds R, Scudds R; Hong Kong Polytechnic University, Hung
PERSPECTIVE WITH EMPHASIS ON CARDIOPULMONARY Hom, Kowloon, Hong Kong
EDUCATION
PURPOSE: The purpose of this study was to determine the use and
Matsuo Y1 , Cahalin L2 , Collins S3 , Matsuya A1 , Caro F4 ;
1 Kobe Gakuin University, Kobe, Japan; 2 Northeastern University, perceived effectiveness of transcutaneous electrical nerve stimulation
(TENS) and other electrotherapeutic modalities by registered phys-
Boston, MA, USA; 3 University of Massachusetts, Lowell, MA, USA;
4 University of Massachusetts, Boston, MA, USA iotherapists in the clinical setting in Hong Kong. RELEVANCE: Data
from this study will provide more accurate information about practice
PURPOSE: To provide a worldwide perspective of physical therapy patterns in Hong Kong. PARTICIPANTS: Completed questionnaires
educational issues(PTEI) with emphasis on cardiopulmonary physical were received from 205 registered physiotherapists. Approximately
therapy(CPPT) education in 40 separate countries. RELEVANCE: one half of the respondents worked in an outpatient settings and
Very little information exists regarding physical therapy educational is- the majority (73.1%) had at least five years experience. METHODS:
sues (PTEI) in various regions of the world. A better understanding of A random sample of 30 percent of physiotherapists registered in
worldwide PTEI may facilitate physical therapy(PT) education around Hong Kong was sent a mail survey. The potential respondents were
the globe. PARTICIPANTS: Two separate surveys in six different sent an original questionnaire and then, four weeks later, the non-
languages (English, Spanish, French, Portuguese, Japanese, and respondents were sent a reminder letter and a second questionnaire.
Korean) were sent electronically to the program directors(PD) and The questionnaire asked the respondents about their demographic
cardiopulmonary instructors(CI) of every PT school in 29 out of 40 information and about the use of TENS and other electrotherapeutic
countries (the PT programs in the remaining 11 countries could modalities in their clinical practice. Specific questions about the
not be accessed despite numerous attempts). METHODS: The PD effectiveness of these modalities for acute and chronic pain as well
survey examined four major areas including instruction hours(IH) in as specific types of pain that are commonly seen in clinical practice
four domains of PT (musculoskeletal, neurologic, cardiopulmonary, were also included. Perceived effectiveness of each modality was
and integumentary), clinical affiliation IH, teaching/learning models, rated on a 9-point scale, with 1 being least effective and 8 being most
and the terminal PT degree awarded to graduates. The CI survey effective. ANALYSIS: Descriptive statistics were used to analyse the
examined two major aspects of the CPPT education including the data. Frequency distributions were used to determine the pattern
instructors background (profession, teaching experience, and clinical of modalities use. Means, standard deviations, and medians were
experience) and IH in many areas of the CPPT curriculum. An used to describe the perceived effectiveness of each modality for
introduction letter describing the study was included with the surveys the treatment of pain. RESULTS: After two mailings, 34.1 percent
and stated that returning the completed survey provided informed of the questionnaires were completed and returned. The modalities
consent. Reminder e-mails and additional surveys were resent used more frequently by Hong Kong physiotherapists to treat pain
to non-respondents. ANALYSIS: Descriptive and non-parametric were TENS (97%), ice and superficial heating modalities (both
analyses were performed with the level of significance set at p < 0.05. 89.3%), ultrasound (85.5%) and interferential therapy (IFT)(79%).
RESULTS: The overall PD response rate was 20% and the CI Less used, but still common modalities included shortwave diathermy
response rate was 81%. The greatest PD and CI response rates (SWD) (49.8%), acupuncture (48.8%), laser (44.9%) and pulsed
electromagnetic fields (34.1%). For the treatment of acute pain, NMES management programs used in this study have significant
the modalities with the highest perceived effectiveness were ice positive effects on the gait parameters of spastic diplegic children.
(mean = 6.61), IFT (mean = 6.27), and acupuncture (mean = 5.12). Many proposed mechanisms including reciprocal inhibition, carryover
IFT (mean = 6.40), acupuncture (mean = 6.16)), and SWD (mean effects, muscle activation, and increase of blood supply were
= 5.27) were rated the highest for the treatment of chronic pain. discussed and highlighted. IMPLICATIONS: In the light of this study,
CONCLUSIONS: For the treatment of both acute and chronic pain, gait training programs in CP should be attained either during the
acupuncture was rated highly in terms of effectiveness, but used application of NMES, or during the expected carryover period to get a
in practice less frequently than other modalities rated as been less facilitated walking performance. KEYWORDS: Electrical Stimulation,
effective. This may be a result of the current requirements needed CP, Gluteus Medius, gait. FUNDING ACKNOWLEDGEMENTS: This
to use acupuncture in local hospital settings. IMPLICATIONS: study was completely funded by the 1st author who thank Prince
Physiotherapists use multiple modalities for the treatment of pain. Sultan Humanitarian City for facilitating the use of the motion analysis
However, they should be allowed to use those that they perceive and motor performance laboratory. CONTACT: [email protected]
to be most effective. KEYWORDS: Electrotherapeutic modalities, ETHICS COMMITTEE: Research and The Ethical Committee at
effectiveness, pain. FUNDING ACKNOWLEDGEMENTS: Unfunded College of Applied Medical Sciences, King Saud University, Saudi
project. Arabia.
ETHICS COMMITTEE: Department of Rehabilitation Sciences Ethics
Review Committee, Hong Kong Polytechnic University
08-06 Wednesday 6 June 09:00 DOSE-RESPONSE OF FUNCTIONAL ELECTRICAL
VCEC Exhibit Hall B & C STIMULATION ON UPPER EXTREMITY FUNCTION IN PATIENTS
THE USE OF NEUROMUSCULAR ELECTRICAL STIMULATION WITH STROKE
TO IMPROVE GAIT IN CHILDREN WITH SPASTIC DIPLEGIC Hsu S1 , Hu M1,4 , Wang Y2 , Yip P3,4 ; 1 School and Graduate Institute
CEREBRAL PALSY of Physical Therapy, College of Medicine, National Taiwan University,
Al-Khatrawi W1 , Al- AbdulWahab S2 ; 1 Department of Physiotherapy, Taipei, Taiwan; 2 Department of Physical Medicine and Rehabilitation,
King Fahad Hospital, Madina, Saudi Arabia; 2 Department of Health National Taiwan University Hospital, Taipei, Taiwan; 3 Department
Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia of Neurology, National Taiwan University Hospital, Taipei, Taiwan;
4 Stroke Center, National Taiwan University Hospital, Taipei, Taiwan
PURPOSE: Walking Patterns of spastic diplegic children due to
cerebral palsy (CP) are often inefficient. In spastic diplegia (SD), PURPOSE: It has been proposed that electrical stimulation (ES)
more proximal involvement is typical. Biomechanically, gluteus enhances motor recovery of upper extremity after acute stroke. But
medius muscle plays an essential role in stabilizing the pelvis; the long treatment time proposed by the literature is not practical
dysfunction of this muscle due to lack of normal muscular co- in common clinics. The aim of our study is to investigate the
activation with the hip adductors leads to inadequate abduction treatment effects of clinical dosage of functional electrical stimulation
during walking, and a relatively unstable pelvis. This study was (30- minutes/session electrical stimulation for 4 weeks) on upper
designed to investigate the short and relatively long term effects of limb motor recovery in stroke patients and to investigate whether
continuous neuromuscular electrical stimulation (NMES) of both hip any dose-response of functional electrical stimulation. RELEVANCE:
abductors on the temporal-spatial gait parameters, some of lower this study may provide evidence and reference for clinical practice
extremity kinematics, and hip adductors muscle tone in children PARTICIPANTS: Patients met the following inclusion criteria and
with (SD)due to CP. RELEVANCE: Different types of (NMES) have were recruited for this study: 1)stroke onset less than 2 months,
been used to enhance the ability of walking among this population. 2)Brunnstrom stage of upper extremity 4, 3) no contraindication of
However, NMES of the gluteus medius muscle using a surface electrical stimulation, 4)signed informed consent form. METHODS:
electrode during functional walking training has never been reported Forty-five patients with stroke who received inpatient rehabilitation
as a management option to improve the gait pattern in (SD) children. program were enrolled. Patients were randomized to ES-high
PARTICIPANTS: Experimental group of twenty one ambulant spastic intensity, ES-low intensity or control group. The ES-low intensity
diplegic children (mean age = 7.4±2.1 years) were compared to a group received 30 minutes/day, 5 days per week, and a total of 4
patient control group of ten spastic diplegic children and a healthy weeks of electrical stimulation. The ES-high intensity group received
control group of twenty normal children with matched anthropometric 60 minutes/day, 5 days per week, and a total of 4 weeks of electrical
characteristics. METHODS: The experimental (SD) group received stimulation. All patients also received regular rehabilitation. Fugl-
three different NMES management programs; the 1st NMES program Meyer Arm subscale (FMA) and Action Research Arm Test (ARAT)
was designed to evaluate the immediate and short-term effects were assessed at baseline, 4 and 12 weeks. ANALYSIS: The
of bilateral continuous NMES of both gluteus medius muscles, univariate analysis and two-way ANOVA with repeated measure were
during walking. The 2nd NMES program was aimed to evaluate used for statistical analysis. The results were accepted as statistically
the effect of 15 minutes of simultaneous and continuous NMES significant at p < 0.05. RESULTS: There was no significant difference
of both gluteus medius during walking; 3 sessions a day for a in demographic data, FMA score and ARAT score at baseline among
week. The 3rd NMES program was similar to the 1st NMES and three groups. Two-way ANOVA with repeated measure revealed that
was designed to detect any additional changes in gait after full the FMA score was higher in both ES groups than the control
adaptation to NMES and completion of the 2nd NMES program. group at 4-week (low-intensity group, p = 0.017; high-intensity group,
Dual channel stimulator with self adhesive electrodes at the tolerable p = 0.033) and 12-week (low-intensity group, p = 0.005; high-intensity
motor threshold level was used with frequency of 20Hz and pulse group, p = 0.05) follow ups. The ARAT score was higher in both
width of 50ms. The effect of NMES programs was assessed using ES groups than the control group at 12-week (low-intensity group,
three-dimensional gait analysis system (Motion Analysis Corp., Santa p = 0.018; high-intensity group, p = 0.03) follow up. The difference of
Rosa, CA, USA) and Modified Ashworth Scale. ANALYSIS: One – effects on the FMA and ARAT failed to reach significance between
Way ANOVA with special contrast and repeated measures was the low-dose and high-dose ES groups (p > 0.05). CONCLUSIONS:
employed. RESULTS: Significant improvement of gait parameters Our study demonstrated significant treatment effect of additional
including the temporal spatial characteristics, most of the kinematics, 10 hours and 20 hours of ES on arm functions for patients with
and hip adductor muscle tone of the experimental group (p < 0.001- stroke up to 12 weeks post treatment.Our study failed to demonstrate
0.05) was observed. CONCLUSIONS: It is obvious that the designed significant dose-reponse of ES for arm function of stroke patients,
thus future study may consider further decreasing the ES dosage until to familiarize the testing and that the second measurement in each
the minimal effective clinical dose is identified to provide evidence session be used to achieve better reliability and less measurement
for clinical practice. IMPLICATIONS: it is advised that a minimal error during grip strength assessment in community-dwelling older
of 10 hours of ES in addition to regular rehabilitation for stroke adults. KEYWORDS: reliability, grip strength, older adults. FUNDING
patients may improve the recovery of arm functions for patients ACKNOWLEDGEMENTS: This study was partially supported by a
with stroke at acute stage. It may be a practical program in clinical research grand from the National Science Council, Taiwan (NSC93-
setting. KEYWORDS: stroke, electrical stimulation, upper extremity 2314-B-277-003). CONTACT: [email protected]
function, dose-response. FUNDING ACKNOWLEDGEMENTS: This ETHICS COMMITTEE: The Protection of Human Subjects Institu-
study was funded by Bureau of Health Promotion, Department of tional Review Board Tzu-Chi University and Hospital
Health, R.O.C.
ETHICS COMMITTEE: Department of medical research, National
Taiwan University Hospital Research Report Poster Display
09-14 Wednesday 6 June 09:00 MUSCLE ACTIVITY IN POLIO AFFECTED MUSCLES
VCEC Exhibit Hall B & C (TIBIAL ANTERIOR) DURING WALK WITH AND WITHOUT
ANKLE-FOOT-ORTHOSIS
RETEST RELIABILITY OF GRIP STRENGTH MEASURES
USING SINGLE OR MULTIPLE MEASUREMENTS FOR Krossén C1 , Klefbeck B2,3 , Weinberg J4 , Nilsson B4 ; 1 Department
COMMUNITY-DWELLING OLDER ADULTS of Rehabilitation Medicine Stockholm, Danderyd University Hospital,
Wang C; Department of Physical Therapy, Tzu-Chi College Sweden; 2 Division of Physiotherapy, Department of Neurobiology,
of Technology Health Care Sciences and Society, Karolinska Instituet, Stockholm,
Sweden; 3 Department of Physical Therapy, Karolinska University
PURPOSE: To examine the effect of using a single measurement Hospital, Huddinge, Sweden; 4 Department of Clinical Neuroscience,
or the mean of multiple measurements on the retest reliability and Karolinska Institutet, Stockholm, Sweden
measurement error of grip strength measurement in community-
dwelling older adults. RELEVANCE: To improve the reliability PURPOSE: To evaluate the impact of ankle-foot-ortosis (AFO) in
of grip strength measurement. PARTICIPANTS: A convenience patients with prior polio with weak dorsal foot extensors on muscle
sample of 50 community-dwelling older adults (ages=72.1±6.8) was activity in tibial anterior (TA) and biceps femoris (BF) muscles
recruited from a local community center through a newsletter, flyers, during walk. RELEVANCE: The TA is often affected in patients with
and personal contact. All participants were able to follow simple poliomyelitis with weak dorsal foot extensors. Prior studies have
commands and were ambulatory. METHODS: This was a one week shown an EMG overuse of TA during normal walk in patients with
retest reliability study. Prior to participation, all participants read and prior polio. AFO is used by some of these patients. The AFO lifts
signed an approved consent form. All subjects’ dominant hand grip the foot and prevents the patient from stumbling and makes the
strengths were measured with a Jamar hand dynamometer in the gait more secure. To prevent the patients with prior polio from
standard position (sitting, with arms adducted by their sides, elbow muscle fatigue and increasing weakness, the recommendation is
at 90 degrees of flexion, and dynamometer handle at position 2) not to overuse their polio affected muscles. No study has been
as described by the American Society of Hand Therapists. Subjects found of the effect of AFO on the muscle activity in patients with
were asked to squeeze the handle as forcefully as they could prior polio. PARTICIPANTS: Sixteen subjects, eleven women and
for 5 seconds. After one minute of rest, a second measurement five men, median 67.5 years of age (range 45-73) with prior polio
was taken. All subjects returned for grip strength measurements with reduced muscle strength in lower extremity, TA 2-3 and BF <4
one week later at about the same time of day. ANALYSIS: measured with manual muscle test (0-5 scale), were included in the
Test retest reliability of grip strength using the first measurement, study. METHODS: The subjects wore their ordinary walking shoes.
the second measurement, and the mean of both measurements Six subjects were familiarized with the use of AFO and used their
of both sessions was calculated using the intra-class correlation own AFO and the others used an AFO just for the test. Surface
coefficient with 2-way random and absolute agreement definition electrodes were placed on TA and BF in the weaker leg. Under the
(ICC). The standard error of measurement (SEM) and the smallest same shoe, contact electrodes were placed to register heel strike
real difference (SRD = 1.96×• 2 × SEM) are also reported. RESULTS: and toe off. All electrodes were connected to the Viking II EMG
The descriptive statistics of grip strength, one week retest reliability, machine with a 20-meter long cable. The subjects walked in a corridor
SEM, and SRD of the grip strength measure are reported for using 40 m back and forth and were randomised to start walking with
the first measurement, the second measurement, and the mean or without the AFO. From each subject the best recordings during
of both sessions (Table). The one week retest reliabilities of the heel strike to heel strike were chosen. For each subject 21 steps
grip strength measurements were 0.90, 0.93, and 0.94, respectively, from walking with AFO and 21 steps from walking without AFO were
using the first measurement, the second measurement, and the taken out for analysis and the integrated EMG activity was measured.
mean of both measurements from each session. The SEM and ANALYSIS: Nonparametric analysis, Wilcoxon Rank Test was used.
SRD were about 2kg and 6kg, respectively, when using either the RESULTS: There was a significant decrease in muscle activity from
second measurement or the mean of both measurements of both heel strike to heel strike in TA while walking with AFO (p= 0.001,
sessions. The SEM and SRD were 3kg and 7.5kg, respectively, median 253 mVms without AFO, 183 mVms with AFO), both in swing
when using the first measurement of both sessions. CONCLUSIONS: face (p = 0.002 median 96 mVms without, 67 mVms with) and in
The one week retest reliability of grip strength measure was reliable stance face (p = 0.011 median 144 mVms without, 106 mVms with).
(ICC0.9) across three conditions. However, the SEM and the SRD There was a tendency towards a decrease in muscle activity BF while
were less when using the second measure or the mean of both walking with AFO. CONCLUSIONS: AFO reduces muscle activity in
measures of each session. Since the reliability of a measure is polio affected TA while walking. In future work it would be of interest
sample dependent, the retest reliability of grip strength measure to study if long-term use of AFO could prevent overuse in TA and
needs to be determined for the population of interest. Using the thus slow down the progression of muscle weakness in the polio
average score of two measurements could reduce the SRD value affected TA. IMPLICATIONS: The findings of reduced muscle activity
by 1.65 kg compared to using the first measure and reduce by 0.1kg while using an AFO can be of importance for the physiotherapist
compared to using the second measure. IMPLICATIONS: Based on to motivate patients with prior polio to use AFO. KEYWORDS:
our results, we suggest that a practice trial be given to participants EMG, poliomyelitis, walking. FUNDING ACKNOWLEDGEMENTS:
The Swedish Association of Survivors of Traffic Accidents and Polio (COP). The aim of the study is to compare postural mechanisms
provided funding for the study. CONTACT: [email protected] measured by single force platform in healthy subjects under different
ETHICS COMMITTEE: Ethics approval by Forskningsetisk kommitté visual conditions and patients with diabetic sensory neuropathy.
Syd, Karolinska Institutet, Stockholm, Sweden 42/00, 2000-02-07. RELEVANCE: It is well known that patients with diabetic neuropathy
need special trearment according to the type of the affected
nerve fibers. Therefore it is important to differentiate between the
Research Report Poster Display impairment sites. PARTICIPANTS: 9 patients with type 1 diabetes (D)
09-22 Wednesday 6 June 09:00 and 9 healthy control subjects (C) took part in the study. The subjects
VCEC Exhibit Hall B & C were randomly selected. METHODS: The COP displacement was
LOWER EXTREMITY FLEXORS AND EXTENSORS ISOKINETIC quantified in Romberg position by using a single force platform
TESTING DURING CLOSED KINETIC CHAIN under two visual conditions (eyes open and eyes closed). First the
Elhafez S, Nassif N, Elhafez G, Abdelwahid S, Ali M; Department of sway path was calculated in anteroposterior (AP) and mediolateral
Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt (ML) directions. Secondly the data were analysed by fast Fourier
transformation in various frequency bands (low: 0-0.1 Hz; middle
PURPOSE: This study was conducted to determine the lower low: 0.1-0.5 Hz; middle high: 0.5-1 Hz; high: 1-3 Hz). Sensory nerve
extremity flexors/extensors ratio of the dominant side in normal function (CPT-Current Perception Threshold) was studied with a
individuals during closed kinetic chain (CKC) isokinetic testing and to Neurometer using transcutaneous electrical stimulation. ANALYSIS:
investigate the effect of velocity on this ratio. RELEVANCE: Although All data were subjected to analysis of variance The post hoc test
the CKC activities have been introduced and well documented was the LSD multiple comparison test. The Pearson correlation was
as an alternative tool to evaluate patient’s ability to return to a applied to determine the relationship between the data. RESULTS:
higher functional level, limited data exists about muscle strength The D showed a significantly longer sway path in AP direction
balance during this type of activities. This study provides the than the C without visual control. In the low frequency band the
information regarding muscle strength balance in multiple joint D showed a significantly higher power with eyes open in the ML
performance, i.e. CKC activity which may help in assessment of direction compared with the AP direction, whereas without visual
functional performance and for injury prevention. PARTICIPANTS: control the AP power was significantly higher. In the middle low
Thirty healthy male subjects with a mean age of 19.8±2.9 years and middle high frequency bands both in AP and ML directions
volunteered to participate in the study. They were free from any the lack of visual input significantly increased the frequency power.
musculoskeletal impairment. METHODS: Each subject was asked to The D showed significantly higher values with eyes closed in each
perform a CKC testing (leg press task) which consisted of concentric frequency band I the AP direction than the C. Significant correlation
isokinetic lower extremity flexion and extension at linear velocities was found between the CPT of median nerve at 2000 Hz and the
of 24.44 cm/sec (slow velocity), 48.89 cm/sec (medium velocity), sway path in all conditions. Interestingly the CPT of peroneal nerve
and 73.33 cm/sec (fast velocity). The test was performed using at 2000 Hz correlated with the sway path only in ML direction in
a Biodex system 3-isokinetic dynamometer. ANALYSIS: One way EC condition. CONCLUSIONS: The significantly higher sway values
ANOVA with repeated measures was performed using StatGraphics seen in case of the D without visual input suggests the involvement of
software to test the effect of the three velocities on the peak force somatosensory system. The frequency analysis revealed a significant
ratio. RESULTS: The main outcome of this study was that the peak increase of frequency power in AP direction at each frequency band.
force ratios of the lower extremity flexors and extensors were 0.36, The high correlation between the CPT values at 2000 Hz and the high
0.48, and 0.60, at slow, medium and fast velocities respectively. There frequency band values are consistent with the findings that the high
was a significant increase (p < 0.05) in flexors/extensors ratios of frequency band is linked with propriocepive control. Interestingly the
peak force with increased speed. The total work and average power best correlations was seen with the median nerve, and not with the
ratios remained constant around 0.30 with no significant difference peroneal nerve which may be explained by the fact that every third
(p > 0.05) between the three tested velocities. CONCLUSIONS: Ratio diabetic patient has Carpal tunel entrapment. IMPLICATIONS: Since
of peak force is velocity dependent. When using this ratio as an the correlation between the CPT and frequency band values was
evaluative tool of the leg strength, the velocity dependent changes better in case of median nerve it needs further electrophysiological
in the flexors/extensors ratio must be taken into consideration. Total investigation in order to clarify its reason. KEYWORDS: Diabetic
work produced and average power generated, are highly relevant neuropathy, neurometer, force platform, postural sway. FUNDING
measures but are not affected by increasing speed. IMPLICATIONS: ACKNOWLEDGEMENTS: The work was unfunded.
The CKC ratio of isokinetic testing can be used as an alternative tool
to assess the isokinetic muscle strength instead of only depending on
the open kinetic chain ratio of flexors and extensors. KEYWORDS: Research Report Poster Display
Isokinetic, Closed Chain. FUNDING ACKNOWLEDGEMENTS: This 11-10 Wednesday 6 June 09:00
study was not funded. CONTACT: [email protected], VCEC Exhibit Hall B & C
[email protected] PULMONARY FUNCTION IN HIV CHILDREN
ETHICS COMMITTEE: Egyptian Physical Therapy Syndicate
Luque A1,2 , Gazzotti M1,2 , Lanza F1,2 , Diego M1 , Jaqueline S1 ,
Scarlato A1,2 ; 1 São Camilo University, São Paulo – Brazil; 2 Federal
Research Report Poster Display University of São Paulo - São Paulo – Brazil
11-06 Wednesday 6 June 09:00 PURPOSE: In Brazil between 1983 and 2004, more than 9231 new
VCEC Exhibit Hall B & C cases of HIV – Mother to Child Transmission had been registered,
CONNECTION BETWEEN POSTURAL CONTROL AND part of this children usual develops respiratory diseases and course
SENSORY NEUROPATHY IN PATIENTS WITH TYPE 1 DIABETES with changes in pulomonary function, whichever is responsible for
50% of cause of deaths.Outcome: Evaluated pulmonary function
Feher Kiss A1 , Nagy E1 , Barnai M1 , Varkonyi T2 , Horvath G3 ;
1 University of Szeged Faculty of Health Sciences Department (forced vital capacity (FVC) and forced expiratory volume in first
second (FEV1)) in a positive HIV children population (Mother to
of Physiotherapy; 2 University of Szeged Faculty of Medicine
Child Transmission). RELEVANCE: To verify if any alterations in
Department of Internal Medicine; 3 University of Szeged Faculty
pulmonary function is preview detected in children with positive
of Medicine Department of Physiology
HIV Mother to Child Transmission. PARTICIPANTS: Children with
PURPOSE: The somatosensory information may be deteriorated in age between 6 and 17 years old, who were in treatment with
type I diabetes influencing the displacement of the centre of pressure Anti-retro viral therapy in a medical centre (CEADIPe) of Federal
University of São Paulo. METHODS: Patients were evaluated and Star Test and the other measures may be a function of what each
subdivided in three clinical classification, A (soft symptom or sign), test measures, i.e., the Star Test may be measuring a different or
B (moderate symptom or sign), C (severe symptom or sign). They unique combination of attributes. IMPLICATIONS: We did not find
were evaluated by a physiotherapist and performed a spirometric test. any correlation between the Star Excursion Balance Test and other
ANALYSIS: Data were analyzed using SPSS for Windows (Version balance tests commonly used in clinical settings. While the test-
6.0, Microsoft Windows) and statistical significance was attained retest reliability of the Star Test has been shown the validity of the
when p < 0.05. Means and standard errors of the mean (SEM) were Star Test was not demonstrated in this study. Further studies will
used to summarize the data. The statistical significance of different need to be conducted in order to establish the value of the Star
values for FVC, FEV1 and FEV1/FVC ratio was determined with the Test in terms of concurrent and predictive validity. KEYWORDS:
t test. RESULTS: The medium values for FVC was 1.7±0.4 L and for Star Excursion Balance Test; balance test; geriatric; assessment.
FEV1 1.43±0.37 L with the FEV1/FVC ratio of 84.49±13.71%. When FUNDING ACKNOWLEDGEMENTS: The study was funded in part
analysed in subgroups of clinical classification, group A showed a through a “Research & Creative Activities” grant from California
FVC 1.76±0.4 L, group B 1.70±0.41 L and group C 1.61±0.35 L State University, Sacramento, California, United States. CONTACT:
(p = 0.917). FEV1 in group A was 1.59±0.32 L, group B 1.41±0.35 L [email protected]
and group C 1.32±0.45 L (p = 0.597). In relation to FEV1/FVC ratio, ETHICS COMMITTEE: Committee for the Protection of Human
group A showed a medium value of 90.8±9.2%, group B 83.41±14% Subject, California State University, Sacramento, United States
and group C 80.38±15.35% (p = 0.329). CONCLUSIONS: In this
population of positive HIV children (Mother to Child Transmission),
we did not observed any significant alterations in pulmonary function.
IMPLICATIONS: Promote prevention of respiratory complications in 12-18 Wednesday 6 June 09:00
this kind of population. KEYWORDS: Pulmonary function, HIV, chil- VCEC Exhibit Hall B & C
dren evaluation, Vital capacity. FUNDING ACKNOWLEDGEMENTS: A STUDY OF DYNAMIC POSTURAL CONTROL BY
N.A. PERTURBATION ROTATIONAL STIMULATION WITH A
ETHICS COMMITTEE: The Ethics Committee for Human Research MOVABLE PLATFORM
of the Federal University of São Paulo approved this study. Tanaka T1 , Maeda Y2 , Shirogane S3 , Oyama Y4 , Sugihara S5 ,
Ishikawa A6 , Izumi T7 , Ino S8 , Ifukube T8 , Nakajima Y9 ,
Research Report Poster Display Tsuruga T10 ; 1 Department of Design, Sapporo City University;
2 Hokkaido University; 3 Institute of Rehabilitation Science, Tokuyukai
Medical Corporation; 4 Tokeidai Memorial Hospital; 5 Sapporo
Shuyukai Hospital; 6 Department of Physical Therapy,Sapporo
CONCURRENT VALIDITY OF THE STAR EXCURSION BALANCE Medical University; 7 School of Engineering, Hokkaido Tokai
TEST IN A GERIATRIC POPULATION University; 8 Research Center for Advanced Science and
Stockert B, Dawna B, Priscilla L, Kevin L, Judd M; Department Technology, The University of Tokyo; 9 Section Of Human
of Physical Therapy, California State University, Sacramento, Engineering,Department Of Product Technology,Hokkaido Industrial
California, United States Research Institute; 10 Department of Clinical and Rehabilitation
Engineering, Hokkaido Instutuse of Technology
concurrent validity of the Star Excursion Balance (Star) Test in a PURPOSE: We examined a dynamic postural control for external
geriatric population. RELEVANCE: The ability to maintain balance rotational stimuli on yaw and pitch movable platform by carrying
during activities of daily living is essentail for maintaining an out a three-dimensional kinematic and EMG analysis. RELEVANCE:
independent lifestyle. The Star Test examines balance in single leg There are few studies of dynamic standing balance induced by
stance. Reports by Hertel and Stockert have shown that the Star rotational stimuli on a movable platform. Dynamic postural control
Test has good test-retest reliablity in subjects 20-40 and greater is necessary to maintain balance. PARTICIPANTS: Ten healthy
than 59 years old. The validity of the Star Test has not been adults voluntarily (23.4±2.2 years) participated in the experiments.
demonstrated in the literature. PARTICIPANTS: All 28 subjects METHODS: We obtained finding from the surface electromyographic
were community dwellers able to stand and walk independently. (sEMG). The sEMG signals were used to study the firing bilateral
Subjects were 61-83 years old (x=73), weighed 108-223 pounds behavior on gastrocnemius, tibialis anterior, rectus femoris, biceps
(x=155)and were 58-73 inches tall (x=66). There were 9 males femoris, gluteus medius, rectus abdominis, and paraspinal muscles.
and 19 females. METHODS: Informed consent was obtained from The VICON (motion analysis system) was used for measuring
all subjects. Subjects performed the Star Test, Berg Balance Test, the angle of the head, trunk, pelvis, hip, knee, and ankle joints.
Dynamic Gait Index and the 30 second sit-to-stand in a single The VICON and the sEMG were synchronized. The perturbation
test session. The test administrators followed standard protocols stimulation was done by the moving platform with four directions
described in the literature. The subjects completed the Yale Physical of platform tilting up and down in yaw axis, tilting left and right
Activity Survey. ANALYSIS: Data were analyzed using SPSS v14.0. in pitch axis. The angular stimulation strengths (degrees) of 3.8 º,
We determined the strength and significance of the relationship 7.5 º, and 15 º were used. Each period of perturbation stimulation
between the test results and survey responses using a Spearman was 200ms. All subjects tried to maintain an erect standing position
Correlation Coefficient (rho) for nonparametric data. Significance was while each external perturbation stimulation was active. ANALYSIS:
set at p < 0.05. RESULTS: The Star Test was not correlated to the We defined from T0 (the onset of perturbation) to T1 (the end
other tests or the survey responses. The strength of the relationship of perturbation) as “first period”, T1 to T2 (200 msec after T1)
between the Dynamic Gait Index and 30 second sit-to-stand was fair as “second period”. The integrated sEMG (%MVC·msec) of each
and the correlation was significant (r = 0.40; p = 0.034). The strength period was calculated. Moreover, a time which activity of sEMG
of the relationship between the Berg Balance Test and the Dynamic was started after perturbation stimulation was measured as a latent
Gait Index was fair but the correlation only approached significance EMG response. For three-dimensional motion analysis, the maximal
(r = 0.32; p = 0.097). CONCLUSIONS: We found the strength of the values of angle of the head, trunk, pelvis, hip, knee, and ankle
correlation between the tests results and survey responses was fair joints were calculated during each stimulation period. RESULTS:
to nonexistent. We believe this may be due in part to the high level For tilting upward, TA was more active than other muscles at first
of function found in the subjects, i.e., half of the subjects scored the period, and activity of gastrocnemius became twice as much at the
maximum on the Berg Balance Test and/or the Dynamic Gait Index second period. For tilting downward, the activity of gastrocnemius
(ceiling effect). We believe that the lack of correlation between the was larger 2.2 times greater than other muscles at the first period.
For the maximal angle values, the ankle mainly dorsiflexed when the phases, and very significantly for the step and double support
platform tilted upward and the ankle mainly plantarflexed when the phases. The interaction (speed/anaesthesia effect) is significantly
platform tilted downward. When the platform tilted to the left, the left different only for the swing phase. During the stabilometric tests
hip adducted and the right hip abducted and the right hip and knee the instability is increased (p < 0.05), especially during the unstable
flexed. When the platform tilted to the right, the result was opposite conditions with EC. CONCLUSIONS: These results show that the
to the tilting to the left. Accooding to the latency time, the activity of skin mecanoreceptors play an important proprioceptive role for
gastrocnemius and tibialis anterior muscles were shorter than other motor control during static and dynamic conditions and seems to
muscles in both yaw and pitch axes conditions. CONCLUSIONS: The confirm the observations of Moberg and Edin. But the mechanism
results of EMG and kinematic analyses showed that the ankle and of the concious and unconcious proprioception is not yet clearly
knee strategies were used to maintain standing balance under the understood. Other studies with skin anaesthesia (e.g., associating
condition of perturbation stimulation by the moving platform in yaw EMG and propioceptive scores) are necessary to better understand
axis. Moreover, the hip and knee strategies were used in pitch axis. the importance of this inter-activity. The different levels of motor
Standing balance exercise for adjusting versatile ADLs may benefit control perturbation induced by skin anaesthesia between subjects
by the assessment of dynamic postural control in the condition of are considerable and must be evaluated. IMPLICATIONS: This
an unstable floor in which a linear stimulation or rotational stimuli aspect of the proprioceptive role of the skin can enhance the
occurred IMPLICATIONS: Effective clinical balance assessment and work of the physiotherapist and suggests that skin sensitivity could
exercise for improving dynamic postural poor balance strategy are be an important component of physiotherapy treatment, as has
needed for assessment. KEYWORDS: dynamic posural control, mov- already been suggested by Dellon. KEYWORDS: Skin anaesthesia,
able platform,balance strategy. FUNDING ACKNOWLEDGEMENTS: proprioception. FUNDING ACKNOWLEDGEMENTS: Our thanks in
This work was supported by the Northern Advancement Center for particular to the Laboratoire d’Aerodynamique et de Biomécanique
Science & Technology,2005. CONTACT: [email protected] de Marseille (LABM). We also thank Dr. MT JIMENO who carried
ETHICS COMMITTEE: SAPPORO CITY UNIVERSITY out the statistical analysis of the results, and Dr. Nancy SAINT-
ONGE (Montreal, Canada) for her valuable assistance, and the
SATEL company for providing the force-plate. Thanks also to Pr. Eric
BERTON for his critical analysis. CONTACT: [email protected]
12-22 Wednesday 6 June 09:00 ETHICS COMMITTEE: The Committee of Medical Research of the
VCEC Exhibit Hall B & C University of Marseille, France.
INFLUENCE OF CUTANEOUS ANAESTHESIA ON WALKING
DYNAMIC BEHAVIOR AND STABILOMETRIC SCORES IN
HEALTHY SUBJECTS Research Report Poster Display
Roland-Gosselin A1 ,
Chavet P2 ,
Pognant-Gros E2 ,
Rabischong P1 ; VCEC Exhibit Hall B & C
1 Laboratory of Motion Analysis, Centre Propara, Montpellier,
France; 2 Aerodynamics and Biomechanics of Motion Laboratory ALTERATION IN LOWER LIMB KINEMATICS AND KINETICS
(LABM), Marseille, France IN INDIVIDUALS WITH HIP OSTEOARTHRITIS DURING STAIR
CLIMBING
PURPOSE: Anaesthesia of the skin of the sole of the foot has
Protopapadaki A1 , Drechsler W1 , Cramp M1 , Coutts F2 , Scott O1 ;
been shown to disturb motor control. The activity of the skin 1 University of East London, London, UK; 2 Queen Margaret
mechanoreceptors around the knee is important and is correlated
University College, Edinburgh, UK
with the speed and the amplitude of the active movement as shown
by Edin. We want to quantify whether the skin around the ankle, PURPOSE: This study was designed to investigate lower limb
like the skin around the arm, plays an important role during motor kinematics and kinetics during stair ascent and descent in hip
control. RELEVANCE: In reeducation of the ankle, the instability of osteoarthritic patients. It was anticipated that individuals with hip
standing patients is frequently seen by physiotherapists. However, osteoarthritis (OA) would have altered joint kinematics and kinetics
are only the ligaments and muscle receptors implicated in the loss during stair ascent and descent. RELEVANCE: Understanding stair
of this motor control around this joint? The skin mecanoreceptors climbing characteristics of individuals with hip OA furthers the
of the lower limbs are very active during movement and seem to understanding of joint pathology and intervention. However, there
participate in proprioception. We can evaluate their importance for is no data in the literature regarding stair climbing patterns in
motor control during static and dynamic tasks, eg., walking on a patients with hip OA. The aim of this ethically approved study was
treadmill and standing on a force-plate, by suppressing their activity to monitor changes in hip, knee and ankle angles and moments of
with anaesthesia of the skin around the two ankles. PARTICIPANTS: the affected lower limb during stair ascent and descent in patients
20 young (21-26 years) healthy voluntary subjects, students of the with hip OA. PARTICIPANTS: Nine patients with hip OA; 6M,
university, were recruited. Inclusion criteria: desease-free, pain-free, 3F, mean (SD), age 63.78 (6.78) years and nine elderly healthy
without orthopedic abnormalities, not currently under medication, and subjects; 4M, 5F, age 64.78 (4.92) years with no history of lower
without prior surgical intervention. METHODS: − The cutaneous zone limb injuries, back or pelvis pathology, systemic or neuromuscular
around the two ankles was anaesthetised with EMLA cream (5%) disease participated in the study. All were able to go upstairs and
and the level of anaesthetic effect was quantified with monofilaments, down stairs without using a handrail. METHODS: The stair case
− Anesthetic effect was quantified during different tasks: (1) Subjects consisted of four steps (rise height 18 cm, tread length 28.5 cm).
walking on a treadmill (servo-controlled by torque) and 3D kinematic Kinematic and kinetic data of the lower limb was collected using
movement was evaluated at 4 different speeds (Elite BTS). A force a ten camera Vicon motion analysis system (Oxford Metrics LTD,
plate was embedded under the treadmill belt, (2) Subjects in a UK) and one Bertec Force Platform (Model MIE Ltd, Leeds, UK)
standing position on a force plate during 10 stable and unstable positioned on the second stair step. ANALYSIS: Key variables
conditions (SATEL force-plate), (3) Seated subjects, with eyes closed included for analysis were: temporal characteristics, hip/knee/ankle
(EC), measuring the ability to reproduce different angular positions angles, and external hip/knee/ankle moments, during stair ascent
of the ankle. One observer recorded all the data. ANALYSIS: and stair descent. One way ANOVA was performed to determine
ANOVAs were used to compare the temporal parameters during possible significant differences between hip OA patients and controls.
walking and the stabilometric scores (24 parameters) before and Statistical significance was defined as p < 0.05. RESULTS: During
after anaesthesia. Bonferroni correction was applied. RESULTS: The stair ascent, subjects with hip OA showed: significantly reduced
anaesthesia significantly influenced all the parameters (p < 0.001). hip flexion angles (p < 0.05), external ankle dorsiflexion moments
These decreased significantly (p < 0.05) for the stance and swing (p < 0.05) and stride velocity (p < 0.001) and significantly increased
Poster Displays, Wednesday 6 June

Keynote Presentations: Physiotherapy Volume 93 Supplement 1

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Keynote Presentations: Physiotherapy Volume 93 Supplement 1

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Physiotherapy Volume 93 Supplement 1 S1

Keynote Presentation Keynote Presentation

Non-disabled people looked to the helping professions as the Keynote Presentation

Back in 1980s Rocabado (11-13) showed that 65.1% of the pediatric

At present it is well recognized the inﬂuence of abnormal mus-

Focused Symposium Overviews

Focused Symposium Overview Focused Symposium Overview

the non-speciﬁc effects, there may be inadequate identiﬁcation of

Focused Symposium Contributions

Focused Symposium Contribution

Workshop Funding ear-marked for invited and international educators can

Within this workshop, our case discussion will serve to summarize

reﬂex. FUNDING ACKNOWLEDGEMENTS: This research study was

Quebec City, Canada

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

Yoshida K, Odette F, Du Mont J, Lysy D; Department of Physical

FUNDING ACKNOWLEDGEMENTS: IMK Fonden (Copenhagen, Research Report Platform Presentation

Platform Presentations, Monday 4 June Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

ACKNOWLEDGEMENTS: Australian Post-graduate scholarship Research Report Platform Presentation

of Physiotherapy, Univerity of Melbourne, Australia; 3 School of

Care Sciences and Society, Karolinska Institutet, Stockholm,

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

Brazil; 2 Back Pain Research Group, School of Physiotherapy, The

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation

Hamilton, Canada Medicine, University Hospital Zurich, Switzerland; 2 Association

VCEC Exhibit Hall B & C

Sciences and Society, Karolinska Institutet, Stockholm, Sweden;

Research Report Poster Display Research Report Poster Display

Korea (South); 3 Daegu University, Daegu, Korea(South); 4 Inje

Research Report Poster Display Research Report Poster Display

Research Report Poster Display

Research Report Poster Display Research Report Poster Display

Näslund A1 , Sundelin G2 , Hirschfeld H3 ; 1 Department of Health; 3 University of Jyväskylä, Finland

Research Report Poster Display Research Report Poster Display

PURPOSE: Short wave diathermy (SWD) is a common modality

JAPAN; 4 Nagasaki University School of Health Sciences, Nagasaki,

Research Report Poster Display Research Report Poster Display

Gakuin University, Kobe, Japan; 4 Anabuki Rehabilitation College,

Research Report Poster Display

Spirometry. FUNDING ACKNOWLEDGEMENTS: Partly supported interdisciplinary education. FUNDING ACKNOWLEDGEMENTS:

Research Report Poster Display

Research Report Poster Display Song J

Research Report Poster Display

Research Report Poster Display

Collins J; Nazareth College, Rochester, New York, USA

Research Report Platform Presentation Research Report Platform Presentation

Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

of rehabilitation following lumbar micro-discectomy although none

ACKNOWLEDGEMENTS: Edmonton Orthopaedic Research Com- Research Report Platform Presentation

Research Report Platform Presentation Research Report Platform Presentation

Research Report Poster Display

Research Report Poster Display Research Report Poster Display